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Patellar Femoral Pain Syndrome

What is it?

Patellar (puh-tell-er) femoral (feh-mer-ull) pain syndrome (sin-drome) is also called patellar femoral stress syndrome or runner's knee. Runner's knee is when the patella (kneecap) rubs against the end of the femur (thigh bone) as the knee moves. This causes pain.


One or more of the following problems may be causing your runner's knee.

  • Weak thigh muscles which normally help keep the knee stable.
  • Tight hamstrings and muscles in the back of the lower leg.
  • Foot pronation (pro-na-shun). This is when the foot rolls inward when walking or running while the front thigh muscles pull the kneecap outward.
  • Kneecap is too high in the knee joint.
  • Tight Achilles tendons.

Signs and symptoms:

You may have one or more of the following symptoms.

  • Pain starts during running. At first the pain is only felt when running downhill. But, later any running and leg movements hurt, especially walking down steps.
  • Swelling under the kneecap.
  • Dull ache in the middle of the knee.
  • Pain with stair climbing or sitting for a long time.


  • The most important part of treating runner's knee is resting your knee while it heals. Resting your knee as much as possible will lessen swelling and keep the problem from getting worse. When the pain decreases, begin normal, slow movements.
  • Ice causes blood vessels to constrict (get small) which helps lessen inflammation (swelling, pain, and redness). Put crushed ice in a plastic bag and cover it with a towel. Put this on your knee for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite.
  • You may use ibuprofen (i-bew-pro-fin) and acetaminophen (uh-c-tuh-min-o-fin) for your pain. These may be bought as over-the-counter medicine. Do not take ibuprofen if you are allergic to aspirin.
  • Your caregiver may want you to go to physical (fiz-ih-kull) therapy. A physical therapist will do treatments to help your knee heal faster. You may be taught exercises to stretch your thigh and calf muscles and tendons to make them stronger.
    • Caregivers may give you special shoe inserts to correct foot pronation. Do not return to running until you are pain-free and your caregiver says it is OK.
    • Caregivers may give you a hard knee sleeve to help support the patella. You may need to wear this knee sleeve during activity for several weeks to months.
    • Avoid bending your knee more than 90°. Try not to go up and down stairs whenever possible.
    • Start exercising when caregivers say that it is OK. Make sure you remain pain-free as you use your leg more.
      • Use high-quality running shoes and replace them often.
      • You will increase to jogging, stationary bicycling, and swimming with time as your pain goes away. When bicycling use the low gears with the seat raised as high as is comfortable. This will avoid excessive bending of the knee.
      • Always do stretching exercises before working out. This will loosen your muscles and lessen stress on your hamstring. Rest between workout programs. Do cool-down exercises after working out.
  • You may need surgery if your runner's knee is very bad and does not heal with other treatments.

Call your caregiver if:

  • Your pain and swelling increase.
  • You have pain in other joints.
  • You have new symptoms.
  • You have a temperature over 100.4° F (38° C).

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.