Author: Dr. Leor Giladi, CSCS, CF-L2
If you are here to read about your knee, you have come to the wrong place. We are not here to talk about your hips and ankles either. Well, not entirely true. We are really here to talk about your diagnosis: patellofemoral pain syndrome, or PFPS, which typically describes pain in the front of the knee.
Unfortunately, PFPS is more of a description than a true diagnosis.
Before diving deeper, let’s briefly review the relevant anatomy. A joint exists anywhere two bones meet, and the knee is no exception. The knee joint is formed by the femur, or thigh bone, and the tibia, or shin bone. While it may look like the knee moves like a simple hinge, it does not. Like every joint in the body, the knee relies on rotation.
As you straighten your knee, the femur rotates inward while the tibia rotates outward. When you bend your knee, the opposite occurs.
The top of the tibia is relatively flat, while the bottom of the femur resembles two rounded surfaces resting on it. Ligaments and muscles work together to keep the joint stable. Although many muscles influence knee position, the quadriceps are often the main focus in PFPS discussions because the patella, or kneecap, sits within the quadriceps tendon itself.
Now that we understand the anatomy, here is the part that matters most.
Why Force Management Matters More Than Anatomy
What truly matters in PFPS is not the knee structure itself, but how forces move through your body.
Every time your foot contacts the ground, force travels up the leg and through the body. To move forward, you must then push force back into the ground. This is walking. When done at higher speeds, it becomes running. The same principles apply to strength training, even when your feet stay planted.
How efficiently your body absorbs and redistributes force determines how much stress is placed on the knee, muscles, ligaments, and surrounding tissues.
There is no need to fear normal tissue stress. Strain is a natural and necessary part of being human. It is how tissues adapt and become stronger. The issue arises when the amount of stress exceeds your ability to recover from it.
You can think of this like a budget. Small withdrawals are normal and manageable. Over time, if withdrawals exceed deposits, you slowly go into debt. That accumulated debt is what often shows up as pain.
Why PFPS Does Not Explain the Real Problem
PFPS tells you where your pain is located, not why it exists. Because of this, the label itself offers very little guidance on how to actually resolve it.
The most common advice given for PFPS is to strengthen the quadriceps, hamstrings, calves, and glutes. The reasoning is that stronger muscles will better tolerate force and reduce strain on the knee.
Strength training absolutely matters, but this approach is often incomplete.
Strong muscles are only useful if they activate at the right time, in the right sequence, and in coordination with the rest of the body. Strength alone does not guarantee proper force distribution.
Many people do find relief through strengthening programs. However, if you have already gone down that path and are still dealing with pain, something important was missed.
Even the presence of old injuries such as meniscus tears, arthritis, or ligament damage may not be the main driver of your symptoms. Improving how your body manages and distributes force through the knee can lead to meaningful improvements, even when structural issues exist.
The Takeaway
If you have persistent pain in the front of your knee, PFPS does not mean you are stuck with it forever. Mechanical pain always has a source.
When the focus shifts away from isolated structures and toward improving how forces move through your body, real change becomes possible. With the right approach, anterior knee pain can absolutely be resolved.
