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Knee pain


Patellofemoral Pain Syndrome (PFPS) is an umbrella term used for pain arising from the patellofemoral joint (knee cap) itself, or adjacent soft tissues. The knee pain often increases when you run, walk up or down stairs, sit for long periods, or squat. PFPS can be due to a patellar trauma, but it is more often a combination of several factors (multifactorial causes): overuse and overload of the patellofemoral joint, anatomical or biomechanical abnormalities, muscular weakness, imbalance or dysfunction.


Typically, this type of knee pain is initiated by improper movement of the patella (knee cap). The patella glides up and down through a groove called the patellofemoral groove. When the patella’s movement through this groove is distorted or affected, the patella begins to ‘maltrack’ meaning that it’s movement is biased more to one side of the knee than the other. The more this happens, the more pressure builds in the knee as the kneecap rubs against the femur, resulting in pain.

Usually, poor muscular strength & mechanical control around the knee itself will cause maltracking of the kneecap. As a result of these two issues, muscular tightness in the dysfunctional structures around the knee can occur. Commonly this presents in vastus medialis oblique & vastus lateralis - 2 heads of the quadricep muscle, which will result in the kneecap being pulled medially or lateral and thus causes ‘maltracking’ of the knee, resulting in pain.

PFPS can also be due to knee hyperextension, alignment issues in the knee (lateral tibial torsion, genu valgum or varus, increased Q-angle), as well as tightness in the iliotibial band, hamstrings or gastrocnemius. Flat feet or higher than normal arches can also provoke PFPS.




Patients with PFPS typically complain of the following symptoms:

- Pain with weight bearing in a single or both knees.
- Improper mechanical movement of the patella (knee cap) which can cause excess pressure on the knee. This means bending and flexing the knee may be painful. 
- Tenderness around the kneecap, or a feeling of discomfort behind/inside the knee cap (especially when pressure is applied). 
- Some cracking or clicking when knee movement (this can sometimes be reported as being painful). 
- Muscular tightness surround the knee
- A sensation of knee stiffness when walking around. 
- Sitting for a long period of time can cause the muscles around the knee to also tighten, thus eliciting pain when standing as the kneecap is pulled into irregular positions. 



Repetitive movements which elicit your knee pain will continue to build the pressure within the knee itself. Typically, repetitive squatting, running & stairs are all common movements which make this type of knee pain worse. In addition to this, sitting or standing for too long will also continue to increase the pressure within your knee thus resulting in pain.

If you are experiencing any of the symptoms outlined above, be sure to see one of your Sydney physiotherapist or book online for one of our services for further investigation and an accurate diagnosis. PFPS injuries are commonly detected via a physiotherapy investigation, assessing range of motion, strength, and special tests specific to knee injuries, rule out other pathologies and confirming a diagnosis. 

Further medical investigations such as an x-ray and MRI can be used to investigate if there may be something else contributing to your pain and/or more specific information on the extent of injury is needed.


Prognostically speaking, the healing prospects for this injury are positive. If treated correctly with the appropriate rehabilitation tailored to the individual’s knee, you could expect full return to your sport or previous level of function pain free within 4 to 6 weeks. Following this period, whilst you may not be in any more pain, we still advise that you continue with the prescribed rehabilitation exercises given by your treating practitioner to prevent regression or the return of symptoms.



If your symptoms persist and do not settle with resting from the movements or type of exercise which is exacerbating your knee pain, then we advise to seek the help from a health professional to give you expert guidance in rehabilitating your knee pain.

At Infinite Health, our Physiotherapists are highly trained with diagnostic skills to assess where the source of your knee pain is originating from. Our therapists will also be able to educate you how the pain came about, whether this pain was derived from lifestyle factors or just how mechanically sound your knees are when walking or running (a.k.a playing sport).

Our therapists will undertake a subjective interview with you in the first session to understand what lifestyle habits or exercises may have caused your pain. From here, both passive & functional movement tests will be conducted to highlight what mechanical deficiencies and weaknesses your knee has, thus explaining why your knee is painful.


Once a diagnosis has been established, the pain relief process will begin which includes: soft tissue release, dry needling, passive muscular & joint stretching to unload the knee joint. As pain decreases, your therapist will guide you through a progression of rehabilitative exercises which will aim to: a) stretch & unload the painful/overused area, b) strengthen the mechanical imbalance which led to your knee pain in the first place!

We'd love to help you! Visit one of our clinics or sign up for one of our online services for expert help!

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