By Carl Green
Patellofemoral Pain Syndrome (PFPS) is a common condition that affects people across all activity levels, from elite athletes to those with a more sedentary lifestyle. It is typically characterised by pain around the kneecap (patella), particularly during activities that place stress on the knee joint, such as squatting, stair climbing, running or prolonged sitting.
What Causes PFPS?
The pain associated with PFPS is generally linked to mechanical overload or sensitisation of the soft tissues around the patella and the trochlear groove. This is the area of the femur where the kneecap glides. This may involve irritation of the bone, cartilage or joint capsule.
A wide range of factors can contribute to PFPS, including:
Sudden changes in physical activity (volume, intensity, or technique)
Poor recovery and sleep quality
Psychological stress and anxiety
Weakness in key muscle groups (particularly the quadriceps and gluteals)
Faulty biomechanics and poor movement control
In fact, research has identified over 500 potential risk factors for PFPS, underscoring its multifactorial nature.
Differential Diagnosis: Could It Be Something Else?
When assessing PFPS, it's important to consider other conditions that can present with similar symptoms.
These include:
Patellofemoral instability
Synovial plica syndrome
Patella stress fractures
Osteochondritis dissecans
Osgood-Schlatter disease
Iliotibial band syndrome (ITBS)
Lateral meniscus injury
Knee osteoarthritis
Additionally, referred pain from other areas such as hip osteoarthritis, lumbar spine issues (e.g., L3/L4 nerve root irritation) or rare conditions like Perthes disease, must also be considered.
An accurate diagnosis is essential for effective treatment and avoiding unnecessary interventions.
What Contributes to Overload and Sensitisation in PFPS?
Understanding why overload and sensitisation occur is central to effective management. Contributing factors may include:
Poor core, trunk, or pelvic control
Weak quadriceps and glutes
Limited mobility in the hip, ankle, or lateral thigh
Inadequate recovery from physical activity
Emotional stress and disturbed sleep patterns
How We Assess PFPS at Colchester Physiotherapy & Sports Injury Clinic
Our assessment process combines both objective and subjective measures to get a complete picture of your condition.
Objective Measures:
Muscle strength testing (quads, glutes, calves)
Joint mobility screening (hip, knee, ankle)
Gait and movement analysis
Symptom provocation through load-based testing
Subjective (Qualitative) Evaluation:
Conversations to explore the emotional and psychological impact of PFPS
Identifying stress, anxiety, or beliefs that may affect pain perception or recovery
This holistic approach allows us to develop a tailored, patient-centred treatment plan that addresses your specific needs, physically and emotionally.
What's next?
If you’re experiencing pain, weakness, stiffness or balance issues whether due to injury, surgery, illness or for no clear reason, don’t wait. Early assessment and treatment are key to a full recovery.
Book an appointment with one of our senior clinicians at Colchester Physiotherapy & Sports Injury Clinic today for expert care and guidance.
Author
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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