Upon Further Review: Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) accounts for about 25% of all knee injuries and is the most common reason for knee pain when running. The patellofemoral joint is the joint made up of your knee cap and your femur that slides below it. Patellofemoral pain syndrome is a broad term meaning pain coming from under and around your knee cap, otherwise referred to as anterior knee pain. Many important studies have been published on PFPS in the past 5 years, making this topic the next perfect topic to address in our “upon further review” series to see what we have been missing when it comes to PFPS.

There have been several theories on why certain people are susceptible to PFPS, all mostly looking at the knee and muscles around the knee. While these theories hold some water, they do not explain the whole story. With the advent of new technology we have been able to better track the movements and traits of the human body. It has been found that people with PFPS tend to let their femur and knee fall into a “knock kneed” position (referred to as knee valgus) during activity, which causes increased stress under the knee cap. This movement pattern is caused by weakness and poor timing of the hip muscles, specifically the gluteus maximus and gluteus medius.1 Over-using your knee while having this pattern of movement is thought to be the recipe for developing PFPS.

Knee PainAfter the importance of the hip muscles was realized strengthening and training of the hip muscles was researched and was found to be more effective than other strategies in the treatment of PFPS.2,3 Bingo! If you are suffering from PFPS there is hope and oddly enough the answer may lie more at what is going on at your hips then at your knees. There are other exercises, stretching, and modalities that are likely to be important in the treatment of your specific condition but don’t miss the important contribution of gluteus maximus and medius strengthening in patellofemoral pain syndrome.

While the importance of gluteus maximus and medius strength has become apparent in recent years in regards to PFPS, their importance goes far beyond PFPS. This is because the hip is the gateway between the upper and lower body and because the hip is a ball and socket joint (a joint with many possible movements). These two factors mean weakness and poor muscle timing around the hip can create unwanted stress at many parts of the body. From low back pain, to IT band pain, to hip pain, to ACL injuries, to stress fractures, to shin splints, to plantar fasciitis, to poor balance – a lot of it can all be traced back to problems with your muscles around your hips. There are many exercises you can do to train and strengthen you gluteus maximus and medius, some better than others. Check out our Build a Better Body Series for the how to in how to strengthen these muscles on your own, or better yet, talk to your physical therapist to learn which exercise would be beneficial for you.


1. Willson, John D., et al. "Gluteal muscle activation during running in females with and without patellofemoral pain syndrome." Clinical Biomechanics 26.7(2011):735-740.

2. Khayambashi, Khalil, et al. "Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: A comparative control trial." Archives of Physical Medicine and Rehabilitation 95.5(2014):900-907.

3. Fukuda, Thiago Yukio, et al. "Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: A randomized controlled clinical trial." Journal of Orthopaedic & Sports Physical Therapy 40.11(2010):736-742.