This page is awaiting validation. It does not replace a consultation or a programme adapted to your situation.
What does the kneecap do?
The kneecap is a small bone at the front of the knee. It moves within an area of the thigh bone and helps the quadriceps, the muscle at the front of the thigh, work. Contact between kneecap and thigh bone receives different loads depending on the movement, knee bend and effort required.
Patellofemoral pain means pain around or behind the kneecap, often during activities that load a bent knee. The term alone does not mean cartilage is damaged or a bone needs putting back into place. Kneecap dislocation and patellar tendinopathy are different situations.
Understand the picture
Understanding the front of the knee
Quadriceps
This muscle helps straighten the knee.
Kneecap and thigh bone
Their contact accompanies bending.
Activity
Difficulty depends on the movement, duration and load.
How does the pain appear?
It may occur going downstairs, running, squatting or sitting for a long time with the knee bent. Sometimes it is spread out and hard to point to with one finger. A cracking sound may accompany movement without proving a new injury.
Discomfort varies with activity and recovery. A task that is comfortable one day may be harder after a busy week. Marked swelling, true locking, a kneecap moving out of place or sudden pain after a blow should not automatically be put in this category.
Why might it start?
An increase in running, jumping, stairs or sports sessions may exceed your current capacity. Strength, recovery and movement habits can contribute. However, there is not always one identifiable cause, and pain can affect people who do little sport.
Leg shape, a shoe or a detail of posture cannot explain every case. Assessment looks for factors that can usefully be changed. It should avoid making you watch every step as if your knee were fragile. Sleep and worries can also change how symptoms affect you.
Chapter sources [1]
What happens during assessment?
The professional asks which activities trigger pain and how your load has changed. They observe useful movements, strength around the knee and hip, and sometimes walking or running. They may adapt a movement to see whether it becomes more comfortable.
Examination also checks other causes of pain at the front of the knee. MRI is not automatically necessary when the history and examination fit and there are no unusual signs. It may be discussed if another injury is suspected or progress needs review. An image does not replace this reasoning.
When should you seek prompt medical advice?
A red, hot and swollen knee, particularly with fever, needs assessment the same day. After an injury, deformity, inability to bear weight or lasting locking needs urgent help. Do not put a visibly displaced kneecap back yourself.
Also seek advice for repeated giving way, marked swelling or worsening despite adjustments. These signs may require a different assessment. The Warning signs page distinguishes emergencies from situations needing a prompt appointment. In an emergency in Luxembourg, call 112.
Which treatments have the best support?
The 2024 best practice guide puts knee-targeted exercise, sometimes combined with hip work, and education at the centre of care. Education means understanding symptoms, load and progression. Exercises are chosen according to your limitations and goals, not only the diagnosis name.
Taping, prefabricated insoles or a change in running may help some people as additions. Their value should be checked in a specific task. They are not essential for everyone and do not prove that poor alignment was the only cause. Passive approaches do not replace active progression.
Chapter sources [1]
How can strengthening start without a flare-up?
Your physiotherapist may change range, resistance, repetitions or support. Rising from a high chair may be more accessible than a deep squat. In other situations, a hip exercise may make starting easier. The right entry point depends on your response, not a compulsory list.
The Exercises page explains general movements and their limits. For patellofemoral pain, the dose needs to suit your current sensitivity. Mild discomfort that settles differs from increasing pain with swelling or worsening the next day. Note this response and adjust with your professional.
In everyday life
Make stairs more manageable
Reduce difficulty
Use the handrail and a comfortable pace.
Build capacity
Practise a suitable strengthening variation.
Return to the task
Gradually reintroduce necessary trips.
How can you adapt stairs, desk work and journeys?
Use a handrail on stairs and temporarily avoid unnecessary trips up and down. You may slow down or spread tasks out during a sensitive period. The aim remains to regain this ability, not to ban stairs. If the knee gives way, have it assessed before repeatedly trying again.
At a desk or during travel, changing the knee angle and standing when possible may help. Choose a stable chair at a height that makes getting up easier. These are practical trials; no single sitting position guarantees freedom from pain. Look for an option you can actually use.
How can you return to running or jumping?
Temporarily reducing volume may allow you to remain active. The route, downhill sections, speed and closely spaced sessions affect difficulty. Choose a starting point with your physiotherapist and keep some variables steady to understand the knee’s response.
Then increase one component at a time. Alternating walking and running may be a step, without a universal duration. Changes to cadence or technique should follow assessment; they are not a compulsory correction for every runner. Tolerance afterwards and the next day matters as much as the session itself.
Chapter sources [1]
How long does it take, and when should you review?
Progress often develops over several weeks and may take longer when symptoms are longstanding. Improvement is not always steady. Patellofemoral pain can persist, so promising that it will disappear in a few sessions would be misleading.
Track concrete markers: easier stairs, better sitting tolerance or a return to running. Agree on a review point. If nothing changes despite following a suitable programme, reconsider the diagnosis, total load and barriers. Unusual worsening warrants advice before the planned review.
Chapter sources [1]
Your questions
Is this the same as chondromalacia?
Not necessarily. Patellofemoral pain describes a clinical presentation; chondromalacia describes a cartilage change. Words in a report do not by themselves explain your pain or determine care.
Chapter sources [2]
Must I stop all squats?
Not automatically. Depth, load and repetitions can be adapted. A painful squat is not a test to repeat for reassurance. A professional can help you find a variation you tolerate.
Chapter sources [1]
Are insoles essential?
No. They may be tried in some people to make an activity easier, but do not replace exercise. Judge their usefulness by a concrete benefit, not the idea that every foot should have the same shape.
Chapter sources [1]
Sources and references
- [1] Neal et al. — Best practice guide for patellofemoral pain (2024)
- [2] IQWiG — Vorderer Knieschmerz
- [3] HAS — Pertinence de l’imagerie en cas de gonalgie chez l’adulte
- [4] Assurance Maladie — Douleurs du genou : que faire et quand consulter ?
- [5] NHS — Dislocated kneecap
- [6] NHS inform — Exercises for knee problems
- [7] AAOS OrthoInfo — Osgood-Schlatter Disease
- [8] CGDIS — 112 Luxembourg
Text updated on
Medical review: awaiting Hasib Selimovic.