The biggest secret of knee cap pain revealed

Have you had knee pain that just needed a couple of days rest? Lots of acute injuries will resolve on their own, unfortunately for those that suffer with ‘patellofemoral pain’ (pain under the kneecap), this will not likely be the case. Although there are definite gaps in our knowledge of this condition, if you have it, it would be in your best interest to get it seen to. I know I sound morbid, but let me spell out what we know, and what can be done for you. My goal is that you walk away better informed.

What is ‘patellofemoral pain’

It’s a very vague term used to describe pain around or behind the knee cap. If you have pain in this area, and your knee hurts when you put load through the knee, then you qualify. As you can see this definition would cover other things as well, like knee arthritis, so you do need to rule out other conditions first.

We don’t know much about what causes this knee pain, except that females are almost twice as likely to suffer from it. Traditionally, patellofemoral pain was thought to be an ‘overuse’ injury, however now this is debated because undertraining can sometimes lead to this knee pain!

So, what’s the big secret???

We used to think that this condition would eventually fix itself, like some other knee injuries. We are now beginning to understand that we were wrong in our assumptions, and this condition does not get better on its own. In fact, this condition has the potential to stay over your lifetime and could eventually link with arthritis under the kneecap. That is why it is important to recognise your symptoms earlier rather than later and seek appropriate treatment.

How can we fix this?

When treating patellofemoral pain, the evidence will suggest adopting a shotgun approach. We know it’s more effective to target both hip strength and leg strength than just focusing on the quads. If possible, you will need to reduce the load going through your knee. We also know that orthotics can be beneficial for a couple of months pain relief, whilst you get your exercise routine sorted.

Strengthening the leg

I want to show you an exercise I would recommend, to help you get started on being pain-free. As the evidence would suggest, hip strength is a great place to start. There are many ways to target hip strength, I would advocate for starting by isolating your gluteus medius. For this I recommend weighted side leg raises. For this exercise you lay on your side with body and legs straight, have some weight on your ankle, then lift your leg upwards to the roof. Slowly lower it and repeat 8 times. I recommend three sets every second day. For further instructions please check out Click Physio’s YouTube channel here.

Reducing the load

The key to managing patellofemoral pain is to decrease the load going through the front of the knee. There are certain activities which load the knee more than others. Deep squatting is certainly one culprit where there is increased load. I’ll talk on this subject in detail another time, but for now if you love squatting and suffer patellofemoral pain, then I would recommend you try front squats. This will help reduce some load on the knee.

Sport can be hard on those joints as well, and unfortunately, we all love it! I believe that sport is important and good for you, but if this knee pain is limiting you, there are certain sports that may suit better than others. It would be prudent to avoid sports that include excessive jumping or running/cutting across hard surfaces as these will load up that knee joint. These sports include volleyball, netball, basketball etc. Other sports, like ones on a field, at least have some cushioning for those poor knees. Alternatively, you could become the next Australian swimmer gold medallist!

Did somebody say custom orthotics??

No, no-one said custom orthotics, because they don’t work any better that your off-the-shelf orthotics from the shops. We know that if it fits and is comfortable, then it has the same chance of working as any custom orthotics! You can thank me later for saving you $600+.

In a nutshell…

Patellofemoral pain needs to be treated and it will take work until you see results. Click Physiotherapy is more than equipped to help you on this journey if you need that extra hand. Remember this pain won’t fix itself so stay on top of it!


Crossley KM, van Middelkoop M, Callaghan MJ, et al 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) Br J Sports Med 2016;50:844-852.

Barton CJ, Lack S, Hemmings S, et al The Best Practice Guide to Conservative Management of Patellofemoral Pain: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med 2015;49:923-934.