Patellofemoral joint pain/anterior knee pain

Patellofemoral pain can also be known as anterior knee pain. This is a very common condition and does not usually come as a result from a significant injury or trauma. It usually starts at a low level and can progress over a few days, weeks or months as aggravating activities continue. There are many structures around the front of the knee that can be involved and there can be more than one structure involved at a time.


Anyone can develop patellofemoral joint pain. It is more common in women and people aged 20-30 years old.

This condition can come on after a sudden increase in exercise, either intensity or duration, or as a result of overloading the knee over a long period of time. For example it can be common among people who run on a regular basis earning the name “runners knee”.

Muscle tightness or weakness around your hip and knee can contribute to this condition, as can altered foot posture such as having flat feet.

All of these things can change the way your knee moves putting extra strain around the front of the knee and causing pain.

Common symptoms

  • The usual symptom is a dull, aching type pain, generally felt around the front of the knee and sometimes at the back of the knee cap.
  • The pain usually gets worse the longer you continue to do the aggravating activity
  • Pain when deep squatting
  • Pain on walking up or down slopes or stairs
  • Pain when standing up after a period of time sitting down
  • Some people get a clicking or grinding noise when they bend or straighten the knee. This is not causing damage to your knee joint and it is important to keep moving to improve your symptoms.

Pain relief

  • An ice pack can help relieve pain and swelling but be careful not to put ice directly on your skin – wrap them with a tea towel or cover.
  • Over the counter painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. A short course of anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.

Activity modification

  • If you have recently increased your level of activity significantly it may be that you have overloaded your knee and allowing it a period of rest will help to settle the pain.
  • After an initial rest period, it is important to build up your activity levels on a gradual basis to avoid the same thing happening again.

Weight management

  • If you are overweight, load through your knee is increased and therefore may make symptoms worse. Aiming for a healthy weight may help to manage your symptoms.


  • A change of footwear is recommended after you have run 300 miles in your current pair. If you have altered foot mechanics it might be worth getting custom made trainers or insoles to put in your usual trainers. Please see the “Foot and Ankle” page for further information regarding appropriate footwear Foot & Ankle – msk (


Exercises to improve movement and strength in your knee are the main form of treatment for this condition, starting off with gentle exercises and increasing the load as you get stronger will help to build muscle strength and reduce the pain in your knee

Experiencig some pain during the exercises is normal and should settle down relatively quickly (within 2 -3 hours) after stopping the exercise. If you notice your pain continuing longer than this it might be the exercise needs adjusting or stopping all together.

Try the exercises below to start to improve the movement and strength in the knee

Balance exercise

These exercises are to improve and regain your balance.

Start with the first exercise on the left;

  • Put your feet one in front of the other as if standing on a tightrope

Once this gets easier progress onto the photo on the right;

  • Stand on one leg and trying to balance.

Strengthening exercise in lying

Using a pillow or a rolled towel under you knee, tighten your thigh muscles to straighten your knee pushing into the towel, this will lift your heel off the bed. Slowly lower heel down to the bed again and repeat.

Strengthening in standing

Loop a resistance band around your knee and a table leg or solid support in front of you. Start with a bent knee and then straighten the knee against the band. Hold for 10 seconds. Slowly release the knee back to bent position and repeat.

Chair squat

Sit on the edge of the chair and without using your hands, push with your legs to stand up, slowly lower your bottom back to the seat.

Wall squat

Once the chair squat exercise gets easier, progress onto a standing wall squat.

  • Rest your back against the wall
  • Slide it down so that your knees bend
  • Straighten your knees and slide back up to standing.

Front of thigh stretch

Stand with the foot of the leg you wish to stretch held in your hand, or resting on a chair behind you. Pull in your stomach so your belly button moves up towards your nose and tuck your bottom under. Feel the stretch in the front of your thigh. You should not feel pain in your knee. If you do, try:

  • placing more weight on your standing leg
  • changing the amount of bend in the knee (more or less), or by using a chair to put your foot on behind you

Hamstring Stretch

Lie on your back. Bend the hip of the side to be stretched to 90 degrees, until the knee points to the ceiling.

  • Hold behind your thigh with both hands.
  • Keeping your thigh and back still, straighten your knee.
  • Feel the stretch in the back of your thigh.

Your opposite leg can be slightly bent or straight.