Patellofemoral pain syndrome (PFPS) is characterized by pain in the front region of the knee, around the patella (kneecap), and is often described as stabbing, aching, and/or burning—especially during movements that increase pressure between the femur and patella. Common aggravating activities include prolonged sitting, transitioning from sitting to standing, climbing or descending stairs, kneeling, squatting, running on hills or uneven surfaces, and jumping or other high-impact movements. In moderate to severe cases, PFPS can make even simple tasks painful and frustrating, potentially leading to increased sedentary behavior, muscle deconditioning, and secondary mental health concerns.

Although PFPS can occasionally arise from a specific incident—such as a fall, jump, or direct trauma to the kneecap—it often develops gradually. The prevailing theory is that most cases stem from repetitive stress combined with faulty movement patterns, which over time overload the patellofemoral joint. These abnormal mechanics may result from misalignments, imbalances, or injuries affecting the bones, muscles, joints, or soft tissues of the knee. Over time, poor biomechanics increase localized stress and may lead to irritation or pain around the kneecap.

Importantly, PFPS may also originate from dysfunction elsewhere in the kinetic chain. Contributing factors include improper running mechanics (such as overstriding or heel striking), foot and ankle issues like pes planus (flat feet), or excessive pronation, as well as weakness or imbalances in the hips. Pelvic instability or tilt and core weakness can also alter lower limb alignment, further increasing stress on the patellofemoral joint. Even a slight increase in tissue load over time—especially in the context of repetitive movements and insufficient recovery—can lead to microtrauma and eventual pain.

When a patient presents for chiropractic care with suspected PFPS, a thorough history and physical examination are essential to rule out other causes of anterior knee pain, such as chondromalacia patella, runner’s knee, jumper’s knee, bursitis, or osteoarthritis. These conditions may co-occur with PFPS and require concurrent management to ensure the best clinical outcome. Assessment of the entire kinetic chain—including the feet, ankles, hips, pelvis, and core—is crucial to identify biomechanical contributors that may place undue stress on the knee.

Once contributing factors are identified, treatment is typically multimodal, incorporating manual therapies to restore normal joint motion (especially in the knee, hip, and ankle); in-office physiotherapy modalities; therapeutic exercises to strengthen weak muscle groups and/or stretch tight muscles; and activity modification to reduce load on the patellofemoral joint during recovery. A comprehensive, individualized approach is key to reducing symptoms, restoring function, and preventing recurrence.