Patellofemoral Pain & Runner’s Knee Physiotherapy in North York & Don Mills

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain refers to pain felt around or behind the patella, or kneecap.

The kneecap sits at the front of the knee and moves within a groove in the femur as the knee bends and straightens.

The patellofemoral joint is exposed to increasing loads during activities such as:

• Stairs
• Squatting
• Running
• Jumping
• Lunging
• Hiking
• Gym exercise

These loads are normal.

Patellofemoral pain can develop when the demands placed on the knee exceed what the person is currently able to tolerate.

The term runner’s knee is commonly used because the condition frequently affects runners, but patellofemoral pain can affect athletes, active adults, adolescents and people who do not run at all.

What Does Patellofemoral Pain Feel Like?

Common symptoms include:

• Pain around the kneecap
• Pain behind the kneecap
• Pain at the front of the knee
• Pain going downstairs
• Pain going upstairs
• Pain with squatting
• Pain with lunges
• Pain during or after running
• Pain after sitting for a long time
• Discomfort kneeling
• Pain with jumping
• Knee stiffness
• Clicking or grinding sensations

Some people describe:

• “Aching under my kneecap”
• “Pain when I walk downstairs”
• “Pain after sitting for too long”
• “Pain when I squat”
• “Pain after I run”

Symptoms often increase when the knee is exposed to repeated or higher-load activities.

What Can Contribute to Patellofemoral Pain?

Patellofemoral pain usually does not have one single cause.

Factors that may contribute include:

• A sudden increase in running distance or frequency
• Increasing hills or speed work
• Increased jumping or sport participation
• Starting a new gym program
• Increasing squat or lunge volume
• Returning to activity after time away
• Reduced current strength or exercise capacity
• Inadequate recovery between training sessions
• Previous knee pain
• Changes in footwear or training environment in some cases

The useful question is usually not:

“What is wrong with my kneecap alignment?”

but rather:

“What activities currently exceed my knee’s capacity, and how can we gradually build that capacity?”

Is Patellofemoral Pain Caused by Poor Kneecap Tracking?

Not necessarily.

Older explanations often attributed patellofemoral pain to:

• Poor kneecap tracking
• Poor knee alignment
• Weak hip muscles
• Knees moving inward
• Flat feet
• Poor running mechanics

These factors may be relevant for some individuals, but no single movement pattern or body characteristic explains patellofemoral pain in everyone.

People naturally move differently from one another.

Your physiotherapist may assess how you squat, run, jump or use stairs when those activities reproduce symptoms, but the goal is not necessarily to make everyone move according to one ideal pattern.

Movement may sometimes be modified if doing so makes an activity more comfortable or allows you to progress rehabilitation.

How Do I Know if My Knee Pain Is Patellofemoral Pain?

Patellofemoral pain is commonly diagnosed clinically based on your symptoms and examination.

Pain is typically located around or behind the kneecap and is aggravated by activities that load the patellofemoral joint, such as:

• Squatting
• Stairs
• Running
• Jumping
• Prolonged sitting

However, front knee pain can have other causes.

These may include:

• Patellar tendinopathy
• Knee osteoarthritis
• Meniscus injury
• Fat-pad irritation
• Quadriceps tendon problems
• Bursitis
• Previous knee trauma
• Other knee conditions

A physiotherapy assessment can help determine which presentation best matches your symptoms.

How Does a Physiotherapist Assess Patellofemoral Pain?

Your physiotherapist will ask about:

• Where you feel pain
• When symptoms began
• Recent changes in exercise or activity
• Running volume
• Sport participation
• Gym training
• Stairs
• Squatting
• Sitting tolerance
• Previous knee injuries
• Your activity goals

Assessment may include:

• Knee movement
• Hip and ankle movement when relevant
• Quadriceps strength
• Hip and leg strength
• Calf strength
• Squatting
• Step-down tasks
• Single-leg activities
• Walking
• Running when appropriate
• Jumping or sport-specific tasks when appropriate

The goal is to understand what currently limits your function and identify an appropriate starting point for rehabilitation.

Can Physiotherapy Help Patellofemoral Pain?

Yes.

Physiotherapy and exercise-based rehabilitation are commonly used to help people with patellofemoral pain improve symptoms and function.

Treatment may help you:

• Improve knee and leg strength
• Increase tolerance for stairs
• Improve squatting capacity
• Return to running
• Return to gym exercise
• Progress sport participation
• Manage training loads
• Increase confidence using the knee

Rehabilitation should be individualized rather than based on one standard exercise program.

How Is Patellofemoral Pain Treated With Physiotherapy?

Education and Activity Management

The first step is often understanding which activities are currently aggravating your knee and how to modify them temporarily without unnecessarily stopping all physical activity.

For example, a runner may temporarily adjust:

• Running distance
• Running frequency
• Hills
• Speed sessions
• Consecutive running days

A gym participant may temporarily adjust:

• Squat depth
• Resistance
• Number of sets
• Lunges
• Step exercises
• Jumping volume

The goal is to find a manageable starting point and then gradually rebuild activity.

Progressive Knee and Leg Strengthening

Progressive exercise is an important part of patellofemoral rehabilitation.

Strengthening may include:

• Quadriceps exercises
• Hip strengthening
• Calf strengthening
• Squats
• Sit-to-stand
• Step-ups
• Step-downs
• Lunges
• Leg press
• Single-leg exercises

The purpose is to increase the physical capacity needed for the activities you want to perform.

Hip Strengthening

Hip exercises are commonly included in patellofemoral rehabilitation.

This does not mean weak hips necessarily caused your knee pain.

Hip strengthening is useful because activities such as:

• Running
• Squatting
• Stairs
• Jumping
• Sport

require coordinated strength through the entire lower limb.

Hip exercises can therefore form part of a broader progressive strengthening program.

Functional Exercise

Rehabilitation should eventually resemble the activities you want to return to.

Depending on your goals, this may include:

• Squats
• Lunges
• Stairs
• Running
• Jumping
• Hiking
• Gym exercise
• Sport-specific drills

Progression is based on tolerance and function rather than simply avoiding any activity that produces knee load.

Running Assessment and Modification

For runners, your physiotherapist may review:

• Current weekly running volume
• Recent mileage changes
• Running frequency
• Hills
• Speed work
• Training recovery
• Running symptoms

In some cases, temporary changes in running strategy may make running more tolerable.

The goal is not necessarily to identify one “correct” running form.

Manual Therapy

Manual therapy may sometimes be used to improve comfort or relevant mobility.

When used, it should generally complement an active program involving exercise, education and progressive return to activity.

What Exercises Help Patellofemoral Pain?

There is no single best exercise for runner’s knee.

Depending on your presentation, exercises may include:

• Sit-to-stand
• Squats
• Wall sits
• Leg press
• Step-ups
• Step-downs
• Split squats
• Lunges
• Knee-extension strengthening
• Hip strengthening
• Calf raises
• Single-leg strengthening

The appropriate starting exercise depends on how irritable your knee is and what you need to return to.

For example, someone whose main goal is walking downstairs may require a different progression from a competitive runner.

Knee Exercise Video Library

What Can I Do at Home for Patellofemoral Pain?

Keep Moving

Completely stopping activity is not always necessary.

Continue activities that are reasonably comfortable while temporarily modifying activities that consistently produce significant symptoms.

Adjust Exercise Rather Than Abandon It

If squatting hurts, you may temporarily adjust:

• Depth
• Weight
• Repetitions
• Exercise variation

If running hurts, you may temporarily adjust:

• Distance
• Speed
• Hills
• Frequency

The goal is usually to modify and rebuild rather than permanently avoid.

Do Your Strengthening Program

Your exercise program should gradually become more challenging as your tolerance improves.

Very gentle exercises may be useful initially, but they should not remain the entire program if your goal is running, gym exercise or sport.

Monitor How Your Knee Responds

Some discomfort during or after exercise may be acceptable depending on the individual.

A substantial increase in symptoms that lasts well beyond the activity may indicate that the current exercise or training load needs adjustment.

Progress Gradually

Avoid making several large training changes at the same time.

Gradually increase the amount, intensity or difficulty of activity.

Should I Rest Patellofemoral Pain?

Complete rest is usually not necessary.

A short period of modifying irritating activity may be useful when symptoms are highly aggravated.

For example, you may temporarily reduce:

• Running volume
• Hills
• Jumping
• Deep squatting
• High-volume lunges

At the same time, other activities and strengthening exercises can often continue.

The aim is to maintain activity while creating enough tolerance to progressively return to what you want to do.

Why Does My Knee Hurt Going Downstairs?

Going downstairs places substantial demand on the quadriceps and patellofemoral joint.

When the knee is sensitive, this can produce pain around or behind the kneecap.

Rehabilitation may include:

• Quadriceps strengthening
• Step-down exercises
• Hip and leg strengthening
• Gradual stair exposure

The goal is to build the capacity required for stairs rather than permanently avoiding them.

Why Does My Knee Hurt When I Squat?

Squatting increases load through the patellofemoral joint as the knee bends.

That does not mean squatting is damaging your knee.

If squatting is painful, your physiotherapist may temporarily modify:

• Squat depth
• Resistance
• Repetition volume
• Foot position
• Exercise variation

As knee tolerance improves, squatting can often be progressively rebuilt.

Why Does My Knee Hurt After Sitting for a Long Time?

Patellofemoral pain is sometimes associated with discomfort after prolonged sitting with the knee bent.

People may experience aching around or behind the kneecap when:

• Sitting at a desk
• Driving
• Sitting in a theatre
• Travelling

Changing position or straightening the knee periodically may help.

You do not need to maintain one perfect sitting posture.

Is Clicking or Grinding in My Knee Dangerous?

Clicking, popping or grinding around the kneecap is common.

These sounds are sometimes called crepitus.

Noise by itself does not necessarily indicate knee damage.

If clicking is accompanied by significant pain, swelling, locking or a traumatic injury, further assessment may be appropriate.

Otherwise, treatment is generally guided more by symptoms and function than by noise alone.

Is Running Bad for Patellofemoral Pain?

Not necessarily.

Many runners with patellofemoral pain can continue some running while modifying training.

Others may need a temporary reduction depending on symptom severity.

Running rehabilitation may involve adjusting:

• Distance
• Frequency
• Pace
• Hills
• Speed training
• Recovery days

As strength and tolerance improve, running can be gradually progressed.

Sports Injury Physiotherapy

Can I Keep Going to the Gym With Runner’s Knee?

Often, yes.

Gym exercise can be a useful part of rehabilitation.

Exercises may temporarily need modification based on symptoms, but stopping all leg exercise is usually unnecessary.

Your physiotherapist can help adjust:

• Squats
• Lunges
• Leg press
• Step exercises
• Knee-extension exercises
• Cardiovascular exercise

and progressively increase them as your knee becomes more tolerant.

Do I Need to Strengthen My Hips?

Hip strengthening is commonly included in patellofemoral rehabilitation and can be useful.

However, this does not mean your knee pain exists because your hips are “too weak” or because your knee is misaligned.

Hip exercises are one component of an overall lower-limb strengthening program.

For most people, quadriceps and knee-focused strengthening remain important as well.

Can Taping Help Patellofemoral Pain?

Patellar taping may help some people temporarily reduce pain during activities such as:

• Stairs
• Squatting
• Exercise

If it makes exercise more comfortable, taping can sometimes be used as a short-term adjunct while strength and activity tolerance improve.

It should not replace progressive rehabilitation.

Do Knee Braces Help Patellofemoral Pain?

Some people report temporary comfort from a knee sleeve or brace.

However, a brace is not required for everyone with patellofemoral pain.

If used, it should generally support rather than replace exercise and gradual return to activity.

Can Foot Orthotics Help Runner’s Knee?

Foot orthoses may be helpful for some people with patellofemoral pain, particularly when they provide a noticeable improvement in comfort during walking, running or exercise.

They are not necessary for every patient.

If foot mechanics, footwear or orthotic assessment appears relevant, Physiomobility’s Chiropody & Orthotics service can complement physiotherapy.

Orthotics

Is Patellofemoral Pain the Same as Patellar Tendonitis?

No.

Patellofemoral pain is usually felt around or behind the kneecap.

Patellar tendinopathy, sometimes called jumper’s knee or patellar tendonitis, more commonly causes localized pain in the tendon just below the kneecap.

Both can hurt during squatting, running or jumping, so examination can help differentiate them.

Patellar Tendinopathy / Patellar Tendonitis

Is Runner’s Knee the Same as Knee Arthritis?

No.

Patellofemoral pain commonly affects adolescents, younger adults, runners and active people, although it can occur at any age.

Knee osteoarthritis involves degenerative changes within the knee joint and more commonly affects middle-aged and older adults.

If your main concern is osteoarthritis or general knee pain, visit our Knee Pain & Arthritis Physiotherapy page.

Knee Pain & Arthritis Physiotherapy

Do I Need an X-Ray or MRI for Patellofemoral Pain?

Patellofemoral pain can often be diagnosed clinically without imaging.

Imaging may be considered when:

• Symptoms followed significant trauma
• There is substantial swelling
• The knee locks
• Another condition is suspected
• Symptoms are unusual
• Symptoms are not progressing as expected
• Imaging would change management

MRI findings should always be interpreted together with symptoms and physical examination.

How Long Does Patellofemoral Pain Take to Improve?

Recovery varies.

Some people improve relatively quickly after adjusting training and starting exercise, while others with longer-lasting symptoms may require a more gradual rehabilitation period.

Factors that may influence progression include:

• Duration of symptoms
• Current activity level
• Training demands
• Exercise capacity
• Rehabilitation consistency
• Sport requirements

Useful signs of improvement include:

• Easier stairs
• Better squat tolerance
• Longer walking tolerance
• Increased strength
• Increased running tolerance
• Greater exercise participation
• Less interference with daily activities

Progress is more useful than trying to predict one exact recovery date.

When Should Front Knee Pain Be Medically Assessed?

Further medical assessment may be appropriate if you experience:

• Significant knee trauma
• Inability to bear weight
• Major or rapidly increasing swelling
• A knee that is locked and cannot fully bend or straighten
• Obvious deformity
• Repeated episodes of the knee giving way
• Fever or feeling systemically unwell
• Severe unexplained pain

Your physiotherapist can recommend additional medical assessment when your history or examination suggests it is needed.

Patellofemoral Pain & Runner’s Knee Physiotherapy at Physiomobility

At Physiomobility Health Group in CF Shops at Don Mills, physiotherapy for patellofemoral pain is focused on helping you gradually rebuild the capacity required for everyday activity, running, exercise and sport.

Rehabilitation may include:

• Education and activity modification
• Quadriceps strengthening
• Hip and leg strengthening
• Progressive squatting and step exercises
• Running rehabilitation
• Functional exercise
• Sport-specific progression
• Taping when appropriate
• Manual therapy as an adjunct
• Home exercise and self-management

Patients can also use Physiomobility’s Knee Exercise Video Library to support exercises selected for their individual rehabilitation program.

If you are a runner or athlete, our Sports Injury Physiotherapy service can also support later-stage running and sport-specific rehabilitation.

Physiomobility is a multidisciplinary clinic, and other services may complement care when appropriate. For patellofemoral pain, physiotherapy, progressive exercise, appropriate activity management and gradual return to activity remain central to our approach.

If pain around your kneecap is limiting stairs, squatting, running or exercise, our physiotherapists can assess your knee and develop a rehabilitation plan based on your current function and goals.

Physiomobility Health Group
CF Shops at Don Mills
6 Maginn Mews, Suite 211
North York, Ontario M3C 0G9

Book a Patellofemoral Pain Physiotherapy Assessment