Patellofemoral Pain (Anterior Knee Pain): Assessment, Rehabilitation & Return to Activity
Patellofemoral pain (PFP) — often known as runner’s knee — is one of the most common sources of front-of-knee pain in active people. It doesn’t just affect runners; it can occur in anyone who experiences knee discomfort when climbing stairs, squatting, kneeling, or sitting for long periods.
At Fit2Function Allied Health, we specialise in evidence-based physiotherapy to assess, manage, and rehabilitate patellofemoral pain. Our goal is to help you move confidently, return to your sport or activities, and avoid future flare-ups.
Understanding Patellofemoral Pain
Patellofemoral pain refers to discomfort around or behind the kneecap (patella), typically caused by activities that load the knee joint. Importantly, it isn’t always linked to structural damage — often, it’s related to how the knee, hip, and surrounding muscles work together during movement.
Common Causes and Risk Factors
Patellofemoral pain can arise from a combination of factors such as:
-
Repetitive loading from running, jumping, or cycling.
-
Weakness or poor coordination in the quadriceps, glutes, or abdominal wall muscles.
-
Changes in patellar alignment or tracking.
-
Sudden increases in training volume or intensity.
-
Muscle tightness in the hamstrings, calves, or iliotibial band.
Symptoms
Typical symptoms of patellofemoral pain include:
-
Pain around or behind the kneecap.
-
Discomfort during stairs, squats, running, or long periods of sitting.
-
Clicking, grinding, or a “gritty” sensation in the knee.
-
Mild swelling or tenderness around the patella.
-
Pain that worsens with sport or increased activity load.
Early Management
Addressing patellofemoral pain early helps control symptoms and prevents long-term issues. Early physiotherapy management focuses on:
-
Activity modification: Reducing aggravating activities while staying active safely.
-
Load management: Gradually building tolerance through structured exercise progression.
-
Strengthening: Targeted exercises for the quadriceps, glutes, and core.
-
Movement retraining: Improving running, squatting, and landing mechanics.
-
Education: Understanding pain, pacing training, and managing flare-ups.
Short-term pain relief techniques, like ice or anti-inflammatories, may assist symptom control but should complement—not replace—your rehab program.
When Is Imaging Needed?
Most cases of PFP don’t require scans. However, imaging may be recommended if:
-
Pain persists after consistent physiotherapy.
-
There are signs of cartilage changes or other structural issues.
-
Symptoms are unusual or severe.
An MRI can reveal cartilage condition, while X-rays may help exclude bony abnormalities.
Physiotherapy Approach
Physiotherapy is the gold-standard treatment for patellofemoral pain. Your physiotherapist will develop an individualised program that typically includes:
-
Strength training: Focused on quadriceps, gluteal, and hip stability.
-
Movement retraining: Refining squat, lunge, and running technique.
-
Neuromuscular control: Balance, plyometric, and dynamic stability drills.
-
Taping or bracing: Used selectively to assist alignment or comfort.
-
Progressive return to sport: Guided by pain-free function, strength, and control.
Your plan will be tailored to your goals, activity level, and sport for long-term results.
Returning to Sport or Activity
Progression is criteria-based, meaning you’ll return to activity once key milestones are achieved, including:
-
Performing functional tasks without pain.
-
Restoring muscle strength and coordination.
-
Maintaining proper movement patterns under fatigue.
-
Gradually reintroducing running, jumping, and sport drills.
Your physiotherapist will monitor your progress and adjust your program to prevent recurrence.
Prevention and Long-Term Knee Health
Preventing future flare-ups means continuing the habits built during rehab:
-
Maintain strength and endurance in the quadriceps, glutes, and core.
-
Increase training loads gradually.
-
Keep refining your movement technique.
-
Use supportive footwear and suitable training surfaces.
Ongoing exercise, technique awareness, and load management are key to keeping your knees pain-free and strong.
Book a knee assessment
If you’re experiencing discomfort around your kneecap or pain with kneeling, squatting, or running, our physiotherapists can help. We’ll assess your movement, identify contributing factors, and design a personalised rehabilitation plan to get you back to full activity safely.
