Patellofemoral knee pain can cause aching, stiffness, or discomfort around the kneecap, often worse with stairs, squatting, kneeling, running, or prolonged sitting.
Pain around the kneecap can make everyday activities like walking, climbing stairs, or squatting uncomfortable. Dr. Siefferman discusses the causes of patellofemoral pain and treatment options to improve movement and reduce discomfort.
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Hi, I’m Dr. Jason Siefferman, Medical Director at Manhattan Pain Medicine. Patellofemoral knee pain occurs when the patella, or the kneecap, starts tracking laterally and rubs up against the femoral condyle of the knee. Let me visualize this for you. So, if this is the knee, the kneecap is here. This generally happens with genu valgum, which is where the tibia comes out laterally. As it comes out laterally, what this does is it alters the line between the femur and the foot so that the direct line between the hip and the foot actually comes lateral to the knee joint. So because of that biomechanical line, the kneecap gets pulled laterally. And now the kneecap is meant to move in a groove.
There’s a groove along the condyle inside the knee here. As it gets pulled laterally, it rubs up against the edge of that groove. Because it does this over time, there’s wear and tear to the cartilage. Chondromalacia patella is another name for the same situation. This is a situation where we have to address the mechanics of the knee. If we just put steroid in it or hyaluronic acid and we don’t actually fix the mechanics, it’s not going to get any better. Even a knee replacement, if the mechanics are not addressed, can still have patellofemoral pain syndrome. We look to understand why this is occurring. Why is there some valgum at the knee? How do we address that? How do we fix that? And then we try to get the knee functional again.
Patellofemoral knee pain is pain around or behind the kneecap, also called the patella. It is often referred to as patellofemoral pain syndrome or runner’s knee.
Symptoms may worsen with stairs, squatting, kneeling, running, jumping, standing after sitting, or sitting with the knee bent for a long time. Mayo Clinic describes patellofemoral pain as dull, aching pain in the front of the knee that may increase with stairs, kneeling, squatting, or prolonged sitting.
Because similar symptoms can come from arthritis, meniscal tears, tendon pain, patellar instability, hip mechanics, hypermobility, or referred pain, evaluation should focus on why the kneecap region is painful.
At Manhattan Pain Medicine, evaluation begins by identifying why the front of the knee hurts, rather than treating patellofemoral pain as one simple diagnosis. For patients looking for patellofemoral pain treatment in Manhattan, MPM evaluates kneecap tracking, cartilage irritation, tendon and soft tissue overload, arthritis, hip mechanics, gait, strength, instability, hypermobility, EDS-related laxity, and referred pain from the hip or spine.
Care may include movement-based treatment, diagnostic ultrasound when appropriate, ultrasound-guided injections, PRP, BMAC, prolotherapy, hyaluronic acid viscosupplementation, and orthopedic referral when clinically needed.
Patellofemoral knee pain is common, but it should not be treated as a generic exercise problem. Pain around the kneecap may involve patellar tracking, cartilage irritation, quadriceps and hip coordination, tendon overload, joint alignment, hypermobility, instability, arthritis, or referred pain from the hip or spine. AAOS describes patellofemoral pain syndrome as pain in the front of the knee and around the kneecap, often called runner’s knee, and notes that it can affect athletes and nonathletes.
MPM’s diagnosis-first approach asks what is actually driving the pain. A patient with patellar instability and EDS may need a different plan than a runner with load-related symptoms, a patient with patellofemoral arthritis, or someone with knee pain referred from another source. Treatment should match the pain generator, not just the location of pain.
Patellofemoral knee pain fits within MPM’s Musculoskeletal issues Zone of Expertise, with important overlap in Hypermobility when EDS, ligamentous laxity, patellar tracking problems, or recurrent instability are present. This matters because kneecap pain may reflect more than simple overuse.
A patient may have patellofemoral pain syndrome, chondromalacia, patellofemoral arthritis, tendon irritation, meniscal symptoms, hip mechanics, spine referral, or hypermobility-related instability. MPM uses the Zones of Expertise framework to evaluate whether symptoms are tracking-related, cartilage-related, tendon-related, arthritic, instability-related, referred, or mixed. This helps guide whether the next step should be movement retraining, bracing, diagnostic ultrasound, injection, regenerative discussion, or orthopedic referral.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
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This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
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Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
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Dr. Siefferman is a genius. He is very informed and listens attentively.
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Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
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Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
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Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
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Patellofemoral knee pain is pain around or behind the kneecap, often called patellofemoral pain syndrome or runner’s knee. It is a pain pattern, not always a complete diagnosis. The pain may come from patellar tracking, cartilage irritation, muscle coordination, tendon or soft tissue overload, activity changes, hypermobility, instability, or joint mechanics. AAOS describes patellofemoral pain syndrome as front-of-knee pain around the kneecap that can affect athletes and nonathletes. (OrthoInfo) MPM evaluates why the kneecap region is painful before recommending treatment.
Patellofemoral pain often feels like dull, aching pain in the front of the knee, under the kneecap, or around the kneecap. It may worsen with stairs, squatting, kneeling, running, jumping, standing after sitting, or sitting with the knee bent for a long time. Cleveland Clinic describes front-of-knee pain as the most common symptom and notes that pain may worsen with squatting, stairs, standing after prolonged sitting, increased activity, or changes in training surface or shoes. (Cleveland Clinic) Some patients also notice popping, cracking, stiffness, or a sense of instability.
Patellofemoral knee pain may be caused by patellar tracking problems, muscle imbalance, hip and quadriceps coordination issues, overuse, rapid activity changes, cartilage irritation, joint alignment, tendon overload, hypermobility, instability, or prior injury. In some patients, symptoms are related to running, jumping, stairs, squatting, or prolonged sitting. In others, the pain is influenced by EDS, ligamentous laxity, patellofemoral arthritis, or referred pain from the hip or spine. Because the causes vary, treatment should be based on the patient’s specific mechanics, symptoms, and exam findings.
No. Patellofemoral pain syndrome is not the same as arthritis. Patellofemoral pain usually describes pain around or behind the kneecap that may relate to tracking, load, movement mechanics, soft tissue overload, or nervous system sensitivity. Patellofemoral arthritis involves joint cartilage degeneration or arthritic change in the kneecap joint. The two can overlap, especially when cartilage irritation or chondromalacia is present. MPM evaluates whether symptoms appear mechanical, arthritic, instability-related, tendon-related, referred, or mixed before recommending treatment.
Patellofemoral pain is diagnosed through medical history, physical examination, movement assessment, patellar tracking evaluation, hip and knee strength testing, gait review, and assessment of symptoms during activities such as squatting, stairs, sitting, or kneeling. Imaging may be reviewed when symptoms persist, follow injury, or suggest arthritis, cartilage injury, meniscal tear, tendon pathology, or another condition. Diagnostic ultrasound may help evaluate selected soft tissue findings or guide injections, but it is not required for every patient. Diagnosis-first care helps separate kneecap pain from meniscal, tendon, arthritic, hip, or spine-related pain.
Yes. Hypermobility and Ehlers-Danlos syndrome may contribute to kneecap pain when ligamentous laxity affects patellar tracking, joint stability, or load control. Patients may feel that the kneecap shifts, slides, gives way, or becomes irritated with stairs, squatting, running, or prolonged sitting. Hypermobility-related knee pain may also involve muscle guarding, fatigue, recurrent sprains, tendon irritation, and chronic pain sensitivity. MPM evaluates patellofemoral pain in the context of the whole movement system, especially when instability, repeated injury, or EDS-related symptoms are present.
Treatment depends on the pain driver. Many patients begin with activity modification, targeted hip and quadriceps strengthening, movement retraining, gradual return to activity, bracing or taping when appropriate, and load management. AAFP’s summary of clinical practice guidance notes that combined hip and quadriceps exercises reduce pain and improve function in patellofemoral pain. (AAFP) In selected cases, MPM may consider diagnostic ultrasound, ultrasound-guided injections, PRP, BMAC, prolotherapy, hyaluronic acid viscosupplementation, or orthopedic referral. These options should be individualized and not used as automatic treatment for every case.
PRP, BMAC, prolotherapy, and hyaluronic acid viscosupplementation may be considered only in selected cases after the diagnosis, anatomy, cartilage status, instability pattern, symptoms, risks, goals, and evidence are reviewed. They should not be presented as guaranteed cartilage repair, improved tracking, or a way to avoid surgery in every case. A randomized trial found that a single hyaluronic acid injection had no clinically meaningful effect on pain or function for patellofemoral pain in that study, so hyaluronic acid should be discussed cautiously and diagnosis-specifically. (Sage Journals)
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Patellofemoral knee pain refers to pain around or behind the kneecap. It is commonly called patellofemoral pain syndrome or runner’s knee. The patellofemoral joint is where the kneecap, or patella, moves along the groove at the end of the thighbone. When this area becomes irritated, patients may feel pain in the front of the knee, under the kneecap, around the kneecap, or sometimes along the sides of the knee.
Patellofemoral pain often feels like dull, aching pain in the front of the knee that may worsen with stairs, kneeling, squatting, or prolonged sitting with the knee bent. AAOS also notes that symptoms may occur with climbing stairs, running, jumping, squatting, prolonged sitting, changes in activity, or popping and crackling when climbing stairs or standing after sitting.
Patellofemoral pain can happen for several reasons. The kneecap may not track smoothly. The muscles around the hip and thigh may not coordinate load well. The cartilage under the kneecap may be irritated. Tendons or soft tissues around the knee may be overloaded. Training changes, stairs, running, jumping, kneeling, squatting, or prolonged sitting may trigger symptoms.
In some patients, patellofemoral pain is related to hypermobility or EDS. Ligamentous laxity can affect kneecap tracking and stability. The kneecap may feel like it shifts, slides, or gives way. Muscles may guard to create stability, which can create pain, fatigue, and altered movement. In these cases, treatment often needs to focus on stability and control rather than generic stretching or high-volume exercise alone.
Front-of-knee pain is not always patellofemoral pain syndrome. Similar symptoms can come from patellofemoral arthritis, patellar tendinopathy, quadriceps tendinopathy, meniscal tears, ligament injury, bursitis, referred hip pain, lumbar spine referral, inflammatory arthritis, or peripheral nerve irritation.
A patient with pain while squatting may have patellofemoral irritation, but they may also have a meniscal tear, tendon pain, hip mechanics issue, or arthritis. A patient with clicking may have benign crepitus, patellar tracking irritation, cartilage changes, or meniscal symptoms. A patient with swelling after activity may need evaluation for intra-articular knee pathology rather than assuming runner’s knee.
MPM begins with a detailed history and physical examination. The clinician reviews where pain occurs, what activities provoke it, whether there is swelling, whether the knee feels unstable, whether symptoms started after injury, and whether prior physical therapy, bracing, injections, or imaging helped.
The exam may assess patellar tracking, tenderness, range of motion, strength, hip control, quadriceps function, gait, foot mechanics, squat mechanics, and signs of hypermobility. Imaging may be reviewed when available. Diagnostic ultrasound may be used when it can help evaluate selected soft tissue structures or guide a procedure. MRI or X-ray may be considered when symptoms suggest arthritis, cartilage injury, meniscal tear, instability, or another structural problem.
Treatment should match the cause. Many patients begin with activity modification, temporary reduction of painful movements, targeted strengthening, movement retraining, and gradual return to activity. Hip and quadriceps strengthening are commonly used in patellofemoral pain care.
Bracing or taping may help selected patients when patellar tracking or instability contributes. Patients with hypermobility may need a stabilization-focused plan. Patients whose pain flares with standard therapy may need slower pacing, different exercise selection, or evaluation for another pain generator.
Injections are not first-line or automatic for every patient with patellofemoral pain. They may be considered when the pain generator is clearer, conservative care has not been sufficient, or diagnostic clarification is needed. Ultrasound-guided injections may help improve precision for selected targets. Steroid injections, hyaluronic acid viscosupplementation, PRP, BMAC, or prolotherapy may be discussed only when the diagnosis, anatomy, cartilage status, symptoms, risks, goals, and evidence support them.
Hyaluronic acid should be discussed carefully in this condition. One randomized trial found that a single hyaluronic acid injection had no clinically meaningful effect on pain or function in patients with patellofemoral pain. Other cartilage-related knee conditions may have different evidence, so treatment should be diagnosis-specific.
Most patellofemoral pain is managed without surgery, but orthopedic referral may be appropriate when symptoms persist despite appropriate care, when instability is recurrent, when there is patellar dislocation, when imaging suggests structural cartilage injury, or when mechanical symptoms such as locking or significant catching are present. Referral may also be needed after trauma, major swelling, inability to bear weight, or rapidly worsening function.
Patellofemoral knee pain should be evaluated when pain persists, worsens, limits walking or activity, causes swelling, instability, catching, locking, inability to fully straighten the knee, or follows trauma. Patients should seek timely or urgent evaluation for inability to bear weight, major swelling after injury, fever, redness, calf swelling, visible deformity, new weakness or numbness, loss of pulses, or rapidly worsening pain.
MPM approaches patellofemoral pain through a diagnosis-first, function-focused model. The evaluation considers patellar tracking, cartilage irritation, tendon overload, arthritis, hypermobility, EDS, kneecap instability, hip mechanics, spine referral, meniscal symptoms, and chronic musculoskeletal pain contributors.
For patients looking for patellofemoral pain treatment in Manhattan, MPM offers a careful pain medicine perspective that can work alongside physical therapy, orthopedics, sports medicine, and rehabilitation. The goal is to identify why the kneecap region is painful, match treatment to the actual driver, and build a plan that supports function, confidence, and long-term knee tolerance.
