Anterior knee pain / patellofemoral pain syndrome (PFPS)

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What is anterior knee pain?

Anterior knee pain is a term given to pain arising from behind the knee cap (patellofemoral joint). It is sometimes referred to as patello-femoral pain syndrome, reflecting the affected structures.

The patellofemoral joint is unique as the knee cap sits in a shallow groove at the lower end of the femur rather than being formed from a deep socket. As such, the joint relies heavily on adequate flexibility of the soft tissues around the knee as well as adequate muscle control and strength around the hip and knee. Certain individuals are particularly vulnerable to developing anterior knee pain.

Young adults, particularly adolescent females
Individuals with poor lower limb alignment (termed biomechanics)
Individuals who do not exercise regularly to keep their muscles flexible and strong
Individuals with a high BMI

Common symptoms

Pain is felt in the front of the knee.

Pain on squatting movements and ascending or descending stairs are often the main aggravating activities. These movements place a far greater load through the patellofemoral joint than walking on the flat.

There may be some associated grinding (crepitus) and clicking of the patellofemoral joint. Pain may result in the knee feeling weak and unstable. These symptoms can often be resolved by an appropriate exercise routine (outlined below).

How is anterior knee pain diagnosed?

Anterior knee pain can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature is tenderness under the patella. Other common features are weakness of the quadriceps muscles, crepitus and pain with squatting movements. This condition is not normally associated with swelling.

X-rays and scans are not routinely required.

How is anterior knee pain treated?

Anterior knee pain can be managed very effectively by a therapeutic exercise regime. For active individuals, the most effective are specific strengthening and flexibility exercises (see below).

In those who are inactive or overweight, weight loss and an increase in general activity may be helpful.

Exercises
Regular exercises to enhance muscular strength and flexibility across the hip and knee joints:

Weight loss
You can use a BMI calculator to find out if it might be advisable for you to try to lose some weight.

Losing weight reduces the load which weighs down on your joints as you move about. Evidence shows that weight loss can result in significantly better mobility. There is also some evidence to suggest that weight loss alone may actually help to reduce pain. However, in combination with exercise, the results can be staggering.

There is lots of support and advice available. For example, you can find some excellent ideas, including recipes and advice on making healthy food choices, on the NHS Change 4 Life website, which also has information about healthy activities local to you.

Physiotherapy
If a home exercise programme is ineffective a referral to a physiotherapist is appropriate. The physiotherapist will be able to provide more specific advice regarding treatment options.

Orthotics
Your clinician may feel that poor foot biomechanics are contributing to your symptoms. In these cases they may recommend insoles to support the arches of the foot and assist alignment of the knee.