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Patellofemoral pain:
symptoms, what it means, and practical next steps

Front of knee or “behind the kneecap” pain is one of the most common knee issues in active adults.

 

Patellofemoral pain (sometimes called “runner’s knee”) often is aggravated by climbing stairs, hills, squats, or after long periods of sitting, and can make everyday things feel much harder than they should.

 

This page walks you through what patellofemoral pain typically looks like, why it happens, when imaging is useful (and when it isn’t), and what usually helps it settle. It’s designed for adults 45–70 in Camberwell and Melbourne’s inner east who want clear information and a sensible plan.

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What you’ll learn on this page

  • How to recognise typical patellofemoral pain patterns

  • When it’s reasonable to see a physio or consider a scan

  • Practical ways to start easing kneecap pain in daily life

Typical symptoms & patterns

​People with patellofemoral pain often describe: 

  • Aching or sharp pain around or behind the kneecap (rather than one tiny point)

  • Pain going downstairs or downhill, often worse than going up

  • Discomfort with squats, lunges, kneeling, or step-ups

  • A “movie-theatre sign” – the knee aches after prolonged sitting or driving, especially when you stand up again

  • Pain with running, especially on hills or when your training load has jumped

  • Symptoms that warm up a little with movement, then return if you overdo it

  • Occasional grinding, clicking, or crackling around the kneecap – often noisy but not necessarily dangerous in itself

 

You don’t have to tick every box to have patellofemoral pain. Some people mainly notice trouble with stairs; others feel it more with sitting or running.

Why it happens

​​Your kneecap (patella) sits in a groove at the end of your thigh bone and acts like a pulley for your quadriceps. When you bend your knee under load, the pressure between the kneecap and the groove increases. In patellofemoral pain, that joint becomes sensitive to this load.

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Common contributors include:

  • Sudden changes in load – big jumps in steps, hills, squats, or running volume

  • Reduced hip and thigh strength, so the knee tracks or loads less efficiently under load

  • Technique factors such as very long steps downhill, knees collapsing inward, or heavy, slow landings

  • Previous pain or injury, which can alter how the muscles around the hip and knee fire and share load

 

It’s important to know: patellofemoral pain is about a sensitive joint, not “kneecap wearing away overnight”. Many people improve well with a combination of education, exercise, and small technique changes.

When to see someone – and when to scan

​When to see a physio

It’s reasonable to book a physio review if:

  • Your kneecap pain has lasted more than a few weeks

  • Stairs, hills, or squats are becoming harder to manage

  • You’ve already tried simple load changes and it’s not improving

  • You’re avoiding activities you used to enjoy because of your knee

 

When scans may be considered

Guidelines generally don’t recommend routine scans (X-ray or MRI) as a first step for typical patellofemoral pain without red flags.

 

Imaging may be considered if:

  • There was a significant trauma (fall, twist, direct blow)

  • The knee is locking, giving way, or getting stuck

  • There is significant swelling, red flags for infection, or a history of inflammatory disease

  • Your symptoms don’t improve despite a good period of appropriate rehab

 

Even when scans show things like cartilage changes or “chondromalacia”, treatment is still driven by symptoms and function, not the scan alone.

 

If you’re unsure whether a scan is appropriate, a hip and knee physio can assess your pattern and communicate with your GP or specialist if imaging is needed.

How we assess & plan at The Hip and Knee Physio (Camberwell)

​In your first consultation, we’ll typically:

  • Talk through your story – where the pain is, what brings it on, what you’ve tried so far, and what you want to get back to

  • Check how your hip and knee move under load – stairs, squats, step-downs, and walking or jogging patterns, within your tolerance

  • Test strength and control around the hip, knee, and ankle

  • Screen for other causes of front-of-knee pain (like fat pad irritation, tendon issues, or arthritis) and for any red flags that might need GP or specialist input

 

From there, you’ll leave with:

  • A clear explanation of what’s most likely driving your pain

  • A prioritised plan (not a long list of exercises) focused on load tweaks, key strength work, and technique changes

  • An idea of what progress might look like over the coming weeks, acknowledging that everyone responds at a different pace

 

If scans or a surgical opinion are appropriate, we’ll discuss that openly and liaise with your GP or orthopaedic specialist.

 

You can read more about broader knee care on the Knee Physiotherapy page and related blogs, then come back here when you’re ready to book.

FAQs – Patellofemoral pain

​1. Why does going down stairs hurt more than going up?

Going down stairs or hills increases the load between your kneecap and thigh bone because your knee is bent and controlling your body weight as you lower yourself. That higher compressive load can be more provocative in patellofemoral pain, which is why “down” often feels worse than “up”.

 

2. Do I need a scan for kneecap pain?

Most people with typical patellofemoral pain don’t need a scan straight away. Clinical guidelines suggest starting with a thorough assessment, education, and exercise unless there are red flags such as major trauma, locking, large swelling, or failure to improve over time.

 

3. What’s the difference between patellofemoral pain and fat pad irritation?

Both cause pain at the front of the knee, but:

  • Patellofemoral pain is usually more diffuse around or behind the kneecap, and often flares with stairs, hills, squats, or sitting.

  • Infrapatellar fat pad irritation tends to be more pinpoint just below the kneecap, and often worsens with knee locking, hyperextension, or straight-knee landings.

 

It’s common for people to be unsure which pattern fits. Part of your assessment is teasing these apart and tailoring treatment accordingly.

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4. Can I keep walking or doing Pilates with patellofemoral pain?

In many cases, yes – staying active within your tolerance is encouraged, as long as the activity isn’t consistently flaring symptoms for hours or days afterwards.

We’ll help you adjust the dose, pace, and your technique so that walking, Pilates, or gym work supports your recovery instead of constantly poking the sore area.

Local practicals – Camberwell clinic

​The Hip and Knee Physio consults from 1/3 Prospect Hill Road, Camberwell, a short walk from Camberwell Junction and public transport. The building offers good access and facilities, including accessible entry and amenities, and there is parking available nearby.

Book Now

If front of knee pain is starting to limit your walking, stairs, or confidence, a structured assessment can help you understand what’s going on and what to do next.

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  • Book a patellofemoral pain consult in Camberwell – Book Now Hip and Knee Physio

  • Prefer to talk first? You can contact the clinic to discuss whether an appointment is appropriate for your situation

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