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Patellofemoral Syndrome

Causes, Symptoms, Treatment Options, & Other Resources

What is the Patellofemoral Joint?

The kneecap is also known as the patella.  The thigh bone is the femur.  The patellofemoral joint is formed by the kneecap and the grooved surface of the thigh bone.  The patella slides up and down in a grooved track in the femur. The groove is more specifically called the trochlear groove. Like a train that travels on a track, under ideal conditions the patella tracks up and down in the trochlear groove.

What is Patellofemoral Syndrome?

Patellofemoral syndrome is a medical condition characterized by discomfort in the front of the knee and around the patella. Patellofemoral syndrome may also be known as “jumper’s knee” or “runner’s knee.”

Anatomy

The patellofemoral joint is composed of bones, cartilage, tendons, and ligaments.

The patella and the thigh bone are the two bones.  Both are covered with cartilage which allows for a smooth, effortless movement of the patellofemoral joint.

There are two major tendons:  the quadriceps and patellar tendons.  Your quadriceps is the large muscle in the front of the thigh.  It connects to the top portion of the patella. The quadriceps is one of the largest and most powerful muscles in your body.  It is responsible for the extension of the knee joint.  The patellar tendon extends from the base of the patella down to the shin. It works with the quadriceps tendon to straighten the knee.

The patellofemoral ligament is the major ligament in the knee.  There is one on the inside of the knee called the medial patellofemoral ligament (MPFL). There is also one of the outside edges of the knee which is called the lateral patellofemoral ligament (LPFL).  They both serve to stabilize the knee and keep it tracking within the trochlear groove.

Causes 

Overuse and trauma, such as hitting the kneecap or falling on it, are the two common causes of injury to the patellofemoral joint. Although athletes are more likely to be afflicted with this condition, anybody can develop it. Some factors include:

  • Overuse of the knee
  • Kneecap misalignment
  • Muscles in surrounding areas weaken
  • Improper training and misuse of equipment
  • Changes to footwear
  • Playing sports on hard surfaces

Some individuals have a kneecap that tracks abnormally or move in the trochlear groove. This can cause pain, swelling, and damage to the cartilage.

Symptoms of Patellofemoral Syndrome

Bruising in Knee

Bruising in the knee, also known as a knee contusions, is an uncomfortable yet common condition that occurs when you strike your knee with force or a symptom of a knee condition. When the tiny blood vessels are damaged and blood leaks out beneath the skin, causing the typical swelling and red/purple discoloration seen in these injuries, it is termed a bruise or contusion. Although a knee contusion does not usually require medical intervention, you may need to visit your doctor to ensure that you do not have a more significant problem. If you hurt your knee and have swelling/pain that gets worse instead of better…

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Burning Pain on Outside of Knee When Kneeling

There are many possible causes of burning pain on the outside of the knee while kneeling. One possibility is that you may have patellofemoral syndrome, which is a condition that results in pain around the kneecap. This pain can be aggravated by activities such as kneeling or squatting. Other potential causes of this type of pain include iliotibial band syndrome, runners knee, and meniscal tears. If you are experiencing burning pain on the outside of your knee while kneeling, it is important to see a doctor for evaluation. Some of these conditions can be treated with conservative measures such as rest, ice, and physical therapy…

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Can’t Straighten Knee

Your knee is capable of moving in a number of directions. The most common are flexion and extension. Flexion is when you bend your knee and the shin bone moves towards the buttock. Knee extension is when you straighten out your knee. The extension is the opposite of flexion. PT, trainers, and physicians alike measure the degree of knee flexion and extension. When lying flat on an examination table or hard surface your knee should be able to extend so that there is no angle between the thigh and shin bone. The inability to straighten the knee is also known as an extension lag and is a reason for concern.

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Knee Buckling

Knees can buckle, causing a sensation of one or both knees giving out that affects nearly 17% of adults. The knees are regarded to be one of the most essential (and biggest) joints in the human body because they play significant roles in basic activities such as walking and sitting. When our knees begin to feel unstable, weak, or begin giving out, it is easy to become stressed since we rely so heavily on them for movement. The knee can become stable from numerous types of injuries. The knee is kept stable by the following structures: Tendons attach the leg muscles…

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Knee Clicking

Clicking in the knee can occur for a number of reasons. The 5 major causes include: ligament injuries, meniscus tears, knee arthritis, patellofemoral syndrome, and soft/scar tissue. Let us start with ligament tears. A ligament is a thick piece of connective tissue that connects one bone to another. The knee has 4 principal ligaments: ACL, PCL, MCL, and LCL. Ligaments provide important stability for the knee (1). If injured or torn, ligaments can create instability. This instability can cause clicking in the knee. As ligaments travel across boney surfaces they can also catch make the knee click. The meniscus is a C-shaped cushion situated between the thigh bone and shin bone.

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Knee Pain

Knee pain can be caused by many factors. Overuse injuries, direct trauma to the knee and arthritis are the most common causes of knee pain. Damage to the knee structures may cause swelling, scar tissue formation (fibrosis), and loss of function of the joint. Pain is often accompanied by difficulty walking, weakness, and instability. When the knee is overused, the thigh and shin bones (femur and tibia), cartilage, or tendons may experience stress. This leads to pain and discomfort as well as stiffness in the knee. Overuse injuries are common among athletes who participate in sports that involve running, jumping…

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Knee Popping

Knee popping can be a sensation that something is moving around in the knee. There may also be an audible sound associated with the popping, which in medical terms is called crepitus. This can also cause what we call mechanical catching or locking, which may make the knee feel like it is stuck in an extended or flexed position, and you have to move it in certain ways to get out of that. This knee popping sensation or sound or could be a very simple issue or it could be a sign that more serious damage is going on in the knee, so determining what is causing it is very important. So, the knees may pop and get in a certain position….

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Knee Swelling

Swelling of the knee, also known as water on the knee, is a condition in which fluid collects around the knee joint. Swelling can occur for a variety of reasons and affect patients of any age. Some swelling can be treated with over-the-counter medicines, but persistent and continuous swelling might result in tissue damage, bone softening, and cartilage deterioration. Over-the-counter medicines will assist relieve pain for individuals with a history of osteoarthritis and swelling following physical activity, such as exercise or running. During and after activity, the patient may apply compression sleeves to reduce the inflammation. Ice is another method…

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Knee Twitching & Spasms

Knee twitching and or spasms are common occurrences that can be caused by a variety of factors. In most cases, it is not a cause for concern and does not require treatment. However, in some instances, knee twitching may be a sign of a more serious condition. Knee twitching is often accompanied by a feeling of pins and needles or tingling in the knee. It may also be accompanied by a burning sensation. The twitching usually occurs intermittently and lasts for a few seconds. There are a number of things that can cause knee twitching. Some of the most common…

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Nerve Pain in Knee

Nerve pain in the knee can be very irritating and life-altering during normal activities as well as leisurely pursuits. Nerve pain in the knee can radiate from the lumbar spine, the pelvis, or the small nerves in the knee. It also can begin after surgery from surgical nerve irritation from the incision or can be the type of pain related to knee arthritis. At the Centeno-Schultz Clinic, we are experts in spine, pain management, and non-surgical orthopedics. We perform a thorough physical examination and musculoskeletal ultrasound of your knee to identify the root cause of your pain and how to treat it appropriately….

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Treatment Options

Treatment options for Patellofemoral Syndrome include:

The main goal of physical therapy for patellofemoral syndrome is to strengthen the quadriceps muscle so it can reduce pressure on the patella.

Physical therapy for this condition includes a number of exercises to strengthen the hip and thigh muscles, as well as extensive stretching which will make it less likely that you will experience symptoms while walking or running. Another important part of physical therapy is a home exercise program consisting of a series of stretches and strengthening exercises that improve flexibility and strength.

Deeper Dive Into Treatments

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

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PRP Knee Injections

PRP stands for Platelet-Rich Plasma. Platelets are blood cells that prevent bleeding. They contain important growth factors that aid in healing. Plasma is the light yellow liquid portion of our blood. So PRP is simply a concentration of a patient’s own platelets that are suspended in plasma and are used to accelerate healing. PRP is NOT stem cell therapy. Regrettably, blood contains few circulating stem cells. Rich sources of stem cells are bone marrow and fat. PRP is rich in growth factors. There are many different types of growth factors with different properties. VEGF is a very important one as it can increase the blood flow to an area.

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Doctors That Assist with Patellofemoral Syndrome

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Patellofemoral Syndrome

Free Download: The Knee Owner’s Manual

This e-book by Dr. Chris Centeno examines the knee and its role in the human musculoskeletal system and the body as a whole. The Knee Owner’s Manual provides a series of tests and clearly defined exercises that you can perform on your own to assess and monitor your own knee health. It will allow you to look for trouble spots where your own body may be having difficulty with stability, articulation, symmetry, and neuromuscular function. You’ll be able to see how these deficits in other regions of the body relate to the knee.

The Knee Owner’s Manual also discusses how Regenexx is pioneering the development of interventional orthopedics, a new branch of medicine that employs regenerative biologic therapies such as adult bone marrow concentrate and platelet-rich plasma to help repair and strengthen damaged tissues in other areas of the body.

This is contrasted with invasive knee surgeries, which often remove important tissues or replace the entire knee itself when it becomes damaged. With hyperlinks to more detailed information, related studies, and commentary, this book condenses a vast amount of data, images, and resources into an enjoyable and informative read. This is the first edition of The Knee Owner’s Manual, a companion book to Orthopedics 2.0.

  • Knee Popping After Meniscus Surgery

    Meniscus surgery is a widely performed surgery for meniscus tears with 34,966 performed in 2015 (1).  What is a knee meniscus?  What is meniscus surgery?  What can I expect after arthroscopic knee surgery?  Why is my knee popping after meniscus surgery?  Let’s dig in. What is a Knee Meniscus? The meniscus is a figure-eight fibrocartilage … Continued


  • Can Exercise Help Cartilage in Patellofemoral Syndrome?

    Exercise is good for so many things, but one of the questions we often get from our patients with musculoskeletal conditions is, Can I still exercise? In most cases, the answer is yes, and, in fact, in many cases, exercise may actually improve or relieve your condition. Patellofemoral syndrome or arthritis in the patellofemoral compartment … Continued


  • Can You Exercise with Degenerative Disc Disease?

    Spring is here, and for many of us, that means those activity levels that dwindled off a bit, or a lot, throughout the cold winter months are starting to kick into high gear. The story may not be the same for those who suffer with degenerative disc disease – but let’s not jump ahead of … Continued


  • Learning the Right Way to Squat Protects Your Kneecap

    Kneecap pain can be a symptom of a variety of issues (see infographic below—click to enlarge), and one of those is pressure in the quadriceps muscle. Kneecap arthritis can also be caused by many different issues, and one of those is excess pressure on both the quadriceps muscle and the kneecap. One way to reduce … Continued


  • 10 Benefits of Exercise You Might Not Know About

    The number-one reason most people begin an exercise regimen is to lose weight. You may know people—or you may be one of those people—who binge through the winter, for example, and then thrust themselves into a rigorous exercise program in the spring to lose weight for the dreaded swimsuit season. And while losing and maintaining … Continued


  • Patellofemoral Dysfunction

    The patellofemoral compartment is commonly known as the knee cap joint.  The knee cap (patella)  sits on tops of the thigh bone (femur). With activity there is movement or tracking of the knee cap along the femoral groove.  If there is misalignment of the knee cap within the femoral groove, the patient experiences pain. Lateral release is a … Continued


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