Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS) is a pathology of the knee characterized by pain at the front of the knee joint without any significant structural changes in the knee. 


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Similar to a train on a track, the patella or kneecap moves along a groove formed by the thigh bone (the femur). The thigh bone and shin bone (tibia) can be thought of as forming the tops and bottoms of this track. When muscles of the hip are weak the thigh bone may cave in thus throwing the knee cap off this track. Similarly, in individuals with foot abnormalities such as flat feet or feet that cave outwards (pes pronatus valgus) the shin bone caves in once again throwing the kneecap outwards and off track. This shifted position of the kneecap leads to an abnormal tracking pattern of the kneecap thus resulting in knee pain, discomfort and inflammation at the front of the knee without any significant structural changes in the knee joint. Adolescent and young women are at an increased risk for developing PFPS potentially due to having a wider pelvic angle which in turn changes the angle at which bones in the knee articulate and allow for knee cap movement.  

 Causes: Several different mechanisms may contribute to PFPS

  • Weakness in the hip muscles may lead to a caved in positon of the thigh bone known as a dynamic valgus which in turn throws the kneecap off track

  • Tightness in a large band of connective tissue known as the iliotibial band (IT band) which runs from the side of the hip to the side of the knee

  • Tightness in the muscles of the back of the leg (the hamstrings)

  • Lack of strength in the muscles of the front of the leg (the quadriceps)

  • Flat feet or feet that are excessively caved outwards (excessive pronation) leading to an internal rotation of the shin bone and maltracking of the kneecap


  • Dull pain at the front of the knee

  • Pain may increase with kneeling or squatting

  • Pain may be triggered during inclined stepping movements such as walking up and down stairs

  • Swelling at the front of the knee

  • Feelings of “grinding” when flexing or extending the knee

  • Aggravation of pain after sitting with a bent knee for long durations

What Can PhysioFlow Do For My Patellofemoral Pain Syndrome?

  • Provision of a multi-step physical therapy exercise program along with a home video library that recaps all of the instructions taught in clinic for home exercise execution. This program will deliberately address muscular strength and stretching for all of the muscles in the body that may impact knee tracking. These include muscles of the trunk, hip and lower extremity. Proprioception or limb awareness exercises are also instructed to teach better control of the muscles surrounding the knee. 

  • Use of a range of physical therapy modalities such as cold laser therapy, therapeutic ultrasound, interferential current (IFC), and shockwave therapy.

  • Education and provision regarding the use of custom orthotics such as knee braces and insoles.

  • The use of kinesiology taping to apply an inward force to the knee cap which has been shifted outwards. 

  • Education regarding activity modification to ensure proper movement patterns in order to mitigate the improper gliding movement of the kneecap in PFPS.