Ultimate Guide to Patellofemoral Pain Syndrome

Mitchell Starkman, Physiotherapist, The Movement Centre

14 October 2017

Patellofemoral Pain Syndrome is one of the most common knee problems diagnosed by physiotherapists.

When I tell someone they have Patellofemoral Pain Syndrome they generally respond with the same three general questions:

What is Patellofemoral Pain Syndrome?

Let’s Start with what Patellofemoral Pain Syndrome is.  

At its source, Patellofemoral Pain Syndrome is an issue of friction. Let’s break down the diagnosis – the name itself – to better understand it.

“Patello” refers to the bone called the Patella. You will probably know it by its more common name – the knee cap. “Femoral” refers to the long bone in your upper thigh called the femur.

“Pain” simply refers to the reason you went to your physiotherapist and then this blog in the first place.

“Syndrome” refers to the fact that it is an issue with these two bones and the pain they are causing you.

Which leads us to our next question.

Why Do I Have Patellofemoral Pain Syndrome?

What’s happened? What did I do? Why me?

There is no short and simple answer. But there are answers anyway. And those answers begin with the knee. But you already knew that…

As you bend and straighten your knee doing things like, running, climbing stairs, or even walking your kneecap slides up and down the femur along two distinct grooves.

Trouble arises when the kneecap does not follow those grooves as smoothly as it should.

Think about trying to drive your car straight ahead while your wheels are set at a slight angle.You aren’t going to get where you want to go as quickly or as efficiently as you would expect. And you can expect to end up with issues with your tires and your alignment. Things will begin rubbing and creating unwanted friction.

That is what happens when your knee cap doesn’t track correctly. It creates additional friction along the kneecap and causes you pain!

Photo by Breather on Unsplash

But Why Does My Kneecap Track Poorly?

This can be caused by a number of things. However, the most common reason is that your knee is turning inward towards the midline. When the knee falls in towards midline the femur falls inwards as well. This changes how the kneecap tracks along its groove and ends up causing issues!

And Why Does My Knee Track Inwards?

The simple answer? A bunch of stuff. For instance:

  • A stiff ankle can force the knee to fall inward.
  • Weak hip muscles lead to poor control of both the knee and the whole lower limb!
  • Tightness in the muscles that surround the kneecap like the quads and the IT band can also cause the knee to track inwards..

How Do I Get It Better?

Because there are so many potential underlying causes the first challenge is to figure out what to do first. As with any medical issue the first thing to do is get checked out by a healthcare practitioner that you trust like your family physician to gain a proper diagnosis of this condition.

After you have figured what is really the problem you can figure what to do to correct it.This means finding out which exercises are best for you and your condition. This can be accomplished by going to a clinic and seeing a physiotherapist or other rehab specialist, or with a proper diagnosis you can use an online tool like PhysioReady to address the injury and begin the healing process.

But to get started, here are some basic exercises to help address the underlying issues, whatever they might be:

  • Ever heard the expression “It’s all in the hips?” Well, that’s not too far off. Get started with some glute strengthening like the Pac Man drill demonstrated here.
  • Tackling that tightness in the front of the quads can do wonders on those things pressing on your kneecap. Grab a foam roller and get down to business doing the quad grinder demonstrated here.

Who Should I See to Treat my Patellofemoral Pain Syndrome

A wide variety of healthcare providers could help you to treat this issue. If possible, seeing a sports medicine physician is a great place to get accurately diagnosed and for most of you,  this will be covered. Once you have a more accurate diagnosis you can enroll in the PhysioReady program and get started on your road to recovery!

For those of you with sufficient private health coverage or who prefer a one-on-one coaching experience find a licensed physiotherapist or another orthopedic specialist right away to get assessed and get started!


Patellofemoral Pain Syndrome occurs when your kneecap rubs on the bones below and start causing pain. This can be for a variety of reasons but ultimately they all amount to the same thing. Your knee is falling inwards and causing knee pain! When it comes time to tackling this bad boy from home, the best place to get started is with the Affordable PhysioReady Patellofemoral program.

Authored by:

Mitch Starkman

Mitch Starkman

Physiotherapist and Founder

A Toronto-based Physiotherapist with a passion for sports, orthopedics, and human movement. Mitchell’s goal is to understand how the site of pain is impacted by the entire body – rather than pinpointing a specific disturbance. He is also the founder of - a website geared toward giving people the tools they need to self-manage, treat and prevent their injuries.

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