Patello-femoral pain (PFP) is pain that occurs in the front of the knee. It refers to a number of different conditions such as patella tendinitis, plica syndrome, bursitis, chondromalacia patellae, ilio-tibial-band syndrome, lumbar spine or sacrum dysfunction or referred hip pain. It is also referred to as "runner's knee".  

The kneecap, or patella, sits over the front of the knee and is attached to the bones and muscles by strong tendons: the patella tendon connects to the shin bone and the quadriceps tendon attaches to the top and sides of the knee cap from above. 

Problems begin when the kneecap does not move properly and rubs against the lower part of the thigh bone.  The most common causes of runner's knee are lack of balanced alignment between the knee cap, femur and tibia bone, muscle tightness or weakness, overuse such as running, jumping, playing soccer or skiing, flat feet and overweight. 

When walking, half the body weight acts on the knee; when walking on stairs, it is 3-4 times the body weight and when squatting, 7-8 times the body weight. Now imagine some of the above mentioned causes combined with excessive impact!  

If no surgery is required, the patient  with runner's knee will need to commit to a strict, regular exercise routine with the goal to restore muscular balance. An orthopedic doctor typically refers the patient to a physical therapist for rehab. In my own practice ,  I know of the importance to correct any imbalances in the pelvis, back or feet first. Patella mobilization and friction massage are important to assist with normal patella movement as are strengthening of the gluteal muscles including the hip rotator muscles.  Also, hamstrings and the muscles in the front of the hip need to be stretched.  

Most people with pain in the front of the knee heal well from their injury if they are committed to a regular exercise regimen, usually daily for at least 6-8 weeks.  After that, once your physical therapist has helped you establish your individual exercise program to maintain knee health, you can go back to running, skiing or other athletic activities.


Feel free to contact Marion Kregeloh, PT, CFP for more information on rehabilitation of anterior knee pain and exercise specifics. You can reach Marion 415-479-1765.

Knee injuries and how you can prevent or improve them

One out of every four sports injuries affects the knee. Knees are under a lot of stress when you are running, skiing, dancing or gardening. Climbing stairs may put pressure on the knee equal three to four times the body weight. Our knees are essential for walking, climbing and kicking. In order to be stable the knee depends almost entirely on soft tissue: ligaments, tendons and muscles. Multiple factors subject the knee to injuries: imbalance in thigh muscles (quadriceps and hamstrings), ankle- foot imbalances (pronation and supination), weight, posture and movement habits and angle of thigh bone (hip to knee). Women have a few disadvantages that are the reason for a higher injury rate among female athletes: smaller and weaker muscles that support the knee, wider pelvis with a sharper angle of the femur (thigh bone) to the knee, weaker hamstring muscles and hormonal changes (have an impact on ligaments and connective tissue). All these criteria make women’s knees more unstable. Women are likely to injure the ACL (anterior cruciate ligament) two to eight times more than men in the same sports. They are also more likely to developchondromalacia (“runner’s knee”).

Here are some important tips that can help reduce the risk of knee injury:

1. If you have pain in the anterior part of the knee, most often associated with patello-femoral pain or chondromalacia, it is absolutely important to avoid stairs and sitting with the knee flexed for prolonged periods of time. If the left knee is affected, avoid driving a car with clutch for longer periods of time. Avoid any pain in the knee with exercising.

To heal patellofemoral joint pain, the most important strategy is to unload the knee joint and avoid heavy impact activities. The combination of a careful exercise approach wiht anti-inflammatory medication, is best in most cases and often makes surgery unnecessary (D. Scott Dye: "pathophysiology causing patellofemoral pain")

2.Strengthening hamstrings and quadriceps (especially vastus medialis) muscles: you can perform the following exercises: straight leg raise while lying on your back and standing hamstring curl. Eccentric strengthening of the quadriceps is especially important for the anterior knee pain: it provides proper energy and shock absorption under functional load. (Wojtys EM). Example: partial lunges.

3. Stretching tight hamstring muscles.

4. Maintain balanced crouched position during sports (especially women who tend to be more upright due to quadriceps dominance) to build hamstrings and reduce risk of ACL injury.

5. Plyometric training (when no knee pain is present) in order to prepare the muscles and ligaments to respond quickly to force (for example jumping activities). Consult your physical therapist or trainer.

6. Address ankle foot imbalances: such as flat foot, pronated foot, knock-knees. Get professional advice from your physical therapist or other expert.

7.Lose weight if you are overweight to avoid excess weight on the knee joint.

8.Wear proper foot wear that supports your foot and fits well.

9.Avoid: downhill running, deep lounges and full squatts, cycling with the seat low and in high gear, leg extensions with locked knees and heavy weights, exercising on hard surfaces, large steps on stairs and high heels.

10. If you have knee problems resulting from sports or other activities, get professional advice.

You can contact Marion Kregeloh, PT, CFP at 415-479-1765 for further advice.