Patellofemoral Pain Syndrome: Causes and Treatment

Abstract

The knee is a vital joint that carries our weight, allows movement, and keeps us active every day. However, improper alignment, weak muscles, or overuse can lead to Patellofemoral Pain Syndrome (PFPS), a common source of front-knee pain. Focusing on strengthening exercises, supportive therapies, and proper biomechanics can relieve pain, improve function, and keep the knee healthy for the long run. One study reported that 10% of competitive swimmers experienced PFPS, while another observed that 42% of state-level cyclists in India were affected by this condition. In Ayurveda,  Patellofemoral Pain Syndrome is correlated with Janu-Sandhigata Vata (Knee osteoarthritis). Various formulations and therapies in Ayurveda are beneficial in this and ensures overall joint health.

What is Patellofemoral Pain Syndrome (Runner’s Knee)

The term “patellofemoral” refers to the joint formed between the kneecap (patella) and the thigh bone (femur). Patellofemoral Pain Syndrome (PFPS) is a knee disorder causing pain in or around the kneecap (patella), which usually intensifies during activities that bend or load the knee, such as running, squatting, or stair climbing. It is also known as Runner’s Knee or Jumper’s Knee. It is usually seen in athletes but can be found in non-athelets as well. It occurs when the nerves around the kneecap detect pain in surrounding soft tissues and bone. The affected soft tissues typically include the tendons, the fat pad beneath the patella, and the synovial membrane lining the knee joint. Sometimes, this condition is associated with Chondromalacia Patella, which is the softening and deterioration of the cartilage beneath the kneecap. It often limits daily activities and physical performance, making life hard and may also make the person dependent on other people for their routine life.

Causes of Patellofemoral Pain Syndrome

• Overuse: Activities like running, jumping, cycling, or prolonged squatting can strain the knee.
• Muscle Weakness: Weak quadriceps, hip, or gluteal muscles may lead to improper patellar movement.
• Biomechanical Issues: Flat feet, overpronation, high Q-angle, or uneven leg length can affect knee alignment.
• Patellar Maltracking: Abnormal kneecap movement during bending or extension increases joint stress.
• Structural Factors: Shallow trochlear groove or congenital alignment problems can contribute.
• Previous Injury: Past knee or patella trauma may increase susceptibility to PFPS.
• Worn-out or improperly fitting shoes can also contribute to the problem.
• Excessive knock knees may also cause it.

Symptoms of Patellofemoral Pain Syndrome

• Aching or soreness around the kneecap.
• Pain during movements that bend the knee repeatedly, like running or squatting.
• Discomfort after sitting for a long time with bent knees.
• Knee pain that appears with changes in activity, playing surface, or equipment.
• Popping, cracking, or grinding sensations when climbing stairs or standing after sitting.

Diagnosis of Patellofemoral Pain Syndrome

• History of trauma- The patient may give information about a fall or an injury to the knee.
• Physical Examination- Palpating area around knee to see tenderness. Alignment and strength can be observed. Q-angle can be assessed.
• Patellar Tilt Test- If positive, it indicates tightness in the structures that stabilize the patella on the outer (lateral) side of the knee.
• Imaging Studies like X-ray, MRI and CT scan- To get a clear idea about the joint changes and its associated structures.

Treatment for Patellofemoral Pain Syndrome

It requires medications to relieve pain, physical therapy and surgery in cases of severe pain where medicines don’t work.

1. Medications

• Acetaminophen- For temporary pain relief.
• Non-steroidal Anti Inflammatory Drugs (NSAIDs)- Ibuprofen and Naproxen sodium reduce both pain and inflammation

2. Physical Therapy

• Strengthening exercises to support the knee and prevent inward movement during squats.
• Braces or supports, taping techniques to ease discomfort and improve exercise ability.
• Icing after activity to manage pain.
• Orthotics to relieve knee stress.
• Low-impact sports like swimming or cycling during recovery.

3. Surgery

If the conservative treatment doesn’t work, surgery can be opted. Arthroscopy or Realignment surgery can be done. But it does not ensure that the problem will not arise again.

Ayurvedic Overview of Patellofemoral Pain Syndrome

If we talk about it in a broader sense, aggravated Vata dosha (Biological Energy of Movement) manifests as various Vata Vyadhis (Vata related disorders) and causes pain in the affected region. Patellofemoral pain syndrome can be correlated with Sandhigata Vata (Osteoarthritis). Since, the affected area is the knee joint, we can say it is Janu Sandhigata Vata (Osteoarthritis of the knee).

• When a person excessively consumes Ruksha (dry), Laghu (light), Visham Ahara (irregular or unwholesome diet)
• Suppresses Vegas (natural urges such as urination or defecation), harbors emotions like Krodha (anger), Shoka (grief), or Bhaya (fear), or experiences Abhigata (physical injury/trauma), participates in strenuous physical activities and gets inadequate rest, it can lead to the aggravation of Vata Dosha.
• This aggravated Vata dosha, then travels to the knee joints and affects the Janu Sandhi (knee joint), Snayu (Ligaments) and Kandra (Tendons) associated with the knees and the disease finally manifest as Janusandhigata Vata (Osteoarthritis of knee).
• Patients experience symptoms like Shoth (swelling) in knee joint, Teevrashoola (Excessive, sharp pain) in the knee joint and patient also complains about  pain while flexing or extending the joint. This kind of pain may debilitate a patient and naturally, makes it difficult to perform daily routine activities.

Ayurvedic Formulations

• For Janusandhigata Vata, various Ayurvedic formulations like Mustadi Upnaha (Medicated poultice therapy)
• Utkarikadi Upnaha (Medicated poultice therapy) for external application on the knee region are extremely beneficial to relieve pain and swelling, as they pacify Vata.
• Other than this, Chitrakadi Ghrita, Triphaladi Mahasneha, Nirgundi Taila, Karpaas Taila, Mulak Taila and Rasna Taila are used in various Vata Vyadhis (Vata related disorders) like Janusandhigata Vata. Swedana (Fomentation therapy) using herbs like Eranda leaves (Leaves of Ricinus communis), Moringa leaves (Leaves of Moringa oleifera ) and Nirgundi leaves (Vitex negundo leaves), especially after local application of the oils mentioned above gives instant relief, if done daily for about 15-20 minutes, for seven to ten days.
• Ayurvedic formulations like Trayodashang Guggul, Rasnadi Guggul, Vatavidhvansak Ras etc can be used to manage this condition

The role of Panchakarma (Five purification therapies)

• The role of Panchakarma (Five purification therapies) can not be sidelined. Niruha Basti (Therapeutic enema using herbal decoction), Anuvasana Basti (Therapeutic enema using oils) can be used for treating Vata Vyadhis (Vata related disorders) and it also detoxifies body and balance doshas.
• Since, Patellofemoral pain syndrome is a localised disease, Janu Basti (Knee Joint Oil Retention Therapy) can be performed on the knee joint and it has excellent results in this disease. Janu basti (Knee Joint Oil Retention Therapy) is to be done in a sitting position, with legs hanging down or by laying down in a prone position, on the therapy bed.

Before doing the treatment, support should be given to the knee joint with the help of a pillow. A boundary using Masha Dal (Black lentil) dough should be made around the knee joint and it should be made leak-proof. Then, lukewarm medicated oil is poured on the affected area using cotton and it should be regularly replaced with the lukewarm oil, once the oil starts feeling cold. This should be done continuously for about 30-40 minutes. After this, oil should be cleaned off the skin of the patient and the area is covered properly to avoid exposure to air or wind. Maximum rest should be done by the patient following the Janu basti (Knee Joint Oil Retention Therapy) procedure. Janu Basti therapy should be taken for at least a period of 10-15 days on a regular basis, for maximum results. It not only pacifies Vata and relieves pain and discomfort, it also nourishes the tissues and helps in their healing. Due to its nourishment property, it is often called Janu Tarpan (Knee nourishing and rejuvenation therapy) as well.

Ayurvedic Diet and Lifestyle Modifications for Patellofemoral Pain Syndrome

Follow diet

• Warm, cooked foods, ghee, sesame oil, milk, whole grains like wheat, oats, properly cooked green leafy vegetables, nuts and seeds (almonds, walnuts, sesame seeds), spices like ginger, turmeric, garlic, cumin, ajwain and herbal teas (ginger tea, dashmool decoction) should be taken in diet.
• Avoid diet- Dry, cold, and raw foods, excess legumes like rajma, chana, or peas, excess bitter and astringent foods, excess tea, coffee, and alcohol should be avoided.
• Water intake- Adults are usually recommended to drink about 2.5–3 liters of water daily (around 8–10 glasses), though the exact amount may vary based on climate, physical activity, and individual requirements.
• Yogasana- Asanas that require sitting on knees have to be completely avoided. Mountain Pose (Tadasana), Bridge Pose (Setu Bandhasana), and Triangle Pose are beneficial.
• Physical exercise/Gym- Mild stretching exercises to improve circulation, flexibility and strength can be done. If the pain aggravates, stop immediately. Intense gymming is not recommended.

Herbal Remedies for Patellofemoral Pain Syndrome by Planet Ayurveda

1. Boswellia + Curcumin

These capsules are made from potent herbs like Haridra (Curcuma longa) and Shallaki (Boswellia serrata). They balance Vata, Pitta and Kapha doshas. Together, they help reduce inflammation in muscles, bones, tendons, and skin. They also provide analgesic effects to relieve pain in affected areas. Read More

Dosage- 1 capsule twice daily

2. Rumogin 5 Capsules

These capsules contain key ingredients like Haridra (Curcuma longa), Sonth (Zingiber officinale), Shallaki (Boswellia serrata). These capsules balance all three doshas (Vata, Pitta and Kapha), and due to their hot potency they also provide relief in pain. They are also known to improve mobility and support the overall musculo-skeletal system. Read More

Dosage- 1 capsule twice daily

3. Maha Rasnadi Kwath

This herbal decoction is made from key ingredients like Javasa (Alhagi psedalhagi), Bala (Sida cordifolia) and Eranda (Ricinus communis). They support Vata-related disorders so are beneficial in dealing with symptoms like severe pain. It also ensures tissue nourishment. Read More

Dosage- 10 ml twice daily

4. Lakshadi Guggul

These tablets are made from key ingredients like Laksha (Laccifer lacca), Arjuna (Terminalia arjuna) and Hadjod (Cissus quadrangularis). These balance Vata and Kapha doshas. When used together in formulations, they synergistically strengthen bones, improve skeletal integrity, support fracture healing, and nourish tissues. Read More

Dosage- 2 tablets twice daily

5. Ashwagandhaghan Vati

These tablets are made from potent extract of Ashwagandha (Withania somnifera). Often called Indian Ginseng, it balances Vata and Kapha doshas. It is a Rasayana (Rejuvenator) and also a Balya (Strength giving) herb so it naturally supports the musculo-skeletal system. Read More

Dosage- 2 tablets twice daily

6. Orthovita Oil

This oil is primarily made from Shula Gajendra Oil and also Saindhavadi Oil among other oils. All these oils pacify Vata dosha and therefore, relieves pain. Read More

Dosage– For local application

Frequently Asked Questions (FAQ’s)

1. How long does it take for patellofemoral pain syndrome to heal?

Ans. Recovery from patellofemoral pain syndrome usually takes a few weeks to a couple of months, but severe cases may require 6–12 months for complete healing.

2. What exercises should I avoid with patellofemoral pain syndrome?

Ans. Avoid prolonged sitting, squatting, or kneeling with bent knees, and ensure exercise or bicycle settings are comfortable with proper seat height. Also, limit bent-knee workouts like squats and deep knee bends.

3. How to strengthen the patellar tendon?

Ans. Strengthen the patellar tendon by focusing on quadriceps, glutes, and calf exercises while gradually increasing load. Eccentric moves like single-leg squats and step-downs are especially effective for knee stability.

4. Can patellofemoral syndrome lead to arthritis?

Ams. Patellofemoral pain syndrome can signal thinning of the cartilage beneath the kneecap, which over time may contribute to bone damage and arthritis.

5. Is walking good for patellofemoral syndrome?

Ans. Stretching tight hamstrings, quadriceps, and calves can ease knee pain, while endurance activities like walking, cycling, swimming, or aerobics help build long-term strength.

6. What is the average age for patellofemoral pain syndrome?

Ans. Patellofemoral pain is frequently seen in adolescents, with musculoskeletal-related disability nearly quadrupling between the ages of 5-9 and 10-14 years.