Patellofemoral Pain Syndrome
Expert care for Patellofemoral Pain Syndrome at Gentle Care Chiropractic in West Linn, Oregon.
Understanding Patellofemoral Pain Syndrome
Also known as: PFPS, Runner's Knee, Anterior Knee Pain, Chondromalacia Patella Patellofemoral pain syndrome is pain from the joint between the kneecap (patella) and the groove in the thighbone it slides through. When the patella doesn't track smoothly (because of hip weakness, quad imbalance, foot mechanics, or training errors) the undersurface cartilage becomes irritated. PFPS is the most common cause of knee pain in active adults, and it consistently responds better to addressing the whole kinetic chain than to treating the knee alone. Dull aching around or behind the kneecap, sharper with descending stairs, squatting, or kneeling, and the "theater sign" (pain after sitting with the knee bent for a prolonged period) are characteristic.
Crepitus (grinding or crackling) is common but usually harmless. Female athletes, adolescents during growth spurts, and runners who increase mileage quickly are most at risk. We address every contributor. Patellar and tibiofemoral joint mobilization restores smooth tracking.
Hip and SI adjustments optimize the chain above. The real driver of lasting relief is targeted strengthening of the VMO, gluteus medius, and hip extensors. We release the IT band and lateral retinaculum, apply McConnell or kinesio taping, and prescribe orthotics when overpronation is significant. Running gait retraining and graded return-to-run plans prevent recurrence.
Most patients improve within six to ten weeks. We may recommend: extremity adjustments, mobilization, Graston/IASTM, kinesio taping, corrective exercise, orthotics, ergonomic coaching Seek immediate care if: The knee suddenly gives way with locking, you can't bear weight, or there is significant swelling after trauma.
How We Can Help
At Gentle Care Chiropractic, we take a multi-disciplinary approach, addressing the root cause of your condition, not just the symptoms.
Chiropractic Adjustments
Precise spinal and joint corrections to restore alignment, relieve nerve pressure, and reduce pain. Manual or instrument-assisted based on your needs.
Massage Therapy
Therapeutic massage releases muscle tension, improves circulation to injured tissue, and works synergistically with adjustments for faster recovery.
Physical Rehabilitation
Customized exercise programs strengthen supporting muscles, restore range of motion, and help prevent future flare-ups.
Laser Therapy
Cold laser therapy uses targeted light wavelengths to stimulate cellular healing, reduce inflammation, and relieve deep tissue pain without heat or discomfort.
Electrical Stimulation
E-stim therapy reduces pain and muscle spasm, improves circulation, and supports the healing process. Especially effective for acute injuries.
Personalized Care Plan
Every patient is different. We combine these therapies in a plan tailored to your diagnosis, goals, and lifestyle for the best possible outcome.
Frequently Asked Questions
Common questions about Patellofemoral Pain Syndrome, answered by our team.
Can I keep running with runner's knee, or do I need to stop completely?
Total rest is rarely the right answer. Modifying activity is usually better than stopping: reduce mileage by 30 to 50%, avoid downhills and stairs temporarily, and switch to flatter routes. Cycling and swimming are good substitutes that load the quad without the high patellofemoral stress of running. Most people can maintain some training through recovery — the goal is to keep load below the threshold that provokes pain while building the hip and quad strength that drives long-term resolution.
Why does my knee hurt more going down stairs than up?
Descending stairs requires the quad to work eccentrically (lengthening under load) while the knee is bent, which significantly increases compression between the patella and the femoral groove — sometimes four times body weight. Ascending stairs loads the joint much less. This pattern is nearly diagnostic for patellofemoral syndrome and explains why treatment focuses on building eccentric quad strength gradually, not just general quad size.
What's the difference between runner's knee and chondromalacia patella?
Chondromalacia patella refers specifically to softening or damage of the cartilage on the underside of the kneecap — a structural finding on imaging or scope. Patellofemoral pain syndrome (PFPS) is a clinical diagnosis based on symptoms, and most people who have the pain don't necessarily have cartilage damage. The distinction matters because PFPS responds well to strengthening and biomechanical correction regardless of what the cartilage looks like, and most patients don't need imaging to begin effective treatment.
Will this come back, or can it be fully resolved?
With thorough rehabilitation — particularly addressing hip abductor and VMO weakness plus any foot mechanics issues — the majority of people achieve lasting relief. Long-term studies show around 85% of patients report successful outcomes at 7 years when a structured exercise program is followed. However, the 40% who still have symptoms at one year are typically those who stopped rehab when pain eased rather than completing the strength program. Staying consistent through the pain-free phase is what prevents recurrence.
Does footwear or foot arch affect patellofemoral pain?
Yes, meaningfully. Overpronation (rolling in of the foot) causes internal rotation at the tibia and shifts the knee inward, altering how the patella tracks in its groove. Supportive footwear or a semi-rigid orthotic can reduce this rotational stress at the knee, and several trials show clinically meaningful pain reduction when orthotics are combined with exercise. High arches create their own mechanical pattern. A gait assessment helps determine whether foot mechanics are a significant driver in your specific case.
Ready to Find Relief?
You don't have to live with Patellofemoral Pain Syndrome. Our team at Gentle Care Chiropractic is here to help you recover and get back to doing what you love.