Why endure chronic knee pain from soccer, running, cycling, gardening and other activities of daily living when you could take steps to eliminate the problem? It is estimated that Patellofemoral Pain Syndrome (PFPS) affects between 25-30% of individuals between the ages of 19-30 in a given year1 and between 50-85% of female runners will experience some kind of knee pain annually2.

What are the symptoms of PFPS?

A 2013 study noted that activities such as squatting [like gardening], kneeling, stair climbing and prolonged sitting [like driving] may cause or exacerbate symptoms3. Symptoms include diffuse anterior knee pain, especially along the medial aspect of the patella, but may also include lateral or retro-patellar pain (on the outside or back of the knee, respectively)1.

What Can Cause PFPS?

It is commonly accepted that improper lower extremity mechanics are responsible for causing PFPS 2. Additional factors may include an increased Q angle (angle between hips and knees), increased sulcus angle, increased patellar tilt, decreased lateral hip strength and decreased quadriceps strength3. Increased hip adduction, hip internal rotation and contralateral pelvic drop may also be associated with PFPS2. Continuing to participate in activities with poor mechanics or deficiencies in any of these categories could increase one’s risk of experiencing PFPS.

What are some of the treatment options?

The good news is that various treatment methods like Graston Technique and Active Release Technique (ART) have been demonstrated to alleviate symptoms associated with PFPS. These treatments may be used in conjunction with gait training, hip and knee strengthening and various taping techniques.

One treatment option that you can discuss with your healthcare provider is using both open and closed-kinetic chain exercises to strengthen the hips and knees, which have been shown to address muscle imbalances, and using tape to promote ideal muscle activation patterns1. Real time gait training for walking and running may also be useful when used in conjunction with these other treatment techniques, even in chronic scenarios2.

A comprehensive rehabilitation program for PFPS should include a combination of soft tissue techniques, exercises, stretching and other modalities like cryotherapy (icing)4. Soft tissue techniques like Graston, ART and self-myofascial release (foam rolling, Tiger Ball and Tiger Tail) are an excellent complement to additional exercises and alternative modalities have been very effective in treating conditions like PFPS. Kinesiotape and Rock Tape can also play a valuable role in lateral hip activation and may contribute to proper knee mechanics.

Knee pain and PFPS in particular are very common and can be debilitating. Whether you are young, old, or in between there are steps you can take to address your knee pain.  Discuss next steps of treatment with your healthcare provider, or feel free to call InHealth for an evaluation.


  1. Fagan, V. & Delahunt, E. (2008). Patellofemoral pain syndrome: A review on the associated neuromuscular deficits and current treatment options. British Journal of Sports Medicine, 42(10), 789-795.
  2. Noehren, B., Sholz, J., & Davis, I. (2011). The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. British Journal of Sports Medicine, 45(9), 691-696.
  3. Lankhorst, N., Bierma-Zeinstra, S., & Middelkoop, M. (2013). Factors associated with patellofemoral pain syndrome. British Journal of Sports Medicine, 47(4), 1-16.
  4. Dixit, S., DiFiori, J., Burton, M., & Mines, B. (2007). Management of patellofemoral pain syndrome. American Family Physician, 75(2), 194-202.

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