Patellofemoral Pain Syndrome

Common Symptoms

• Aching pain around or behind the kneecap, often described as diffuse rather than sharply localized
• Pain that worsens with squatting, stairs (especially going down), kneeling, or sitting for long periods with the knee bent
• A sensation of grinding or clicking, sometimes without pain
• Pain that builds gradually with activity rather than appearing suddenly

Why It Happens

The kneecap normally glides in a groove on the thigh bone as the knee bends and straightens. When forces on the kneecap are uneven — due to muscle imbalances (particularly around the hip and the inner thigh muscle), tightness, training errors, or how the leg is aligned — the kneecap can track or load unevenly, irritating the surrounding tissue and cartilage.

Why It Can Become Persistent

Because the underlying issue is usually a movement and loading pattern rather than a single injury, ordinary daily activities (stairs, sitting, walking) tend to keep reproducing the irritation until the contributing strength and movement factors are specifically addressed.

Who Commonly Gets It

Patellofemoral pain syndrome is especially common in runners, in people who do a lot of squatting or stair use, and in adolescents and young adults generally, more often women.

How It Is Usually Diagnosed

Diagnosis is usually clinical, based on the location and pattern of pain and specific exam maneuvers, along with ruling out other causes of anterior knee pain such as patellar tendinopathy. Imaging is not always necessary but may be used if the presentation is atypical or doesn't respond as expected.

Traditional Treatment Options

• Physical therapy: Targeted strengthening — particularly of the hip and the inner quadriceps muscle — and movement retraining is the well-established first-line treatment.
• Activity modification: Temporarily reducing aggravating activities like deep squatting or high-mileage running.
• Taping or bracing: Can provide some symptom relief for certain patients during rehabilitation.
• NSAIDs: Sometimes used short-term for symptom control.

Why Someone Might Start Looking for Another Option

Patellofemoral pain can be slow to resolve, and people sometimes look for additional options alongside physical therapy, including newer research areas like shockwave therapy.

Where Shockwave Therapy May Fit

The evidence here is early: one pilot study combining shockwave therapy with physical therapy found greater pain reduction and improved joint mobility compared with a group receiving conventional electrotherapy, ultrasound, and laser alongside physical therapy. This is a single, smaller study rather than a well-established evidence base — physical therapy focused on hip and quadriceps strengthening remains the primary, better-supported treatment.

How Shockwave Treatment Works for This Area

If considered appropriate, acoustic pressure waves would be applied around the kneecap as an addition to — not instead of — a physical therapy program addressing strength and movement patterns.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation around the kneecap; your provider will discuss what to expect.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not yet had a medical evaluation to distinguish this from patellar tendinopathy or other causes of knee pain
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening
• Active infection, open wounds, or certain bone conditions at the treatment site

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.