Associated factors

The factors that cause patellofemoral pain are complex, and researches are currently not completely clear. However, several transversal studies with people with patellofemoral pain indicated the presence of several impairments in this population, including biomechanical, functional and non-mechanical factors. It is important to emphasize that due to the multifactorial nature of the condition, not all patellofemoral pain patients will present all the impairments that have been found in this population.

In this section, you will find information about the main factors associated with patellofemoral pain.

Psychological factors

The biomedical model in isolation possesses inherent limitations within the complex paradigm of human pain perception.

Elevated levels of anxiety, depression, pain catastrophizing and kinesiophobia (fear of movement) have been reported in patients with patellofemoral pain,7 which have the capacity to negatively influence pain, physical function and activity-related behaviors.8,9

These impairments, in combination with reductions in pain and disability being associated with improvements in psychological health of the patient with patellofemoral pain,10 highlight the importance of comprise non-mechanical factors during clinical examination and integrating these findings into their eventual management plan.


Quality of life

Overweight and obesity

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  1. Powers et al. 2017. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3.
  2. Ferrari et al. 2018. Higher pain level and lower functional capacity are associated with the number of altered kinematics in women with patellofemoral pain.
  3. Powers et al. 2012. Patellofemoral pain: proximal, distal, and local factors, 2nd International Research Retreat.
  4. Lankhorst et al. 2013. Factors associated with patellofemoral pain syndrome: a systematic review.
  5. Priore et al. 2019. Influence of kinesiophobia and pain catastrophism on objective function in women with patellofemoral pain.
  6. Nunes et al. 2019. People with patellofemoral pain have impaired functional performance, that is correlated to hip muscle capacity.
  7. Maclachlan et al. 2017. The psychological features of patellofemoral pain: a systematic review.
  8. Domenech et al. 2013. Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients.
  9. De Oliveira Silva et al. 2020. Pain and disability in women with patellofemoral pain relate to kinesiophobia, but not to patellofemoral joint loading variables.
  10. Doménech. 2014. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain.
  11. Coburn et al. 2018. Quality of life in individuals with patellofemoral pain: A systematic review including meta-analysis.
  12. De Oliveira Silva et al. 2019. Manifestations of pain sensitization across different painful knee disorders: A systematic review including meta-analysis and metaregression.
  13. Bartholomew et al. 2019. Altered pain processing and sensitisation is evident in adults with patellofemoral pain: a systematic review including meta-analysis and meta-regression.
  14. Sigmund et al. 2021. Exploring the pain in patellofemoral pain: A systematic review and meta-analysis examining signs of central sensitization.
  15. IASP. 2017. IASP terminology. Published 2017.
  16. Hart et al. 2017. Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis.
  17. Ferreira et al. 2021. Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength.
  18. Ferreira et al. 2021. Exploring overweight and obesity beyond body mass index: a body composition analysis in people with and without patellofemoral pain.