Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Patellofemoral pain syndrome (PFPS) — commonly called runner's knee — is the most common knee complaint in physically active people. Despite the name, you don't need to be a runner to get it. And despite it being a knee problem, the solution usually lies in the hip.
What Is PFPS?
PFPS is pain arising from the joint between the kneecap (patella) and the groove it tracks in (the trochlear groove of the femur). When the kneecap doesn't track centrally — due to muscle imbalance, biomechanical factors, or excessive load — increased pressure on the joint surface causes pain and inflammation.
Activities that compress the patellofemoral joint cause the most pain: going down stairs, squatting, running, cycling, and sitting for prolonged periods (the "cinema sign").
Why the Problem Is Usually in the Hip
Research has consistently shown that people with PFPS have weakness in their hip abductors and external rotators (primarily gluteus medius). This weakness causes the knee to collapse inward during weight-bearing activities, increasing the stress on the lateral patellofemoral joint. A comprehensive physiotherapy program that includes hip strengthening produces better long-term results than knee-focused treatment alone.
Physiotherapy Treatment for PFPS
- Hip strengthening — gluteus medius, gluteus maximus, and hip external rotator exercises to reduce dynamic valgus
- Quadriceps strengthening — particularly VMO (vastus medialis oblique) in the range that does not aggravate the patellofemoral joint
- Patellar taping — McConnell taping to offload the lateral patellofemoral joint and allow pain-free exercise in the short term
- Running gait retraining — increasing cadence, reducing stride length, or improving hip mechanics during running to reduce patellofemoral load
- Foot assessment — orthotics or footwear modification when overpronation is contributing
- Load management — identifying and modifying training errors (too much, too soon)
What to Expect From Recovery
PFPS is one of the more stubborn knee conditions because the anatomical cause (altered patellofemoral mechanics) requires sustained muscle re-education to correct. Most patients see significant improvement within 6–8 weeks, but complete resolution — particularly in runners returning to full training — takes 3–6 months. The best outcomes come from combining hip strengthening, load management, and a graded return-to-sport program.
Frequently Asked Questions
What causes runner's knee (PFPS)?
PFPS is caused by increased or altered loading at the patellofemoral joint. The most common contributing factors are: hip abductor and external rotator weakness (causing the knee to drop inward during running), reduced quadriceps strength, training load spikes (increasing distance or intensity too quickly), foot mechanics (excessive pronation), and reduced hip flexibility. The problem is rarely in the knee itself.
Is PFPS the same as patellar tendinopathy?
No. PFPS involves pain from the patellofemoral joint itself (behind or around the kneecap), while patellar tendinopathy involves pain in the patellar tendon (at the bottom of the kneecap). PFPS pain is typically aggravated by stairs and prolonged sitting; patellar tendinopathy pain is typically worst at the start of activity or with jumping.
Can I still run with PFPS?
Often yes — with load modification. Complete rest is rarely necessary or beneficial. Your physiotherapist will advise on an appropriate running volume that stays below your pain threshold while rehabilitation exercises address the underlying cause. Most runners are able to maintain some running throughout their recovery.
Do I need orthotics for patellofemoral pain?
Foot orthotics can help some PFPS patients, particularly those with significant overpronation. However, they address only one component of a multifactorial condition. Hip strengthening and quadriceps training are essential regardless of whether orthotics are used.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora