Patellofemoral Pain

Overview

Patellofemoral pain is pain around or behind the kneecap that usually shows up when the knee is loaded while bent — stairs, squats, running, jumping or sitting with the knee bent for a while. It is one of the most common causes of knee pain, especially in adolescents and active adults.

The name comes from the joint behind the kneecap, but pain in that area does not mean the joint surface is damaged. The pain is often related to how the surrounding muscles and tissues handle load, not to visible "wear."

Typical Pattern

• Dull ache around, behind or under the kneecap
• Pain with stairs, squats, running or jumping
• Discomfort after sitting with the knee bent for a long time
• Grinding or clicking sensations that are usually painless and not a sign of damage by themselves
• Pain that comes and goes, sometimes worse after activity than during it

Where it hurts varies from person to person, and pain location alone does not identify a single cause. Tendons, the fat pad, the joint capsule and other tissues can create similar front-of-knee pain.

Why It Develops

Symptoms often follow a change in load rather than a single injury: a jump in running distance, more stairs, new squat volume, a return to sport after a break, or less recovery between sessions. The knee is being asked to handle more than the surrounding muscles are currently prepared for.

That does not mean the knee is fragile or that loading is bad. Appropriately dosed loading is central to getting better.

Some people are told their kneecap "tracks wrong" or is "out of place." That explanation is usually oversimplified. Pain can occur without any obvious alignment problem, and no home test or picture can confirm what is causing it.

Treatment

Current guidelines consistently point in the same direction: education and exercise therapy come first. That usually means:

• Understanding how load affects symptoms and adjusting activity rather than stopping everything
• Progressive strengthening of the quadriceps and hip muscles, including loaded knee exercises and hip-focused work
• Gradually returning to stairs, squats, running and sport as the knee tolerates it
• Using symptoms as feedback: mild discomfort that settles is often acceptable, while sharp pain, catching or repeated giving way is a sign to adjust the dose

Taping, foot orthoses, running retraining or manual therapy can help some people, but they are usually added around an exercise program rather than instead of it. Complete rest may settle symptoms briefly, but it does not rebuild capacity.

Most people improve with this approach, though symptoms can take months and sometimes return. Recovery is rarely a straight line, and there is no way to promise a timeline. For adolescents especially, the pain can persist: studies following teenagers found that up to four in ten still reported pain five years later. That is a reason to take it seriously and get help early, not a reason to panic.

When to Get Assessed

Arrange an assessment if pain is persistent, worsening or limiting daily activity, or if you are unsure what is causing it. Seek prompt care after a sudden injury with rapid swelling, if the knee locks or will not fully straighten, if it repeatedly gives way, if you cannot bear weight, or if there is deformity, numbness or colour change.

Related Reading

• Patella anatomy
• Quadriceps tendon anatomy
• Patellar tendon anatomy
• Why does my knee hurt when I squat?
• General knee loading principles
• Patellar tendinopathy — similar pain, different tissue
• Patellar dislocation and instability — different pattern, same area

References

1. Willy RW, et al. "Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association." Journal of Orthopaedic & Sports Physical Therapy. 2019;49(9):CPG1-CPG95. https://doi.org/10.2519/jospt.2019.0302
2. Neal BS, et al. "Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning." British Journal of Sports Medicine. 2024;58(24):1486-1495. https://bjsm.bmj.com/content/58/24/1486
3. Smith BE, et al. "Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis." PLOS ONE. 2018;13(1):e0190892. https://doi.org/10.1371/journal.pone.0190892
4. Rathleff MS, Collins NJ. "Physiotherapy management of patellofemoral pain in adolescents." Journal of Physiotherapy. 2025;71(1):8-17. https://pubmed.ncbi.nlm.nih.gov/39675948/

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.