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Patellofemoral Pain Syndrome

Updated: Jun 29, 2023

You just started working out more and now the front of your knee hurts. Most likely scenario? It’s patellofemoral dysfunction. Let’s break this down:

The patella is the kneecap. It’s a floating bone that lives in the tendon of your quadriceps. The femur is your thigh bone. The patellofemoral (PF) joint is where the two come together. Your kneecap slides up and down your femur as your knee bends. In a perfect world, this is a pain-free motion, but for many people, it’s not.

physical therapist working on knee injury

The first question to answer- is it structure or function? A thorough examination will reveal if there is an alignment issue in the leg or if there is a muscular dysfunction (or both). Determining the cause is always the most important to ensure effective treatment. In most cases, quadriceps weakness and/or tightness is the main culprit. However, a thorough exam also requires looking at the joint above and below the knee. Both hip weakness and ankle/foot weakness have been shown to add stress to the knee and aggravate PF symptoms.

physical therapist from Zion Physical Therapy performing hip abductor test
Good: Hips in a straight line with hip and ankle; no wobble.

physical therapist with Zion Physical therapy t-shirt performing patella exercise
Dysfunction: Opposite hip drop, knee valgus, and ankle rolled in.

One of my favorite functional tests to evaluate all three of these options is the step down test. When the hip abductors are weak, the pelvis won't stay level and the opposite side drops. This collapse creates increased stress to the inside of the knee. Similarly, a weak foot or ankle may cause excessive pronation which encourages the tibia to roll in, also stressing the inner knee. As the knee crosses toward the middle, the patella is no longer able to track in a straight line in the groove and starts to create friction in the joint. With repetitive loading, as in running, this can quickly become painful.

So what to do? Perform your own step down test and see if you can uncover where your form might be failing. If you notice a hip drop, aim for gluteus medius exercises like band walks. If it seems to be your ankle wants to roll in, try these easy theraband exercises. And if your form is great, but your quad feels shaky, practice these heel taps to improve your eccentric strength.

At Zion PT, we are experts at honing in on the cause of your pain instead of using a band-aid approach to temporarily cover up symptoms. If you’re having trouble getting to the bottom of your PFPS, let us help. With additional mobility and strength testing, we can define what muscles are weak and throwing off your form. We can then create a home exercise program individualized to your needs that will prevent injury down the line. Don’t wait - races aren’t going to run themselves.

Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email:

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