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Anterior knee pain (patellofemoral pain syndrome)

Anterior knee pain can lead to sharp knee pain.

runner sat on stairs holding his painful knee

Anterior knee pain is a term given to pain arising from behind the kneecap (patella). The condition is also sometimes referred to as patellofemoral pain syndrome (PFPS), which reflects the affected structures.

The patellofemoral joint refers to the articulation between the kneecap and the thigh bone. The joint is unique as the kneecap sits in a shallow groove at the lower end of the thigh bone (femur) rather than being formed from a deep socket. As the knee bends or straightens, the kneecap moves up and down this groove.

As such, the joint relies heavily on adequate flexibility of the soft tissues, such as the articular cartilage, around the knee as well as adequate muscle control and strength around the hip and knee.

Patellofemoral pain syndrome is one of the most common causes of knee pain. It is sometimes called runner’s knee because it is particularly common with joggers. It is also associated with sports that involve a lot of running. However, it is worth noting that knee joint pain can also affect non-athletes.

Certain individuals are particularly vulnerable to developing anterior knee pain.

  • Young adults, particularly adolescent females
  • Individuals with poor lower limb alignment (this often falls under the term biomechanics)
  • Individuals who do not exercise regularly to keep their muscles flexible and strong 
  • Individuals with a high BMI, such as people who are over weight

Although patellofemoral pain syndrome can be caused by trauma, such as a fall onto the knee, it often occurs without a noticeable injury.

The condition is sometimes associated with the start of a new activity or with a sudden change in the intensity level of an exercise. This overuse of the knee often puts a repeated stress on the knee joint, particularly if this exercise follows a period of reduced activity that has led to a weakening of the muscles.

Patellofemoral pain syndrome is more likely to develop if there is an existing structural problem that is affecting the knee joint between the kneecap and the thigh bone. These minor problems, such as misalignment of the knees or a weakness in the hip and thigh muscles, can affect the way the knee moves, which can cause pain.

Anterior knee pain can be reliably diagnosed by your doctor or physiotherapist by looking at your history of the condition and by conducting a physical examination. X-rays ;and MRI scans are not routinely required to diagnose the condition.


The main symptom of patellofemoral pain syndrome is a sharp pain in the knee. This pain is generally felt at the front of the knee. You may also feel pain under the kneecap. However, patellofemoral pain syndrome can be felt anywhere around the kneecap, such as back of the knee pain.

Certain activities often aggravate the pain, such as squatting, while walking up or down the stairs can intensify the pain. These movements place a far greater load through the patellofemoral joint than walking on flat ground.

Other common features of the condition are weakness of the thigh muscles (quadriceps muscles),

There most common symptoms include:

  • Clicking or grinding when you walk, this is often called crepitus
  • Mild swelling of the knee
  • The knee feels weak and unstable when weight bearing, such as walking or running  
  • Discomfort or pain in the knee when sitting for long periods

physiotherapist helping patient bend her knee on a hospital bed whilst wearing a knee support bandage
The first course of action to treat patellofemoral pain syndrome is to tackle the pain. This can be done with over-the-counter pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help give knee pain relief. An ice pack applied to the knee can also provide an alternative but effective method for pain relief.

For many people, treatment for patellofemoral pain along with a period of rest will be enough to alleviate the syndrome as the body heals itself. While resting, it helps if you keep the leg straight and refrain from bending the knee for long periods because this will aggravate the condition.

However, to aid the body in its recovery, a regime of therapeutic exercises for knee pain treatment is recommended. As with any exercise while recuperating from an injury, it is best to take it slowly and make sure that you do some warm-up stretches prior to any activity.

Anterior knee pain can be managed very effectively by therapeutic exercises. Speak to your doctor or physical therapist before starting any exercise.

For those who are inactive or overweight, weight loss and an increase in general activity may also be helpful in managing the syndrome.

For active individuals, the most effective physiotherapy is geared towards strengthening and flexibility exercises.

close up of specialist performing tests using shoe soles on patients foot
These regular anterior knee pain exercises will enhance muscular strength, flexibility and range of motion across the hip and knee joints:

Inner Range Quadriceps (IRQ) with weight

In each exercise, perform three to four sets of 10 reps each. This exercise should be performed three to four times a week.

Sit to stand

In each exercise, perform three to four sets of 10 reps each. This exercise should be performed three to four times a week.

Standing quads stretch with posterior tilt

In each exercise, perform the five stretches for 30 seconds each. This exercise should be performed twice a day.

Weight loss

You can use an online BMI calculator to find out if it might be advisable for you to try to lose some weight. Losing weight reduces the load on your joints as you move about.

Evidence shows that weight loss can result in significantly better mobility. There is also some evidence to suggest that weight loss alone may actually help to reduce pain. However, in combination with exercise, the results can be staggering.


Your clinician may feel that poor foot biomechanics are contributing to your symptoms. In these cases they may recommend shoe inserts or insoles to support the arches of the foot and assist alignment of the knee.

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