Patellofemoral pain exercises
Patellofemoral pain is pain around or behind the kneecap, where it glides in a shallow groove at the end of the thigh bone. The kneecap works as a pulley for the thigh muscles, so a lot of force passes through that small joint every time you bend the knee under load. It is one of the most common knee problems, especially in runners, cyclists and active teenagers.
It almost always builds up gradually rather than starting with an injury. The usual story is a change in training - more mileage, more hills, a new sport, a return after a break - or a spell of far more or far less activity than the knee was used to. Strength and control at the hip and thigh matter as much as anything happening at the knee itself.
The typical picture is an ache at the front of the knee that comes on with running, stairs, squatting, kneeling, or sitting with the knee bent for a long time; a long car journey or the cinema is the classic. Grinding or clicking is common and, on its own, harmless. There may be a little puffiness after a hard session, but the knee does not lock or give way.
Nothing is damaged: the tissue around the kneecap has become overloaded and sensitive, and it settles as capacity is rebuilt. Most people improve over 6 to 12 weeks with consistent strengthening and a sensible return to activity, though it takes longer if the load is not managed. This programme settles the irritation, builds hip and thigh strength so the kneecap is better supported, then gradually rebuilds the activities that set it off.
Who this programme is for
Adults and older teenagers with gradual-onset pain at the front of the knee, worse with loaded knee bending such as stairs, squatting or running, and with no locking or significant swelling. A knee that locks, gives way or swelled rapidly after an injury needs assessment first.
Get urgent help now if
- The area is hot, very swollen and red, especially if you also feel feverish or unwell - go to A&E now, or call NHS 111 straight away if you are not sure where to go. Do not drive yourself if you feel very unwell.
Get checked by a clinician first if
- The knee locks and will not straighten, or catches repeatedly
- Marked swelling, particularly if it came on quickly after an injury
- The knee gives way and collapses under you rather than just feeling weak
- The kneecap has dislocated or partly slipped out of place
- The pain followed a significant accident, fall or direct blow and you have not been checked over
- You feel unwell with the pain - a fever, night sweats, or losing weight without trying
- Pain that is severe, steadily getting worse, or keeps you awake every night and does not ease with a change of position
Not sure it's this? Try a self-check
Quick movement tests you can try at home to see what your symptoms might point towards. A guide, not a diagnosis.
- Single-Leg Decline Squat CheckHow well the knee tolerates load through the kneecap tendon and the front of the knee
The staged programme
Settle the pain
Start here while stairs and squatting are sharply painful. Reduce the aggravating load - for runners that means cutting volume, not necessarily stopping - and use low-load strengthening in a comfortable range.
Build strength
The main phase. Strengthen the hip and thigh two to three times a week, with a particular focus on the gluteal muscles and controlled knee bending through increasing range.
Return to activity
The final stage restores running, jumping and deeper squatting. Progress control drills and load, and rebuild your training volume in gradual steps guided by symptoms.
How long recovery takes
It depends on your condition; your physiotherapist will give you an estimate after your assessment. It can be persistent and prone to flares, so in our plans hip and thigh strength work continues even after it settles. We review your progress regularly and adjust your plan.
Knowing when to progress
Use the 24-hour rule and let symptoms guide running progression: increase distance or intensity, not both at once, and only when the previous level caused no lasting increase in pain. Strengthening should feel like effort in the muscles, not sharp pain at the kneecap.
Common questions
Is my kneecap out of alignment?
Small differences in how the kneecap tracks are common and are usually not the cause. The most useful thing you can change is the strength and control of your hip and thigh muscles and how quickly you load the knee.
Should I stop running?
Usually you can keep running at a reduced volume while you strengthen, as long as pain stays low and settles quickly. A complete break is only needed if even easy running is very painful.
Do knee braces or taping help?
Taping or a simple sleeve can reduce pain for some people in the short term and can help you exercise more comfortably. They work best alongside the strengthening programme, not instead of it.
Why does sitting for a long time make it ache?
Keeping the knee bent for a long period loads the back of the kneecap continuously. Straightening the leg regularly, or standing up now and then, usually eases it.
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