Patellofemoral pain

Patellofemoral pain is aching around or behind the kneecap. It often flares with stairs, squats, sitting with bent knees, or increases in running volume.

What it feels like

Anterior knee ache that is hard to pin to one tiny spot is common, sometimes with a movie-theater stiffness after long sitting.

Stairs (especially down), hills, and deep knee bends tend to provoke it.

Swelling is usually mild compared with acute ligament tears. Giving way is less typical unless the kneecap is truly unstable.

What is going on

Load across the patellofemoral joint rises with flexion under demand. Training spikes, weakness, and movement patterns can overload sensitive tissues.

Cartilage irritation, soft-tissue overload, and tracking mechanics can all contribute without a single dramatic injury.

Imaging is often normal or nonspecific early, which does not make the pain less real.

How we evaluate

We review training load, footwear, and recent changes, then examine strength, flexibility, and patellar tracking.

Hip and foot mechanics are part of the knee story for many runners and lifters.

Imaging is used when locking, trauma, or atypical features suggest another diagnosis.

What we may offer

Load reshaping and progressive strength (quad and hip) through physical therapy are first-line.

Taping, short-term activity modification, and return-to-run progressions help many people keep moving.

Injections are uncommon as a first step unless another intra-articular problem is identified.

Is this the same as arthritis under the kneecap?

It can overlap with patellofemoral osteoarthritis, but many younger patients have pain with little structural wear.

Should I stop running completely?

Not always. We often reduce irritating volume and rebuild capacity rather than enforcing total rest.

Do I need an MRI?

Usually not at the start unless the story suggests cartilage injury, loose body, or another specific lesion.

Can weak hips cause kneecap pain?

Hip strength and control often influence how load reaches the patellofemoral joint, so we address both.