Knee Pain (Patellofemoral Pain) - Causes

Authored by Dr Jacqueline Payne, 08 May 2015

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Colin Tidy, 08 May 2015

It is probably due to a combination of different factors which increase the pressure between the kneecap (patella) and the lower part of the thigh bone (femur). This may happen during running, cycling, squatting and going up and down stairs. It is likely that the cause is not the same in everyone affected.

Situations where this can occur include:

  • Overuse of the knee, such as in certain sports - particularly at times of increased training.
  • Cycling when the saddle is too low or too far forward.
  • Some people may have a slight problem in the alignment of the patella where it moves over the lower femur. This may cause the patella to rub on, rather than glide over, the lower femur. It may be due to the way the knee has developed. Or, it may be due to an imbalance in the muscles around the knee and hip - for example, the large quadriceps muscle above the knee and the muscles that stop the hips from tilting when standing on one leg.
  • Weak hip muscles may cause patellofemoral pain by causing the thigh bone to be slightly turned inwards, leading to the patella being pulled slightly to one side.
  • Foot problems may also play a part - for example, where the feet do not have strong arches (flat feet). This makes the foot roll inwards (pronate), which means the knee has to compensate for the inward movement. However, it is unclear whether this causes the knee problems or may be caused by the knee problems.
  • Injury to the knee - including repeated small injuries or stresses due to sports, or due to slack ligaments (hypermobile joints).

A combination of an alignment problem (see above) and overuse in sport is thought to be the most common reason for getting patellofemoral pain.

Further reading and references

  • van der Heijden RA, Lankhorst NE, van Linschoten R, et al; Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015 Jan 201:CD010387. doi: 10.1002/14651858.CD010387.pub2.

  • Witvrouw E, Callaghan MJ, Stefanik JJ, et al; Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med. 2014 Mar48(6):411-4. doi: 10.1136/bjsports-2014-093450.

  • Callaghan MJ, Selfe J; Patellar taping for patellofemoral pain syndrome in adults. Cochrane Database Syst Rev. 2012 Apr 184:CD006717. doi: 10.1002/14651858.CD006717.pub2.

I have tightness and sharp pain across my swollen knee cap & cannot seem to reduce the swelling despite physio, painkillers and ice packs.  What else can I do to reduce swelling and pain - can anyone...

tim86043
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