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Trigger Point Therapy - Patellofemoral Pain Syndrome (PFS)

Posted by Team NAT on

Trigger Point Therapy - Patellar Ligament


Treating Runner's Knee

Trigger Point Foundation Course


Patellofemoral Pain Syndrome (PFPS) can refer to a number of injuries resulting from overuse, causing pain around the knee cap (patella).

PFPS is characterized by a group of symptoms that are easily diagnosed and often respond to simple management. The common presentation is knee pain in association with positions of the knee that result in increased or misdirected mechanical forces between the kneecap and femur.

Ironically, as simple as its presentation is, there is still a lack of consensus on the fundamental factors associated with PFPS. Accordingly, synonyms for the syndrome go in and out of fashion.

No agreement exists on the exact pathophysiology, but significant work is being completed on the extent and direction of the associated forces on the patella, trigger point activity, and on the tracking and alignment of the patella.

Common Causes

PFPS is most likely to occur when the hamstrings and quadriceps are too tight and inflexible. This leaves the patella unsupported creating pressure and causing it to move from its correct position.

It's also worth noting that these type of knee injuries can sometimes be related to tension or weakness in the hip (gluteus medius muscle).

See image above for common trigger point sites. 

Common Symptoms

Symptoms may be felt in one or both knees and whilst some clients will experience the pain as sudden and piercing, other will experience it as chronic and dull.

• Pain will centre around and behind the patella

• Pain will be felt from kneeling, squatting or even getting 
up from a chair
• The client may occasionally report a cracking sensation

• The knee can feel weak and feel and unbalanced

• Symptoms are often more pronounced when walking down hill or downstairs 




Gluteus Medius - Self Massage with a Hard Ball


Who Is Prone to PFPS?

Women are more likely to get than men. This is due to their wider hips which cause a greater angling of the knee to the thighbone, creating increased stress on the knee cap.

Younger runners (teens) as well as those who run for recreational purposes tend to suffer most. But it's pretty common especially amongst hikers, cyclists. and even office workers who sit for long periods can develop this condition. 

A recent report in the USA estimated a PFPS prevalence rate of 20% in student populations.

Interestingly around 40% of professional cyclists will develop a form of PFS each year, and we've certainly seen an increase in the number of amateur and leisure cyclists who we treat for knee problems.

What else could It be?

Here is a list of other conditions which can mimic PFS:

• Medial or Lateral meniscal cartilage tear

• Stress Reaction or Stress Fracture of the Patella (Knee Cap)

• Contusion of cartilage or bone

• Referred pain from lumbar spine L4/5 nerve root

• Quadriceps tendinopathy

• Patellar tendon tendinopathy

• Painful plica

• Pes anserinus bursitis

• Pes anserinus tendinopathy

• Biceps femoris tendinopathy

• Lateral patellar compression syndrome

• Stress reaction or stress fracture of femur, tibia or proximal fibula

• Proximal tibial-fibular joint sprain

Quadriceps Stretch - Can Help Dissipate Trigger Points



Trigger Point Therapy

Common knee injuries including PFPS are often associated with trigger points in the gluteus minimus, medius, maximus, quadriceps and sartorius muscles.

Most commonly overlooked are trigger points in popliteus and the patellar ligament (see video above).

There are a number of well documented treatment protocols for PFPS which include trigger point therapy, stretching, strengthening, and taping.











This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 




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  • Great article – really helpful in beginning to decipher a personal knee issue and that of a friend. Thank you :)

    Julie Fox on

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