Patellofemoral pain is pain around or behind the kneecap, often aggravated by stairs, squats, hills, running, prolonged sitting or sudden changes in training load.

Patellofemoral pain is one of the most common causes of anterior knee pain. It often affects runners, gym users, adolescents, active adults and people returning to activity after a break.

The kneecap joint is sensitive to load. Stairs, hills, squats, lunges and running can increase joint reaction forces. Pain often reflects a mismatch between current tissue capacity and the load being applied.

Assessment considers training history, hip and thigh strength, foot and ankle factors, knee range, swelling and whether another diagnosis is more likely. Treatment usually focuses on progressive strengthening and sensible load modification rather than complete rest.

Common symptoms

  • Pain around or behind the kneecap
  • Pain with stairs, squats, lunges, hills or running
  • Symptoms after prolonged sitting or driving
  • Clicking or creaking that may or may not be painful
Evidence-informed treatment summary

How our treatment options may fit for Patellofemoral Pain

The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.

Foundation

Diagnosis, education and progressive rehabilitation

This is the starting point for most musculoskeletal conditions.

The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.

Evidence is condition-specific; it is not a universal pain treatment.

Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.

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Evidence varies substantially by condition, tissue and preparation method.

PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.

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Best used for specific inflammatory or irritable pain generators, usually for short-term relief.

An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.

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Clinical evidence is still developing and guideline support is limited.

EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.

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Selected cases

Prolotherapy

Evidence is condition-specific and generally less established than exercise-based care.

Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.

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Most relevant when focal myofascial pain is a clear contributor.

Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.

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Relevant only when the history and examination support nerve irritation or entrapment.

Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.

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This is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.

Frequently asked questions

Is clicking in the knee dangerous?
Clicking or creaking is common and not automatically dangerous. It matters more whether it is painful, associated with swelling, locking, instability or loss of function.
What usually causes patellofemoral pain?
It is usually a load-tolerance problem involving the kneecap joint, quadriceps, hip strength, training load, footwear, biomechanics and recovery.
What treatment works best?
Education, load management and progressive strengthening of the quadriceps and hip are central. The plan needs to match the person's activity goals and irritability.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

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