[2][4] Pain may worsen with sitting down with a bent knee for long periods of time, excessive use, or climbing and descending stairs.

[3] Pain is usually initiated when weight is put on the knee extensor mechanism, such as when ascending or descending stairs or slopes, squatting, kneeling, cycling, or running.

[13] In most people with patellofemoral pain syndrome an examination of their history will highlight a precipitating event that caused the injury.

[3] The cause of pain and dysfunction often results from either abnormal forces (e.g. increased pull of the lateral quadriceps retinaculum with acute or chronic lateral patellofemoral subluxation/dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the patellofemoral joint.

The result is synovial irritation and inflammation and subchondral bony changes in the distal femur or patella known as "bone bruises".

[18] The patellofemoral glide, tilt, and grind tests (Clarke's sign), when performed, can provide strong evidence for PFPS.

[21] Magnetic resonance imaging rarely can give useful information for managing patellofemoral pain syndrome and treatment should focus on an appropriate rehabilitation program including correcting strength and flexibility concerns.

[3] Despite this distinction, the diagnosis of PFPS is typically made based only on the history and physical examination rather than on the results of any medical imaging.

[26][27] There is consistent but low quality evidence that exercise therapy for PFPS reduces pain, improves function and aids long-term recovery.

Also, there is growing evidence that shows proximal factors play a much larger role than vastus medialis (VMO) strength deficits or quadriceps imbalance.

[8] Neuromuscular electrical stimulation to strengthen quadricep muscles is sometimes suggested, however the effectiveness of this treatment is not certain.

[34] Manual therapy in addition to exercises helps in reducing pain, improving function, and knee range of motion in patients with PFPS.

However, there is not enough evidence that supports lumbopelvic spine manipulation has any effect on the quadriceps muscle activation to improve function & reduce pain.

[35] Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat PFPS; however, there is only very limited evidence that they are effective.

[7] Glycosaminoglycan polysulfate (GAGPS) inhibits proteolytic enzymes and increases synthesis and degree of polymerization of hyaluronic acid in synovial fluid.

Findings from some studies suggest that there is limited benefit with patella taping or bracing when compared to quadriceps exercises alone.

[38] Low arches can cause overpronation or the feet to roll inward too much increasing load on the patellofemoral joint.

[39][40] Foot orthoses may be useful for reducing knee pain in the short term,[41] and may be combined with exercise programs or physical therapy.

[8] The use of electrophysical agents and therapeutic modalities are not recommended as passive treatments should not be the focus of the plan of care.

[43] Most studies claiming benefits of alternative therapies for PFPS were conducted with flawed experimental design, and therefore did not produce reliable results.

[32] Risk factors for a prolonged recovery (or persistent condition) include age (older athletes), females, increased body weight, a reduction in muscle strength, time to seek care, and in those who experience symptoms for more than two months.

[3][45] Specific populations at high risk of primary PFPS include runners, bicyclists, basketball players, young athletes and females.