Going down the stairs, getting up after a long film or squatting to pick something up, and there it is, an ache around or behind your kneecap. Patellofemoral pain is one of the most common types of knee pain, especially in active people. It can be frustrating, but it usually responds well to the right changes and exercises.

What patellofemoral pain is

Your kneecap sits in a groove at the front of your thigh bone. When you bend and straighten your knee, it glides up and down in this groove. Patellofemoral pain is pain around or behind the kneecap, usually when the knee is bent under load.

It often develops when the knee is asked to do more than it can comfortably handle, like a jump in running, more stairs or squats, a new sport or a return to activity after a break. It is common, and research suggests it affects around one in five people each year.

Patellofemoral pain is not a sign that your knee is wearing out or damaged. It usually means the tissues around the kneecap have become sensitive.

What tends to bring it on

Patellofemoral pain often flares with:

• Going down stairs or walking downhill.
• Squatting, kneeling or lunging.
• Sitting for a long time with your knees bent.
• Running, jumping and sports with lots of changes of direction.

Noticing which activities bring on your pain helps you know what to adjust. Pain can come and go, and it is common for it to feel worse after a busy week or a long day of sitting. That does not mean the knee has been damaged.

Stairs, sitting and squatting

Some changes that can help while it settles:

• Take stairs one at a time, leading with your stronger leg going up and your sorer leg going down.
• Hold the banister for support.
• When sitting for a long time, straighten your legs every so often, or sit with your knees less bent.
• Squat to a box or chair to control the depth.
• Kneel on a cushion if you need to get down to the floor.
• In the cinema, on a plane or in meetings, an aisle seat lets you stretch your leg out.

Strengthening

Strength work is one of the most effective ways to ease patellofemoral pain. Research suggests that combining hip and knee strengthening works better than knee exercises alone. Something to try two or three times a week:

• Sit to stand or box squats, lowering slowly.
• Bridges. Lie on your back with your knees bent, lift your hips, then lower slowly.
• Side-lying leg lifts. Lie on your side and slowly lift your top leg, then lower.
• Wall sits. Lean against a wall with your knees bent to a comfortable angle and hold for 30 seconds.
• Step-ups onto a low step.

If you would like to follow along, VIDA has short videos of sit to stands and bridges you can use at your own pace. Start with a comfortable range and build up over weeks. Holds like wall sits often feel more comfortable when the knee is sore, so they are a good place to start.

If you have been given exercises by a physiotherapist, keep following those.

Managing activity

Most people do not need to stop being active. Adjusting what you do for a while tends to help more than stopping. Some ideas:

• Reduce running distance, or swap some runs for cycling or swimming.
• Choose flatter routes, as downhill running loads the front of the knee most.
• Swap forward lunges for reverse lunges, which usually put less load on the front of the knee.
• Build back up gradually, changing one thing at a time.

A mild ache that settles by the next morning is usually fine. If your knee is sorer the next day, ease back a little.

Footwear

Supportive, cushioned shoes can help, especially for walking and running. Some people find shoe inserts helpful in the short term.

When to get it checked

If your knee regularly locks or gives way, it is worth speaking to your GP or a physiotherapist.

Your VIDA pain check-in can help you notice how your knee responds as you build strength.

What to take away

• Patellofemoral pain is common and usually responds well to the right changes.
• It is not a sign that your knee is wearing out.
• Take stairs one at a time and straighten your legs when sitting.
• Strengthen both your hips and knees two or three times a week.
• Adjust activity rather than stopping completely.

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