# Patellofemoral pain Patellofemoral pain is pain around or behind the kneecap (the patella), often called runner's knee. It builds when load rises faster than the knee can adapt: more running, more hills, a long ski day or a steep hike down. We assess your hip and thigh strength, how you squat and land, your feet and your training, then treat it with load management and targeted strength. ## Symptoms - Aching around or behind the kneecap - Pain going down stairs, hills or ski runs - Pain when squatting, kneeling or lunging - A stiff, sore knee after sitting with it bent - Pain that starts partway through a run and lingers afterwards - Grinding or clicking under the kneecap - A knee that feels weak on a step down ## Assessment The story usually starts with a change in load: more running, a block of hills, the first long ski day, or a long hike down. We watch you squat, step down and land on one leg, and check whether the knee drifts inward. We test the hip and thigh muscles, which control where the kneecap sits as the knee bends, and look at how your feet take weight. A kneecap can be sore without anything being torn, so the assessment is about load and control. If the knee swelled after a twist, locks or gives way, we test the ligaments and the cartilage cushion inside it (the meniscus) too. If you run, a [running assessment](https://backinactionphysiotherapy.com/services/running-assessment) with physiotherapists certified by The Running Clinic adds a closer look. It is a 55-minute one-on-one session with slow-motion video of you on a treadmill, so we can see how each stride loads the knee. ## Treatment The main treatment is the right amount of load, not rest. We cut back what sets the knee off, such as deep squats, long descents and hill repeats, and keep the rest going at a level it accepts. Then we build: - **Hip and thigh strength:** the muscles at the side of the hip and the front of the thigh steer the kneecap. Strengthening them is the core of the plan. The later stages often move into [strength and conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning). - **Control:** squatting, stepping down and landing with the knee in line with the hip and foot, slowly at first, then at speed. - **Taping early on:** tape across the kneecap can ease the pain enough to make the exercises possible. It is a bridge, not the treatment. - **Running form and cadence:** a faster step rate with a shorter stride lowers the load on the kneecap with each footfall. We set it from the running assessment video, with a plan for hills. - **Feet:** where the way your foot lands adds load to the knee, [custom casted orthotics](https://backinactionphysiotherapy.com/services/custom-casted-orthotics), cast from your own feet, can be part of the plan. - **A brace:** some knees do better with a kneecap tracking brace for a time. See [splints and bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing). ## Getting back to sport Running comes back in steps, with no set date: flat ground first, on the Valley Trail or the treadmill, then longer runs, then pace, and the hills last. Downhill loads the kneecap most, so the long descents wait until the flat is easy. Each step holds until the knee accepts it. Skiing asks the kneecap to hold a low stance through a long day of bumps. We build the strength for that stance first, and the early days back are shorter. The same staging covers work, study and sport: stairs, ladders and kneeling come back as the knee allows. Print the [Run RAD](https://backinactionphysiotherapy.com/resources/run-rad) sheet and do it before every run. [Ski RAD](https://backinactionphysiotherapy.com/resources/ski-rad), the dynamic mobility warm-up for ski days, ends on a squat stream and a jump stream, which is where the kneecap gets ready. ## When to come in Book an assessment if kneecap pain keeps returning on stairs, descents or runs, starts earlier in each run, or stops you squatting, hiking or skiing. Go to the emergency department right away, or call 911, if any of these happen: - the knee looks out of shape - you cannot put weight on the leg, even for a few steps - the knee is hot, red and swollen, and you have a fever - your lower leg or foot is numb, cold or pale ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Running Assessment](https://backinactionphysiotherapy.com/services/running-assessment) - [Strength and Conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) - [Custom Casted Orthotics](https://backinactionphysiotherapy.com/services/custom-casted-orthotics) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Programs - [Run RAD](https://backinactionphysiotherapy.com/resources/run-rad) - [Ski RAD](https://backinactionphysiotherapy.com/resources/ski-rad) ## Frequently asked questions ### Should I rest my knee until the pain goes? No, not completely. The kneecap hurts because it has been overloaded, and total rest only lets the hip and thigh muscles that protect it weaken. Keep the activity that feels fine and cut back the rest for a while: deep squats, hill repeats, steep downhill hiking. The guide we use is that activity may make the knee no more than a little worse, and it should settle by the next morning. ### How can I keep running with runner's knee? Lower the dose. Many people keep running while the knee settles: fewer kilometres, flatter routes and an easy day between runs. Shorter, faster steps often take load off the kneecap, and we can check yours on the treadmill. If the knee aches more with every run, or makes you limp, stop and book an assessment. ### Will a kneecap tracking brace help? For some people. A patella tracking brace can take the edge off kneecap pain while the strength work does its job. Some people find it useful for a long ski day or a descent. It supports the knee rather than fixing the cause, so we do not suggest one for everyone. We supply them in a standard or custom fit, and tell you whether yours is a knee that would gain from one. ### Do I need orthotics for kneecap pain? Only sometimes. A foot that rolls in heavily as it takes weight can turn the thigh and pull the kneecap off line. That is where an orthotic earns its place. Many people with kneecap pain get better without one. If your assessment points to the foot, we cast both feet and have the pair made to that cast. ### Why does my knee hurt after sitting? It is common. With the knee bent for a long time, in the car or at a desk, the kneecap sits pressed against the thigh bone. A sore joint surface complains when you stand up. It usually eases after a few steps. Straightening the leg now and then, and getting up every half hour or so, keeps it in check while the rest of the plan treats the cause. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*