Patellofemoral Syndrome

Pain at the front of the knee can be particularly frustrating because the knee may look completely normal from the outside. You may be comfortable walking on level ground but find stairs, squatting, running or simply getting up from a chair increasingly painful. One common cause of this pattern of symptoms is patellofemoral pain syndrome, sometimes described as anterior knee pain.

The patella, or kneecap, normally glides smoothly within a shallow groove at the end of the thigh bone whenever we bend and straighten the knee. Patellofemoral pain develops when the structures around this joint become irritated or when the forces passing between the kneecap and the thigh bone are no longer distributed comfortably.

There is rarely one single cause. Muscle weakness or imbalance around the hip and thigh, changes in the way the kneecap moves, overtraining, running, repetitive jumping, previous injury or suddenly increasing physical activity can all contribute. In some patients, underlying cartilage changes or early osteoarthritis within the patellofemoral joint may also play a role.

A typical symptom is a dull or aching pain around or behind the kneecap. Stairs—particularly walking downstairs—may become uncomfortable, and squatting, kneeling or exercising can aggravate the symptoms. Some patients notice clicking or grinding from the knee, while others develop discomfort after sitting with the knee bent for a long period, sometimes called the “cinema sign”.

Importantly, clicking or grinding does not necessarily mean that the knee is being damaged. The key is understanding why your particular knee hurts.

Getting the mechanics right

For most patients, rehabilitation is the most important treatment.

A carefully designed physiotherapy programme can strengthen the quadriceps, hip and gluteal muscles, improve control of the kneecap and address movement patterns that are placing excessive stress through the joint. Changes to training, footwear, activity levels and weight management where appropriate can also make a substantial difference.

Rather than simply advising patients to stop exercising, the aim is usually to find a way of keeping you active while gradually rebuilding the capacity of the knee.

Image-guided injections

When pain remains troublesome despite appropriate rehabilitation, further assessment may identify a specific structure that could benefit from an injection.

Where there is significant inflammation or associated arthritic change, an ultrasound-guided or X-ray-guided knee injection may occasionally be appropriate. Image guidance allows treatment to be delivered accurately to the intended part of the joint.

For selected patients with appropriate cartilage or musculoskeletal pathology, Platelet-Rich Plasma (PRP) may also be discussed. This involves concentrating platelets from your own blood and injecting them into the affected area with the aim of supporting the body’s natural healing response. The potential benefits, limitations and available evidence should always be considered carefully before proceeding.

Radiofrequency treatment for persistent knee pain

Patellofemoral pain in a younger or active patient is generally treated through rehabilitation rather than nerve treatment. However, some patients develop more advanced patellofemoral osteoarthritis or persistent knee pain that continues despite conservative treatment.

In carefully selected cases, diagnostic blocks of the small sensory nerves carrying pain signals from the knee can be performed. If these provide significant temporary relief, radiofrequency treatment of the genicular nerves may be considered to provide longer-lasting pain reduction.

This treatment does not repair cartilage or alter the mechanics of the kneecap. Its purpose is to reduce pain sufficiently to allow greater movement, rehabilitation and participation in everyday activities.

Finding the right treatment for your knee

One of the most important aspects of treating anterior knee pain is recognising that an injection is not always the answer. A runner who has developed symptoms after rapidly increasing training requires a very different approach from somebody with established patellofemoral osteoarthritis.

My role as a Pain Specialist is to establish what is driving your symptoms, understand what you want to get back to doing and then select treatment accordingly.

Whether your goal is returning to running, getting back to the gym, climbing stairs comfortably or simply walking without constantly thinking about your knee, the objective is to reduce pain while restoring strength, movement and confidence. By combining accurate diagnosis, appropriate rehabilitation and carefully selected image-guided procedures when necessary, we can develop a treatment plan specifically for you.