Why Patellofemoral joint syndrome (PFJS) keeps coming back
Do you experience knee pain when walking down stairs, squatting or sitting too long?
Patellofemoral joint syndrome is one of the most frequent causes of pain around or behind the kneecap.
This guide explains why it happens, what actually works to fix it and how physiotherapy helps you recover in the long term.
TL;DR: PFJS| The key takeaways
- Pain around or behind the kneecap is common and treatable
- PFJS is usually due to poor load management and patella mis-alignment
- Strengthening the hips, thighs and calves is key
- Rest alone doesn’t fix the patellofemoral joint syndrome
- Physiotherapy provides long-term solutions by addressing the underlying biomechanics
What is Patellofemoral joint syndrome?
Patellofemoral joint syndrome (PFJS), often called patellofemoral pain or runner’s knee, refers to pain around or behind the kneecap (patella).
It usually shows up when the kneecap doesn’t move smoothly in its groove at the front of the thigh bone (femur). As a result, the joint gets overloaded, pressure is distributed unevenly and results in pain.
Think of the kneecap like a train on tracks. If the tracks aren’t aligned or the wheels pulls unevenly, the ride becomes rough.
Common Symptoms of Patellofemoral Joint Syndrome
You may notice:
Pain at the front of the knee
Discomfort when walking downstairs
Pain during squats, lunges, or running
Aching after sitting for long periods (movie-theatre sign)
Clicking or grinding sensations (not always painful)
Pain often builds slowly rather than after one big injury.
What Causes PFJS?
PFJS is rarely caused by one thing and is usually a load-management and biomechanics problem.
Poor Patella Tracking
If the kneecap shifts slightly off-centre during movement, pressure increases on part of the joint.
Hip and Thigh Weakness
Weak glutes and quads change how force travels through the knee.
The knee often cops the load for deficits at the hip and/or ankle.
Foot and Ankle Mechanics
Flat feet, stiff ankles, or poor foot control can rotate the leg inward, pulling the kneecap off line.
Training Errors
Sudden increase in running or gym load
Too many hills or stairs
Not enough recovery time
Prolonged Sitting
Long hours sitting, especially with knees bent, can cause the knees to feel stiff and sensitise the joint over time.
Is PFJS the Same as Chondromalacia?
They’re often confused.
PFJS refers to pain and function of the knee
Chondromalacia describes cartilage changes under the kneecap
You can have PFJS without cartilage damage. You can also have cartilage changes and no pain.
It is important to remember that pain does not always equal damage.
How Do Physios Diagnose Patellofemoral Joint Syndrome?
PFJS is a clinical diagnosis and rarely requires x-rays or scans.
A physiotherapist will assess:
Hip, knee, and ankle strength
Movement patterns (squat, step-down, walking, running)
Joint mobility
Training load and daily habits
Scans are only useful if symptoms don’t improve or if red flags are present.
What is the best Treatment for Patellofemoral Joint Syndrome?
Reduce Tissue tightness (Fast pain reduction)
- Hands-on treatments such as dry needling or shockwave therapy
- Remedial massage (hips, ITB, quads, calves) to restore optimal muscle function
- Used early in the treatment process to settle pain and improve mobility
Education and Load Management
Reduce aggravating activities temporarily
Modify (not stop) activities
Learn which movements help vs flare symptoms
Pain settles when load matches tissue capacity
Strengthening the Right Areas
Glute strength (hip control)
Quadriceps strength (especially knee control)
Calf strength and ankle mobility
- Foot posture and joint mechanics (flat feet, high arches)
Core stability
Exercises are progressed gradually and tailored to your sport or lifestyle requirements
Improving Movement Patterns
- How you move matters
Squat and lunge mechanics (neuromuscular training)
Running gait (for runners)
Stair and sit-to-stand technique
Small changes can significantly reduce joint stress.
Taping or Bracing (Short-Term)
- Off-load and reposition the kneecap
Reduce pain
Improve confidence during movement
- It’s a support tool, not a cure
Footwear and Orthotics (When Needed)
Some people benefit from:
Supportive shoes
Temporary orthotics
This is case-by-case, not a blanket solution
What About Rest, Ice or Injections?
Complete rest usually delays recovery and can cause secondary changes (joint stiffness, muscle weakness)
Ice can be used for natural short-term pain relief but doesn’t fix the cause
- In our experience, heat therapy works better than ice as it helps reduce stiffness as well as pain
Cortisone injections are rarely recommended for PFJS (like many other conditions e.g. hip bursitis)
Long-term improvement comes from strength and movement, not passive treatments alone.
How Long Does Patellofemoral Joint Syndrome Take to Heal?
Most people improve within 6–12 weeks with consistent physiotherapy however pain can significantly improve within a couple of weeks with manual therapy techniques.
Recovery typically depends on:
How long symptoms have been present
Training load history
Adherence to exercises
Addressing the real drivers of pain
Chronic cases can still improve they just need more patience and a more gradual return to full activities.
Can You Keep Running or Training With PFJS?
In the vast majority of cases, yes you can keep running or training with patellofemoral joint syndrome.
The goal is always load management and not avoidance.
Any pain or discomfort you experience should remain at a manageable level (e.g. 5/10) and settle within 24 hours.
Our physiotherapists will guide:
How much to train
What to change
When to progress
When Should You See a Physio?
You should book in with a physio if:
Pain lasts more than 2–3 weeks
Stairs or daily tasks hurt
Symptoms keep returning
You’ve tried rest with no improvement
- Early intervention prevents chronic knee pain and secondary compensations (e.g. altered gait)
FAQs
Is PFJS the same as runner’s knee
Yes. PFJS and runner’s knee are often used to describe the same condition, especially in active people and runners.
Can physiotherapy fix patellofemoral pain?
Yes, in most cases.
Physiotherapy focuses on strengthening, movement correction, and load management to reduce stress on the kneecap and improve long-term knee health.
Do knee braces or taping help PFJS?
Tape and braces can help in the short-term by reducing pain and improving confidence during activities however they do not fix the underlying cause.
The best way to fix PFJS is to address the biomechanical issues and imbalances around the foot/ankle, knee and hips.
Can PFJS lead to arthritis?
PFJS itself does not automatically lead to arthritis. Ongoing pain usually reflects load and movement issues rather than joint damage.
If left untreated, the cartilage under the kneecap can wear faster and increase the risk of developing osteoarthritis in later life.
Next Steps: Get your knee pain sorted
PFJS doesn’t usually fix itself.
The longer it lingers, the more it limits training, work, and daily life.
A physiotherapy assessment can identify why your kneecap is overloaded and what needs to change. With the right plan, most people return to pain-free movement without giving up the activities they enjoy.
Your next step is simple:
Get a clear diagnosis
Understand what’s driving your knee pain
Follow a targeted rehab plan that actually works
👉 Book an appointment with our physiotherapists today and take control of your knee pain before it becomes a long-term issue.
Early treatment means faster recovery and better results.
References
Collins, N.J., et al. (2018). Exercise therapy for patellofemoral pain. British Journal of Sports Medicine, 52(18), 1170–1178. https://bjsm.bmj.com/content/52/18/1170
