Jump to content

Patellofemoral Pain Syndrome

Original Editor - Kristin Zumo

Top Contributors - Admin, Farrie Bakalli, Quentin Desantoine, Kim Jackson, Lowie Dedoncker, George Prudden, Kristin Zumo, Evan Thomas, Claire Robertson, Ewa Jaraczewska, Rachael Lowe, Kai A. Sigel, Mandy Roscher, Tarina van der Stockt, Jess Bell, Jessica Pun, WikiSysop, Simisola Ajeyalemi, Scott Buxton, Kirianne Vander Velden, Sarah Haerinck, Fasuba Ayobami, Michelle Lee, Saeed Dokhnan, Rucha Gadgil, Wanda van Niekerk, Robin Tacchetti and Stacy Schiurring

Definition/Description

Patellofemoral Pain Syndrome (PFPS) is an umbrella term for pain arising from the patellofemoral joint or adjacent soft tissues. It is a chronic condition that worsens with activities such as squatting, sitting, climbing stairs, and running.[1] [2] The pain can be felt in all aspects of the knee (including the popliteal fossa), and symptoms can develop slowly over time or be brought on acutely.[3]

The differential diagnosis of PFPS includes chondromalacia patellae and patellar tendinopathy. Neither is considered to be under the umbrella term of PFPS, though patients will complain of similar symptoms.[4][5] The pathophysiology is considered different, so there is an alternative treatment.[5]

Clinically Relevant Anatomy

The knee (art. genus) consists of two major joints: the tibiofemoral and patellofemoral. Patellofemoral Pain Syndrome is localised in the patellofemoral joint.

The patellofemoral joint consists of the following:

The patella sits within the femoral trochlear groove; the facies articularis patellae (posterior surface) is covered with articular cartilage that glides over the cartilage of the anterior part of the femoral condyles (trochlear groove). In this synovial joint, movement and gliding create minimal resistance due to the synovial fluid produced by the membrana synovialis (synovial membrane), the internal lining of the joint capsule, during movement. The synovial fluid lubricates the joint and nourishes the articular cartilage of the femur and patella.[6]

The joint capsule provides structural support and contains the synovial fluid. The medial collateral ligament is integrated with the joint capsule. It contributes to medial joint stability, while the lateral collateral ligament remains separate from the capsule as an extra-capsular structure, providing lateral stability.[7]

On the anterior side of the patella, between the patellar tendon (which is attached to the patella) and the skin, there is an extra-articular bursa (bursa prepatellaris). This bursa is usually not in communication with the knee joint capsule and ensures better gliding of structures over the patella. There is a similar bursa (bursa infrapatellaris) at the level of the tibial tuberosity. When irritated or inflamed, these bursae can become swollen and hyperproductive, possibly related to increased anterior knee pain.

The medial and lateral retinaculum provide necessary stabilisation of the patella. These retinacular structures are formed by the medial and lateral patellofemoral ligaments and patellomeniscal ligaments, creating a ligamentous complex that provides medial and lateral support for proper patellar tracking during knee movement.[7]

Epidemiology /Etiology

PFPS can result from patellar trauma, but it is more commonly caused by a combination of several factors (multifactorial aetiology): overuse and overload of the patellofemoral joint, anatomical or biomechanical abnormalities, muscular weakness, imbalance, or dysfunction. PFPS is more likely to be persistent and treatment-resistant when several factors are present simultaneously.[8]

Excessive overload and abnormal tracking of the patella are among the main mechanisms behind PFP symptoms.[9]

One of the primary contributing factors to PFPS is patellar orientation and alignment. When the patella has abnormal alignment, it may track laterally within the trochlear groove of the femur, causing increased stress and pressure on specific areas of the patellofemoral articular cartilage, resulting in pain, discomfort, or irritation. Multiple factors can contribute to these tracking abnormalities.

Patellar orientation varies between individuals and can differ between the left and right knees in the same person due to anatomical variations. [10] Even minor patellar malalignment can contribute to muscular imbalances and biomechanical abnormalities, potentially resulting in PFPS. At the same time, muscular imbalances or biomechanical abnormalities can cause patellar maltracking and provoke PFPS. For example, weakness in the vastus medialis (particularly its oblique fibres) combined with relatively greater lateral forces from the vastus lateralis can contribute to lateral patellar maltracking, including lateral glide, lateral tilt, or excessive lateral pressure. This can cause increased stress on the patella's lateral facet and the trochlear groove's lateral aspect, resulting in pain or discomfort. Medial maltracking is considerably less common. Tightness of the lateral retinaculum is another structure that can contribute to lateral patellar maltracking.

PFPS can also be associated with knee hyperextension, external tibial torsion, genu valgum or varum, increased Q-angle, tightness in the iliotibial band, hamstrings, or gastrocnemius (see Table 1).[11]

Sometimes the pain is localised in the knee, but contributing factors originate elsewhere in the kinetic chain. Pes planus (foot pronation) or pes cavus (foot supination) can contribute to PFPS development. Excessive foot pronation (commonly associated with PFPS) can cause compensatory internal rotation of the tibia and femur, disrupting the patellofemoral mechanism. Foot supination provides less shock absorption when the foot strikes the ground, potentially placing more stress on the patellofemoral joint.

Hip kinematics can also influence knee function and contribute to PFPS. Research has demonstrated that patients with PFPS often display weaker hip abductor and hip external rotator muscles, which are associated with increased hip adduction and internal rotation during dynamic activities such as running.[11]

Table 1. Muscular etiologies of PFPS
Aetiology Pathophysiology
Weakness in the quadriceps It may adversely affect the PF mechanism.

Strengthening is often recommended.

Weakness in the medial quadriceps It allows the patella to track too far laterally.

Strengthening of the VMO is often recommended.

Tight iliotibial band It places excessive lateral force on the patella and can also externally rotate the tibia.

This can lead to excessive lateral tracking of the patella.

Tight hamstrings muscles It places more posterior force on the knee, causing pressure between the patella and the femur to increase.
Weakness of tightness in the hip muscles Dysfunction of the hip external rotators results in compensatory foot pronation.
Tight calf muscles It can lead to compensatory foot pronation and increase the knee's posterior force.

Characteristics/Clinical Presentation

Patellofemoral Pain Syndrome is often suspected when patients describe a gradual, non-traumatic onset of pain, typically localised to the peri-patellar or retropatellar area. This pain can be unilateral or bilateral, sudden or gradual, and is progressive, worsening with joint-loading activities like climbing stairs or running uphill. While patients report pain during walking and weight-bearing (kneeling and squatting), instability is usually absent. During history-taking, healthcare providers should inquire about prior surgeries or trauma to the joint. It's important to note that PFPS is not a self-limiting condition.[12]

Differential Diagnosis

Different diseases can provoke anterior knee pain, without being PFPS:

Diagnostic Procedures

The diagnostic procedure of PFPS should first involve the exclusion of other pathologies. [13] [14] The clinical practice guideline for PFPS published by The American Physical Therapy Association made the following diagnostic criteria: [14]

  1. Presence of retropatellar or peripatellar pain
  2. Reproduction of retropatellar or peripatellar pain during squatting, or other functional activities loading the PFJ in a flexed position
  3. All other conditions that could cause anterior knee pain, such as tibiofemoral pathologies, should be excluded

Outcome Measures

Patient-reported outcome measures (PROMs) for patellofemoral pain syndrome are categorised into four groups: those for anterior knee pain syndrome, patellar instability, other patellofemoral conditions, and non-specific PROMs. These measures are utilised in both research and clinical settings.[15]

Clinicians frequently use the following outcome measures:

Lower Extremity Functional Scale

Anterior Knee Pain Scale (AKPS) (Kujala Score)

Patellofemoral Pain and Osteoarthritis Subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PF)

Visual Analog Scale (VAS)

England and Pierrynowski Questionnaire (EPQ)

Examination

Subjective Examination

The subjective examination is crucial in determining PFPS's root cause and contributing factors.

A thorough subjective examination will allow you to streamline your physical examination and develop an appropriate management plan.

Asking specific questions about the behaviour of symptoms and the history of the condition will help you clinically understand the cause of symptoms and contributing factors.

Identifying intrinsic and extrinsic factors leading to PFPS will guide your treatment plan. The more factors identified in an individual, the more they are correlated with higher levels of pain and functional impairment. [16]

History

A detailed history will give you many clues about PFPS's causes and contributing factors.[13][17][18]

Table 2. Onset of symptoms
Subjective Finding Possible Clinical Reasoning
Insidious Onset Typical of PFPS
Overload event, e.g. excessive stair climbing,

long-distance running

Typical of PFPS
Traumatic incident Unlikely to be PFPS

Pain Behaviour

Anterior knee pain going up and down stairs, pain when sitting with knees flexed and pain with squatting, kneeling or returning from squat all implicate PFPS.[13]

The table below gives an overview of structures to examine depending on which subjective finding is identified. [16][17][18]

Table 3. Pain behaviour
Subjective Findings Possible Clinical Reasoning
Pain when sitting with flexed knee (cinema sign) Tight quadriceps (sitting, they compress the patellofemoral joint)
Pain while sitting with legs crossed Tight iliotibial band (Gluteus maximus and Tensor fasciae latae tightness)
Pain walking downhill Loads the patellofemoral joint
Pain walking uphill
  • Tight Calf muscles
  • Impaired gluteal control
Pain when wearing high heels
  • Increases load on the patellofemoral joint
  • Increases distal instability
Pain when descending stairs
  • Patellofemoral joint surface problems
  • Muscle length issues
  • Eccentric quads function
Pain when ascending stairs Impaired gluteal control
Squat and kneel:
  • Going down into a squat
  • Staying in a crouch position
  • Coming up from squat
  • Eccentric quadriceps
  • Muscle length of the quadriceps
  • Gluteal control
Pain with tight clothing during knee flexion Compressive forces- PFPS
Pain with tight clothing touching/ rubbing skin Possibly chronic pain with sensitisation (Allodynia)

Patterns of Pain

The table below indicates possible reasons for specific pain symptoms:[17][18]

Table 4. Pain pattern
Subjective Finding Possible Clinical Reasoning
Pain only during activity Think biomechanics
Pain only after activity,

especially much later or the next day

Think inflammatory
Pain that improves with exercise Think tendon/ muscle length

Clinical Signs

Cook et al. suggest a positive diagnosis of patellofemoral pain syndrome when the following occur:[13]

  • Both pain on muscle contraction and pain on squatting are present
  • 2 out of 3 of the following are present - pain on muscle contraction/or pain on squatting, and/or pain on palpation
  • 3 out of 3 are present - pain on muscle contraction, pain on squatting and pain on kneeling

Objective Examination

Due to the multifactorial aetiology of PFPS, there are many things to consider, but key areas to look at include:

  • Observation-patella position (eg tilt or lateralised), femoral position, relative muscle bulk, especially gluteals, vasti and calves. Presence of effusion and or Hoffa's fat pad oedema, foot position.
  • Level of hypermobility of tibiofemoral and patellofemoral joints.
  • ROM, especially loss of extension.
  • Single stance-pelvic, femoral, foot control. Excessive use of VL.
  • VMO-ability to fire, firing speed, endurance capability at zero, ten, twenty and thirty degrees of knee F.
  • Gluteals-firing and endurance as abductor and external rotator in different degrees of hip flexion.
  • Muscle length-Modified Thomas test to assess hip flexors, quads and adductors in adduction for TFL. Hamstrings, gastrocnemius, soleus, and gluteus maximus insert into the ITB (adduction in hip flexion).
  • Stair assessment- consider eccentric control, is there excess use of the pelvis or ankle to avoid knee flexion? Can pain be altered by correcting patella/femoral/foot position?
  • Gait and or running: Observing for the presence of early heel rise, level of pelvic and femoral control, scissoring, stride length, trunk flexion.

Medical Management

Onward referral to an orthopaedic consultant should occur in the presence of:

  • History of patella dislocation.
  • Direct blow to the knee and suspicion of patellar fracture or osteochondrosis dissecans (OCD), (pain and or swelling not settling).
  • Repeated subluxing patella not responding to physiotherapy. (May suggest dysplastic PFJ).

Onward referral to a pain specialist should be considered in the presence of central sensitisation not responding to pacing.

Physical Therapy Management

Common interventions for the treatment of PFPS are listed below:

The largest body of evidence supports using exercise therapy to improve pain and function in the short, medium, and long term. International consensus recommends that the combination of hip and knee exercise be used in preference to knee exercise alone. [20][21][22][23][24]

International experts suggest using foot orthoses, patellar taping or manual therapy as adjuncts to exercise therapy. [24][25]

Although current evidence is mixed, gait or running retraining may be considered for PFPS. [24]

Joint mobilisation and electrophysical agents are not recommended for treatment in PFPS. [24]

There is an emerging appreciation of psychosocial pain processing features in PFPS. [26][27] Clinicians may consider strategies that address psychosocial impairments when treating PFPS.

No significant difference was noted in open vs. closed chain exercises concerning functional outcomes. [28]

Exercise Therapy

Strengthening of the Quadriceps is a key in the rehabilitation program[29]

Pain-free exercises are essential when treating PFPS. Isometric exercises while the knee is fully extended (patella has no contact with condyles) can be used at the beginning of the therapy, because they minimise stress on the patellofemoral joint while reinforcing the Quadriceps. For example (exercise): 1. Straight-leg exercise: patient lies on his back, one knee bent at +/- 90° (! pain-free if that knee is affected by PFPS) and foot flat on the ground. The other knee is fully extended. Patient elevates extended leg and holds it for 10 seconds, before relaxing (concentric contraction and/or eccentric contraction is also possible, which makes it dynamic). Ensure the patient keeps a normal lumbar lordosis and does not compensate with his basin. 2. Pillow squeeze exercise. Patient sits comfortably with his trunk supported. Both knees are extended. Place a pillow (or towel) under one knee (that knee might be slightly flexed). Patient tries to push the pillow/towel on the table by extending their knee. (Quadriceps contraction).

Closed kinetic chain exercises (CKC) VS Open kinetic chain (OKC) exercises[30][31]

CKC are more functional than OKC and provoke lower patellofemoral joint stress, particularly in the terminal ranges of full extension (0° to max 40° knee flexion). Therefore, exercises should be practised within this range and be pain-free. Examples of exercises include performing squats. The patient’s knees should not come further than their toes during this exercise. Once his knee passes the toes, the patellofemoral joint stress becomes too high and might provoke pain.

Suppose the patient is unable to tolerate CKC exercises. In that case, OKC exercises might be a viable option because the load can be better controlled than in CKC, as long as the exercises are pain-free. When using OKC exercises, the patient should stay within a pain-free range of motion (ROM) between 40° and 90° knee flexion.

Vastus medialis obliquus (VMO)[30]

Training of the VMO muscle is appropriate in some PFPS patients but not all. Assessment of the VMO should assess firing, cross-sectional muscle mass, endurance capabilities, and ability to fire at different knee angles, and be used functionally. Too much focus on the selective activation of the VMO muscle should be avoided, as there is no evidence to suggest it can be isolated. However, it is essential in guiding the patella into the trochlea, and hence, although it is active through range, its primary role is between zero and thirty degrees flexion. The need for better VMO function is enhanced with trochlea dysplasia, patella alta, medial patellofemoral ligament rupture or when a greater tibial tubercle-trochlear groove distance is present.[32]

The VMO is particularly adversely affected by swelling and or pain. 10ml of fluid will inhibit the VMO, but 40ml will inhibit the VL. Similarly, pain causes VMO delay, and the more pain, the greater the delay. This helps to explain why patients post-trauma and/or surgery, who will often have a joint effusion, are then left with PFPS. It also explains why resolution of an effusion is a primary goal, and avoidance and reduction of pain are also paramount. Painful exercises are a waste of time.

VMO training, although not isolating to the VMO, should be aimed at 0-30 degrees, incorporate endurance holds, and be prescribed with a tonic bias to represent the muscle's postural function.

Research demonstrates that VMO-type exercises will cause an alteration in the VMO fibre angle (relative to the femoral axis). Fibre angles can change from vertical 40 to more medialising 70 degrees.[33]

Hip muscles training[34]

The rehabilitation program for PFPS should also incorporate strengthening exercises of the hip abductors and lateral rotators. It has been proven that the pain during daily activities was lower and functionality was greater when knee exercises were combined with hip exercises. (Tables 1 and 2 + Figure 2 show which exercises were used in the research and proved efficient. Exercises were performed during 4 weeks)

Another research study found that PFPS patients had decreased eccentric hip abduction compared with healthy people. Thus, it is recommended to use eccentric hip abduction strengthening exercises.[30]

Proprioceptive training[35][36]

It has been proven that the proprioceptive quality in the knee of patients with PFPS is decreased. Even with unilateral PFPS, the proprioception is reduced in both knees (pathological and nonpathological knee). Therefore, proprioceptive training (pain-free exercises) of the knee should be part of the rehabilitation program.

Functional strength training (FST)[37]

Functional strength training (FST) improves motor skills and performance by focusing on proprioceptive control and neuromuscular adaptations. It significantly enhances speed, agility, flexibility, cardiorespiratory capacity, endurance, coordination, maximal strength, and explosive power. According to Xiong et al., for patients with Patellofemoral Pain Syndrome (PFPS), functional strength training is more effective than standard strength training in reducing pain and improving knee function. Therefore, it should be a primary consideration when developing exercise therapy programs for this patient population.[37]

Electrotherapy

One of the causes of the PFPS may be neuromuscular imbalance between the VMO and VL due to muscle atrophy of the VMO and excessive/abnormal lateral tracking of the patella, due to the remaining force of the VL. In case of neuromuscular imbalance between the VMO and VL, electrical stimulation of the VMO should be considered to complement the conservative (exercises) therapy, because it is selective and does not stress the patellofemoral joint.[38]

The following is an example of the electrostimulation procedure: [38]

  • The patient sits with the trunk supported. The leg is slightly flexed at the knee, and the lower limb muscles are completely relaxed. The following parameters were used in research (isometric contraction of the VMO):[38]
    • Electrode placement = 1 on the motor point and the other one next to it.
    • Asymmetric bipolar current
    • Pulse width = 0.5 milliseconds
    • Pulse frequency = 50Hz
    • Intensity = max. The patient can endure without pain- Time = 7 minutes => 6 repetitions, on for 6 seconds and off for 12 seconds, and progressed to 30 minutes, 11 repetitions, on for 10 seconds and off for 12 seconds.

VMO and VL Activation Before and After Therapy

The clinician can use EMG feedback to capture the EMG activity of the VMO and VL before and after the therapy. The patient performs the functional test of stair stepping using the limb affected by PFPS. The clinician must be aware that stepping upon a stair can be very painful for patients with PFPS. Once the patient can perform this test pain-free, the clinician uses this evaluation technique.

Testing Procedure: Start with a very low stair, so the compression between the patella and the femur is minimal. The patient faces the stairs in a standing position. They begin the movement by flexing the limb with PFPS, placing it on the first step, and then extending it in a unilateral stance. In a continuous movement, they put the non-affected limb on the second step and finish the stair stepping with full knee extension.[34]

Results: The VMO muscle consumes more energy to perform the test. After therapy, faster and more accurate VMO muscle activation should be observed.

Foot Orthoses

A few clinical predictors can help decide if a patient is more likely to benefit from foot orthoses:[39][40][41]

  • Individuals with PFPS who wear less supportive footwear
  • Individuals who report lower levels of pain
  • Person exhibiting less ankle dorsiflexion range of motion
  • Patient who reports an immediate reduction in pain with foot orthoses when performing a single-leg squat.

Research indicates that prefabricated foot orthoses significantly enhanced functional performance in individuals with PFPS. These improvements may be important to long-term prognosis and prevention of osteoarthritis development for some individuals with PFPS. [42][43]

Resources

Knee Pain and Patello-femoral Pain Injury Rehabilitation Seminar | Feat. Tim Keeley | FILEX

References

  1. ↑ Nascimento LR, Teixeira-Salmela LF, Souza RB, Resende RA. Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2018;48(1):19-31.
  2. ↑ Shi W, Li Y, Xiong B, Du M. Diagnosis of Patellofemoral Pain Syndrome Based on a Multi-Input Convolutional Neural Network With Data Augmentation. Frontiers in Public Health. 2021 Feb 11;9:643191.
  3. ↑ Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019 Sep;49(9):CPG1-CPG95.
  4. ↑ Blazer K. Diagnosis and treatment of patellofemoral pain syndrome in the female adolescent. Physician Assistant. 2003 Sep 1;27(9):23-30.
  5. ↑ 5.0 5.1 Fernández-Cuadros ME, Albaladejo-Florín MJ, Algarra-López R, Pérez-Moro OS. Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non-Randomized Parallel Controlled Trial. Diversity & Equality in Health and Care. 2017 Aug 4;14(4).
  6. ↑ Gupton M, Imonugo O, Black AC, et al. Anatomy, Bony Pelvis and Lower Limb, Knee. [Updated 2023 Nov 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from https://www.ncbi.nlm.nih.gov/books/NBK507893/#:~:text=Synovial%20joints%20are%20freely%20mobile,which%20lines%20the%20articular%20capsule.
  7. ↑ 7.0 7.1 Garza-Borjón A, González-González M, de la Garza-Salazar JF, Simental-Mendía M, Acosta-Olivo C. Understanding the patho-anatomy of patellofemoral pain: A crucial foundation for comprehensive management. Orthop Rev (Pavia). 2024 Nov 23;16:125840.
  8. ↑ Shi BY, Kremen Jr TJ, Sherman SL, Jones KJ. Patellofemoral Disorders. In Orthopaedics and Trauma: Current Concepts and Best Practices 2024 May 4 (pp. 1655-1664). Cham: Springer International Publishing.
  9. ↑ Yang JS, Fredericson M, Choi JH. The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions. Plos one. 2020 Sep 30;15(9):e0239907.
  10. ↑ Saputra A. The Patella: Anatomy, Variations and Clinical Relevance. GALENICAL: Jurnal Kedokteran dan Kesehatan Mahasiswa Malikussaleh. 2025 Feb 25;4(1):144-9.
  11. ↑ 11.0 11.1 Kania V, Mishra N. Association of common intrinsic risk factors in development of patellofemoral pain syndrome. Int. J. Adv. Multidiscip. Res. 2024;11(11):33-43.
  12. ↑ White SC, Temples HS. Patellofemoral Pain Syndrome in Adolescents: Continuing Education for the Primary Care Provider. Journal of Pediatric Health Care. 2025 Jul 1;39(4):686-94.
  13. ↑ 13.0 13.1 13.2 13.3 Cook C, Hegedus E, Hawkins R, Scovell F, Wyland D. Diagnostic accuracy and association to disability of clinical test findings associated with patellofemoral pain syndrome. Physiother Can. 2010 Winter;62(1):17-24.
  14. ↑ 14.0 14.1 Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM, Altman R, Beattie P. Patellofemoral pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association. Journal of Orthopaedic & Sports Physical Therapy. 2019 Sep;49(9):CPG1-95.
  15. ↑ Barroso Rosa S, Grant A, McEwen P. Patient-reported outcome measures for patellofemoral disorders: a systematic review. Archives of Orthopaedic and Trauma Surgery. 2023 Jul;143(7):3919-27.
  16. ↑ 16.0 16.1 Ferrari D, Briani RV, de Oliveira Silva D, Pazzinatto MF, Ferreira AS, Alves N, de Azevedo FM. Higher pain level and lower functional capacity are associated with the number of altered kinematics in women with patellofemoral pain. Gait & posture. 2018 Feb 1;60:268-72.
  17. ↑ 17.0 17.1 17.2 Claire Robertson. Knee Subjective Examination Course Slides. Plus2019
  18. ↑ 18.0 18.1 18.2 Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017 Dec 1;51(24):1713-23
  19. ↑ Winters M, Holden S, Lura CB, Welton NJ, Caldwell DM, Vicenzino BT, Weir A, Rathleff MS. Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med. 2020 Oct 26;55(7):369–77.
  20. ↑ Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Núñez-Nagy S, Pecos-Martín D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. Journal of Physical Therapy Science. 2015;27(7):2387-90.
  21. ↑ Santos TR, Oliveira BA, Ocarino JM, Holt KG, Fonseca ST. A systematic review of the effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients. Brazilian journal of physical therapy. 2015 May;19:167-76.
  22. ↑ Esculier JF, Bouyer LJ, Dubois B, Fremont P, Moore L, McFadyen B, Roy JS. Is combining gait retraining or an exercise programme with education better than treating runners with patellofemoral pain alone? A randomised clinical trial. British journal of sports medicine. 2018 May 1;52(10):659-66.
  23. ↑ Şahin M, Ayhan FF, Borman P, Atasoy H. The effect of hip and knee exercises on pain, function, and strength in patients with patellofemoral pain syndrome: a randomised controlled trial. Turkish journal of medical sciences. 2016 Feb 17;46(2):265-77.
  24. ↑ 24.0 24.1 24.2 24.3 Collins NJ, Barton CJ, Van Middelkoop M, Callaghan MJ, Rathleff MS, Vicenzino BT, Davis IS, Powers CM, Macri EM, Hart HF, de Oliveira Silva D. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. British journal of sports medicine. 2018 Sep 1;52(18):1170-8.
  25. ↑ Jiao H, Tao M, Cui X. Efficacy on pain and knee function of Kinesio taping among patients with patellofemoral pain syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025 Apr 21;26(1):388.
  26. ↑ Maclachlan LR, Matthews M, Hodges PW, Collins NJ, Vicenzino B. The psychological features of patellofemoral pain: a cross-sectional study. Scandinavian journal of pain. 2018 Apr 1;18(2):261-71.
  27. ↑ Crossley KM, van Middelkoop M, Barton CJ, Culvenor AG. Rethinking patellofemoral pain: prevention, management and long-term consequences. Best Practice & Research Clinical Rheumatology. 2019 Feb 1;33(1):48-65.
  28. ↑ Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomised study. The American journal of sports medicine. 2004 Jul;32(5):1122-30.
  29. ↑ Bolgla L, Malone T. Exercise Prescription and Patellofemoral Pain: Evidence for Rehabilitation. Journal of Sport Rehabilitation 2005, 14(1), 72-88.
  30. ↑ 30.0 30.1 30.2 Tang SF, Chen CK, Hsu R, Chou SW, Hong WH, Lew HL. Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study. Arch Phys Med Rehabil. 2001 Oct;82(10):1441-5.
  31. ↑ Irish SE, Millward AJ, Wride J, Haas BM, Shum GL. The effect of closed-kinetic and open-kinetic chain exercises on the muscle activity of vastus medialis oblique and vastus lateralis. J Strength Cond Res. 2010 May;24(5):1256-62.
  32. ↑ Carlson VR, Boden BP, Shen A, Jackson JN, Yao L, Sheehan FT. The Tibial Tubercle-Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions. Am J Sports Med. 2017 Apr;45(5):1110-1116.
  33. ↑ Benjafield AJ, Killingback A, Robertson CJ, Adds PJ. An investigation into the architecture of the vastus medialis oblique muscle in athletic and sedentary individuals: an in vivo ultrasound study. Clin Anat. 2015 Mar;28(2):262-8..
  34. ↑ 34.0 34.1 Nakagawa TH, Muniz TB, Baldon Rde M, Dias Maciel C, de Menezes Reiff RB, Serrão FV. The Effect of additional hip abductor and lateral rotator muscle strengthening in patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehabil. 2008 Dec;22(12):1051-60.
  35. ↑ Akseki D, Akkaya G, Erduran M, Pinar H.Proprioception of the knee joint in patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 2008 Nov-Dec;42(5):316-21.
  36. ↑ D I Clark, N Downing, J Mitchell, L Coulson, E P Syzpryt, M Doherty. Physiotherapy for anterior knee pain: a randomised controlled trial. Ann Rheum Dis 2000;59:700–704.
  37. ↑ 37.0 37.1 Xiong Z, Zheng W, Wang H, Gao Y, Wang C. Effects of functional strength training on pain, function, and lower extremity biomechanics in patients with patellofemoral pain syndrome: a randomised clinical trial. Journal of Orthopaedic Surgery and Research. 2025 Jan 16;20(1):50.
  38. ↑ 38.0 38.1 38.2 Garcia FR, Azevedo FM, Alves N, Carvalho AC, Padovani CR, Negrão Filho RF. Effects of electrical stimulation of vastus medialis obliquus muscle in patients with patellofemoral pain syndrome: an electromyographic analysis. Rev Bras Fisioter, 2010 Nov-Dec;14(6):477-82.
  39. ↑ Barton CJ, Menz HB, Crossley KM. Clinical predictors of foot orthoses efficacy in individuals with patellofemoral pain. Med Sci Sports Exerc. 2011 Sep;43(9):1603-10.
  40. ↑ Barton CJ, Menz HB, Crossley KM. The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome. Br J Sports Med. 2011 Mar;45(3):193-7.
  41. ↑ Barton CJ, Menz HB, Crossley KM. Effects of prefabricated foot orthoses on pain and function in individuals with patellofemoral pain syndrome: a cohort study. Phys Ther Sport. 2011 May;12(2):70-5.
  42. ↑ Simon S, Dully J, Ludwig O, Dindorf C, Bartaguiz E, Fröhlich M, Becker S. Kinematic effects of sensorimotor foot orthoses on the gait of patients with patellofemoral pain—a randomised controlled trial. Frontiers in Sports and Active Living. 2025 Apr 30;7:1546821.
  43. ↑ Callahan EA, Chin KE, Chu SK. Current Evidence of Evaluation and Management of the Athlete with Patellofemoral Pain Syndrome. Current Physical Medicine and Rehabilitation Reports. 2025 Dec;13(1):1-0.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Patellofemoral_Pain_Syndrome&oldid=372564"