By Carl Green 
Patellofemoral pain syndrome (PFPS) is a prevalent condition that affects individuals of various activity levels, from athletes to sedentary individuals. PFPS is characterised by pain around the patella (knee cap) during activities that load the knee, particularly when the quadriceps contract during knee flexion. The origin of this pain can be attributed to mechanical overload or sensitisation and irritation of the bone, cartilage and joint capsule (soft tissues) associated with the patella and trochlea groove that it moves against. 
There are a range of factors that can contribute to PFPS, these can include changes in physical activity, poor recovery, stress, anxiety, muscle weakness, and poor biomechanics. In fact researchers have identified over 500 individual risk factors for patellofemoral pain which emphasises its multifactorial nature. 

Differential Diagnosis 

When diagnosing PFPS it is important to realise there are other conditions that may present with similar symptoms. These may include patellofemoral instability, synovial plica, patella stress fracture, and osteochondritis dissecans. Differential diagnoses also encompass conditions affecting the patella tendon, such as Osgood-Schlatter lesions and issues related to the ITB, lateral meniscus, and osteoarthritis. 
It is also important to identify whether other structures away from the knee could be causing referred pain, making an accurate diagnosis crucial for effective and appropriate treatment. Common sites that refer pain to the knee can be hip joint osteoarthritis in older patients, mechanical back pain, lumbar nerve root irritation (L3/L4 nerve root irritation), and rare childhood conditions such as Perthes and slipped capital femoral epiphysis (affecting the hip), or tumours. 

Contributing Factors to Overload and Sensitisation in Patellofemoral Pain Syndrome 

Understanding the contributing factors to PFPS is vital for developing a targeted treatment plan. Changes in physical activity intensity, volume, or technique, along with inefficient recovery, sleep disturbances, and increased stress, can contribute to overload and sensitisation. Poor trunk and pelvic control, weakness in the quadriceps and gluteal muscles, and mobility issues in the lateral thigh or ankle may further exacerbate PFPS. 

Objective Findings and Assessment Measures 

At Colchester Physiotherapy and Sports Injuries Clinic, our approach to PFPS assessment involves both quantitative and qualitative measures. 
Objective findings include assessing muscle strength (quad, glute, and calf), loading positions for symptom provocation, and joint mobility in the hip, knee, and ankle. Gait analysis is an integral part of our assessment, focusing on foot and ankle mechanics, hip and trunk control, and general movement patterns during activities. Identifying deficiencies in strength and movement and then addressing these by correcting movement dysfunction and or implementing strength based exercise will often result in a successful outcome. 
Qualitative assessments to assess levels of anxiety associated with the symptoms of PFSF are also useful and this can be established through the conversations we have with you during your assessment allowing us to better understand the impact of PFPS on you as an individual and tailor our treatment plans accordingly. 

What's next? 

If you or those around you are having difficulty with pain, stiffness, weakness, balance due to injury, illness, operations or for no obvious reason, please consider booking an appointment with myself or my colleagues for expert physiotherapy from Senior clinicians


Carl Green 

Carl is a Specialist Musculoskeletal Physiotherapist, Sports Science and Human Biology graduate, former Lecturer in Sport and Exercise, Personal Trainer, and Sports Massage Therapist. 
He has worked as a Physio within the NHS at a senior level, sports injury clinics, his own practice, stroke rehabilitation, occupational health and chronic pain. Carl also has first hand experience of acute and chronic injuries, pain, surgery, and disability, giving him a deeper understanding how these can affect us both physically and psychologically. 
He started his career in health and fitness in 2002. Empowering people to achieve their goals, overcome challenges, and reduce future problems through lifestyle/behaviour change and exercise has continued to be a big part of his approach as a Physio. 
Carl has tried many sports, but mainly focused on rugby, gym training, running (5k to half marathon), and Muay Thai Boxing. He also enjoys snowboarding, home gym training, teaching his dog tricks and playing fetch, covering songs on his guitar, and has recently taken up archery. 
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