Why Does My Kneecap Hurt?

By Robert Lim, PTA

Patello-Femoral Syndrome or Knee-Cap Pain

By Robert D. Lim, PTA


Chondromalacia, technically termed chondromalacia patellae, is the most common cause of chronic knee pain. The condition develops due to softening of the cartilage beneath the knee cap (the patella), resulting in small areas of breakdown and pain around the knee. Instead of gliding smoothly over the knee, the knee cap rubs against the thigh bone (the femur) when the knee moves. The changes can range from mild to complete erosion of the cartilage. This process is sometimes referred to as the patello-femoral syndrome. Chondromalacia commonly occurs in females. Girls in their teens are at elevated risk because the cartilage of the knee is subjected to excessive and uneven pressure due to the structural changes that accompany rapid growth.

Causes of Patello-Femoral Pain

Chondromalacia may also occur in adults over the age of 40 as part of the wear-and-tear process that eventually leads to osteoarthritis of the knee joint. Other factors that may precipitate chondromalacia include trauma, overuse, or abnormal forces on the knee joint. It can develop in skiers, runners, cyclists, and soccer players, especially if someone is knock-kneed or flat-footed. The pain of chondromalacia occurs in the front or inside of the knee. It is generally worse with activities such as running, jumping, climbing stairs, or kneeling. Pain is also typically worse after sitting with the knees bent. This pain is called the “theater sign” of chondromalacia.

There may be tenderness of the knee along with a grating or grinding sensation when the knee is straight. X-rays of the knee are generally normal, but may show a slight displacement of the knee cap. Even if you have symptoms consistent with chondromalacia, your doctor may still order an X-ray to rule out other reasons for your knee pain.


Your physician may order Nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil/Motrin) or naproxen (Aleve).  They can help to alleviate pain and reduce the chronic inflammatory processes that increase the structural damage. Icing the knee can also be very helpful.

Treatment of Patello-Femoral Syndrome

Treatment of chondromalacia is usually conservative with exercises or physical therapy.  Programs with the design to strengthen the muscles around the knee and restore normal alignment of the knee cap. These exercises should be to selectively strengthen the thigh muscles (the quads) and realign the patella.  More specifically, the VMO muscle of the quad.  Most patients with this condition have stronger lateral or outside muscles in the leg.  So, the goal is to strengthen the weaker VMO or inside leg muscles.


It is also important to stretch the IT Band or Iliotibial Band with this condition.  A tight IT band and hamstring muscles can also cause the kneecap to track laterally in the knee.

iliotibial band ITB stretch with belt

iliotibial band ITB stretch with belt

About 85% of patients with chondromalacia improve with conservative treatment alone and require no further therapy. In about 15% of cases, the pain persists or worsens to the extent that surgical correction of the knee joint. While it is not always possible to prevent chondromalacia, avoiding trauma and abnormal stresses on the knee certainly help. Keeping the leg muscles strong and flexible may be able to help to prevent its development in many cases.

If you think you have this condition and want to schedule with a JOI Orthopedic Knee Specialist, please call 904-JOI-2000.  You can also schedule online or click below.

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