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Coping With Patellofemoral Syndrome

Michele LaBotz, MD

Practice Essentials Series Editors:
Kimberly G. Harmon, MD; Aaron Rubin, MD


Patellofemoral syndrome (PFS) is one of the most common causes of knee pain in active patients and stems from problems with the kneecap (patella) as it moves over the front of the knee. PFS causes pain in the front of one or both knees, especially after either exercising or sitting for prolonged periods. Some patients will experience minor swelling and the feeling that their knee "catches" or gives way.

Q. What causes PFS?

A. PFS is usually an overuse syndrome caused by doing "too much, too soon." Other risk factors for PFS include decreased strength or flexibility of the upper leg or hip muscles, poor alignment of the leg bones, or a combination of factors.

Q. How is PFS treated?

A. The first step is to reduce the pain and swelling. Frequent use of ice (about 15 minutes at a time), especially after exercise or when the knee is sore, can ease pain. Anti-inflammatory medications (such as ibuprofen or naproxen) can help reduce pain and inflammation (swelling). Once pain eases, you can begin a stretching and strengthening program guided by your doctor to further decrease symptoms and the risk of recurrence.

Q. Which exercises are useful for PFS?

A. Strengthening (figures 1 and 2) and stretching (figures 3 and 4) for the hamstring and thigh (quadriceps) muscles should be included. All stretches should be held for 15 to 20 seconds and repeated three times on each side. Your doctor may also recommend physical therapy or other treatments.

Q. Can I still train if I have PFS?

A. You can train if you have PFS, but you may find that symptoms tend to come and go depending on your activity level. Keep in mind, however, that the more you train through pain, the longer your knees will hurt. A good rule of thumb is to try reducing the intensity and amount of training by about half. Runners will often benefit from a temporary switch to either swimming or bicycling while the knee recovers. When you are ready to resume or advance your activity, do it slowly. Most patients can tolerate adding about 10% per week to training volume (for example, increasing from 20 miles in week 1 to 22 miles in week 2).

Many factors determine when you can return to activity, so work with your doctor to determine when you can return to full activity or competition.

Remember: This information is not intended as a substitute for medical treatment. Please consult your physician before starting an exercise program or returning to activity.

Dr LaBotz is an assistant professor in the department of family practice and community health at the University of Hawaii at Manoa in Honolulu.

© 2021, by the McGraw-Hill Companies, Inc. Permission to photocopy is granted for educational purposes.