Practice Guidelines

Patellofemoral Pain: Guidelines from the American Physical Therapy Association


Am Fam Physician. 2020 Oct 1;102(7):442-443.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• PFP presents with retropatellar or peripatellar pain with knee flexion.

• PFP is unlikely if squatting does not reproduce pain.

• The most effective treatment for PFP are exercises that target muscles of the posterior hip and quadriceps.

• Adding patellar taping and foot orthoses to exercise improves short-term pain.

From the AFP Editors

Patellofemoral pain (PFP) is a common condition, characterized by poorly defined knee pain in the anterior retropatellar or peripatellar region. PFP affects up to 85% of the population at all ages but appears to be most common in adolescents. PFP can persist for many years and recurs in up to 90% of affected people. It may lead to future patellofemoral osteoarthritis. The American Physical Therapy Association released guidelines for the diagnosis and management of PFP.

Risk Factors

Decreased flexibility and muscle weakness of the hip and knee are present in PFP, but hip weakness appears to be secondary to PFP instead of a cause. Physically active women are more susceptible to PFP compared with similarly active men. Knee extensor weakness in women increases PFP risk. Women who participate in multiple sports are at lower risk than women participating in a single sport. Measurements of static and dynamic knee valgus, including the Q angle, do not predict PFP risk.


PFP presents with retropatellar or peripatellar pain on knee flexion, such as with squatting, stair climbing, or prolonged sitting. With this type of pain, these activities are the most accurate diagnostic tests. Lack of pain with squatting makes PFP unlikely. Reduced lateral patellar mobility with patellar tilt testing is highly specific but cannot rule out PFP. Other proposed tests have insufficient accuracy.

Other causes of anterior knee pain have more specific findings. Patellar instability presents with recurrent subluxation or dislocation episodes and apprehension with lateral patellar pressure. Patellar tendinopathy is common in adults,

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at



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