Patellofemoral Pain Syndrome

Anterior or front knee pain is a pain occurring underneath or around the kneecap. Most people usually refer to it as a kneecap pain front knee pain. However the right medical term is anterior knee pain. In the past there has been many names given to this condition.

Chondromalacia patella – the softening and destruction of knee cap cartilage (patellar cartilage).

Runner’s knee pain – Runner’s knee is a loose term for many specific disorders with different causes, which cause pain around the kneecap. As the name implies it is more prevalent in runners, however other athletes who repetitively bend their knee also get it.

In most recent consensus scientist came to conclusion that the most proper term for this condition is: patella femoral pain syndrome (PFPS).


PFPS (patella femoral pain syndrome) is a variety of structural and functional pathologies or anatomical abnormalities leading to front knee pain (anterior knee pain).


Due to variety of causes the movement of patella on the trochlea as well as the femur under the patella becomes abnormal. A very good analogy to this anatomical scenario is the train (kneecap) moving on the track (trochlea of the femur bone). In the case of PFPS it is usually both. The train is skewing on the track, but the track is also uneven.


The pain is usually diffuse.

It may feel inside the knee or under the kneecap. Frequently there is also pain and tenderness around the kneecap. The knee may have popping or grinding sounds when bending or squatting.

The most classic sign with PFPS is called a “movie” sign. Pain is present during seating.

PFPS is most common in teenage girls and overweight women


1. Being female
(different pelvic architecture)

2. Knee extensor strength deficit


Pain in PFPS is due to compression of the cartilage on the underside of the kneecap as well as in the cartilage of the femur. The increased pressure between the kneecap and the articulating surface of the femur leads to wear in the cartilage. The continued compression within patella-femoral articulation eventually causes subchondral bone stress. The bone gets irritated and inflamed. The pain is actually coming from the bone itself.


The following causes are the only ones proven by research

  • Structural misalignment
  • Hip muscle power deficit
  • Thigh muscle imbalance
  • Calf muscle tightness
  • Flat feet or excessive foot pronation
  • Soft tissue dysfunction around the knee joint capsule
  • Poor motor contro


Since PFPS is a multifactorial disorder, treatment must be comprehensive. Each patient with PFPS has unique presentation, which requires thorough analysis and individual approach.

At NYDNR we use comprehensive approach to eliminate the causes described above. Based on thorough clinical evaluation we create an individual treatment plan. In runners we use technological gait or running analysis.

In athletes who jump or play sports, which involve cutting we use video force plate analysis to analyze motion and forces acting on the knee while athlete jumps or performs other athletic maneuvers.

We use manual release techniques to restore gliding and alignment of patella (knee cap).
We use specific taping techniques to realign patella.
We use CAREN (Computer Assisted Rehabilitation Environment) multisensory environment technology to train motor control.
We also use sophisticated video feedback with surface EMG for runners and athletes. Most athletes with PFPS don’t have to stop training or running because they can run on our antigravity AlterG treadmill


Patellofemoral Pain Syndrome

The structures in your lower body are designed to work in a coordinated sequence to produce uninhibited movement. When correctly aligned, your knee cap facilitates smooth gliding at the knee as your powerful leg muscles contract to propel you forward and upward.

Pain occurring at the front of the knee and around the kneecap can signal a serious problem that, if ignored, may grow worse over time, especially if you are an athlete or are physically active. Patellofemoral pain syndrome (PFPS), also known as runner’s knee, is an umbrella term that covers a range of knee issues commonly found in runners and athletes.

Knee Anatomy

Your knee is the most complex joint in your body, responsible for transferring huge force loads during physical activity. Its structures include four bones: the patella (knee cap), the femur (thigh bone), and the tibia and the fibula of the lower leg. The knee is stabilized by muscles, tendons, ligaments, cartilage and menisci.

As a hinge joint, your knee enables you to stand, sit, walk run and jump. Synovial fluid within the joint capsule lubricates the knee to help it glide smoothly during flexion and extension. Two types of cartilage, meniscus and articular, provide shock absorption and help the bones to move smoothly against one another with minimal friction.

Incidence of PFPS

PFPS is the most common type of knee pain, with its locus in the area surrounding and underneath the knee cap. The syndrome is most common in runners and cyclists, but it can occur in anyone who is physically active, and even in people who sit too much. In professional cyclists, the incidence of PFPS is as high as 40 percent, but it is even more prevalent in runners, ranking as the number one running injury.

Causes of PFPS

Knee injuries are common in athletics, especially strains, sprains, and tears of the ligaments and menisci. But the most common cause of knee pain is overuse, where repetitive motion leads to wear and tear. PFPS is a type of overuse injury.

Common factors contributing to PFPS include:

  • Muscle imbalances that cause the knee to track less efficiently
  • Tight inflexible muscles that inhibit movement
  • Faulty movement mechanics that place excessive stress on the structures of the knee
  • Poor gait mechanics when walking and running
  • Repetitive overuse with inadequate recovery
  • Sudden changes in type, duration, frequency or intensity of physical activity
  • Worn or poorly fitting footwear
  • Sedentary lifestyle with excessive sitting

Often there are multiple factors at play in cases of PFPS. Most non-traumatic knee pain can be resolved with conservative treatment methods.

Diagnosis of PFPS

At NYDNRehab, we use dynamic diagnostic ultrasound to locate and visualize the structures of the knee. During diagnosis, both patient and clinician are able to view the images on the monitor, and the patient is able to provide feedback. Ultrasound imaging allows us to view the knee in motion, in real time, to identify the source of pain. Because diagnostic ultrasound give us immediate results, we can quickly proceed to devise an individualized treatment plan.


After a thorough clinical evaluation, we create an individualized treatment strategy that may include a combination of some or all of the following:

  • Gait and jumping analysis using 3D motion capture force plate technology
  • Manual release techniques to restore knee alignment and patellar gliding
  • CAREN (Computer Assisted Rehabilitation Environment), a multi-sensory virtual reality environment used to train motor control
  • Sophisticated video feedback with surface EMG for runners and athletes
  • Training on our antigravity AlterG treadmill
  • Force-plate video feedback training
  • Extracorporeal shockwave therapy (ESWT)

The sports medicine professionals at NYDNRehab take a holistic approach to treatment, with the end goal of restoring pain-free function and enhancing athletic performance.

130 West 42 Street, Suite 1055, New York, NY 10036
130 west 42 street, suite 1055 New York, NY 10036

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