Knee Pain

Patello – femoral pain syndrome (PFPS)  (pain behind the kneecap)

This is very common problem found across the age spectrum that we see and treat at City Physio.

Pain is thought to arise from uneven surface contact area between the kneecap and the femur – with reduced contact in one area and therefore increase contact and pressure in another leading to pain.

Possible causes:

  • Faulty lower limb alignment caused by muscle imbalances around the pelvis causing the hip to adduct and internally rotates– the appearance of turning inwards towards the other knee. These imbalances may arise from previous injuries and faulty postural habits.
  • The foot may or may not be pronated which may also cause the leg to turn inwards.
  • Both the above may co-exist
  • Tightness of the ITB muscle on the outside of the leg due to sports that cause over activity of this muscle – the ITB is an internal rotator of the hip.


The leg turning inwards has effect of the femur rotating under the kneecap placing it in a tilted position thus causing a decrease in contact on part of the kneecap with the femur and at the same time an increase in contact and pressure on another part.This creates increased friction, which leads to irritation, inflammation and pain and early degenerative changes.


The physiotherapists at City Physio will carefully and thoroughly examine and assess the cause of your problem which may stem from issues such as previous injuries, certain postural types, repetitive faulty movement habits, foot postures and certain types of sports.


At City Physio we follow the current up to date evidence that shows that correction of the lower limb alignment is the most effective strategy. This may include:

  • Release of tight structures
  • Specific strengthening exercises of weak structures
  • Stabilisation exercises directed to where it may be needed which may be the spine, pelvic girdle and or leg
  • Orthotics to help control excessive pronation which may increase the internal rotation of the thigh
  • Correction of faulty movement patterns
  • Correction of poor postural habits