Pain Around Your Kneecap: Understanding Patellofemoral Pain

What is patellofemoral pain?

Patellofemoral pain describes pain around or behind the kneecap. The patellofemoral joint is where the kneecap meets the thigh bone.

It is sometimes called runner’s knee, although it can affect people who do not run. Activities that load a bent knee, such as stairs, squatting and running, commonly provoke symptoms.

What might you notice?

• Aching around or behind the kneecap.
• Discomfort on stairs or during squats.
• Pain during running or other repeated knee-bending activities.
• Discomfort after sitting with the knee bent.

These symptoms can overlap with other knee problems. Pain below the kneecap associated with the patellar tendon is a different condition and may need a different rehabilitation plan.

Why has the pain started?

There is not always one clear cause. Changes in activity, strength and the way you manage repeated tasks can be relevant. Assessment should consider your recent workload and the demands of daily life.

How is it assessed?

Your clinician will ask when the pain began, what makes it worse and how it affects you. Examination may include movement and strength tests and tasks such as a squat or step.

Patellofemoral pain is generally a clinical diagnosis. Ask whether any proposed scan would answer a specific question or change the treatment plan.

Adjust activity while building strength

Your starting exercises might be simpler movements before progressing to steps, squats or other demanding tasks. The choice and resistance should reflect your symptoms and goals.

A small temporary increase in discomfort can occur with new exercise, but symptoms should not be worse overall or remain worse the next morning. Reduce the load and seek advice if the programme causes new or worsening pain.

Can taping, orthotics or running changes help?

Some people benefit from supporting measures alongside exercise. These may include taping, a trial of prefabricated orthotics or changes to movement and running technique.

They should be selected according to your response and needs. Custom orthotics are not an automatic requirement for kneecap pain.

Exercise and education remain the main approach. An injection or shockwave treatment should not be presented as the routine next step simply because the knee still hurts.

How soon can you return to sport?

Progress varies. Build back towards your usual activities gradually rather than testing the knee with a sudden return to full training.

Monitor practical changes, such as more comfortable stairs or better tolerance of exercise. If there is no improvement after around six weeks of following a suitable programme, or symptoms worsen sooner, arrange a review.

When does knee pain need urgent advice?

Contact NHS 111 now if your knee is very painful, you cannot move it or bear weight, it is badly swollen or has changed shape, or it locks, gives way or clicks painfully.

A hot or red knee with fever or feeling shivery also needs urgent advice because infection is a possible cause.