The experience of living with patellofemoral pain: loss, confusion and fear-avoidance – a UK qualitative study

Benjamin E. Smith, Fiona Moffatt, Paul Hendrick, Marcus Bateman, Michael Skovdal Rathleff, James Selfe, Toby O. Smith, Pip Logan

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Objectives: To investigate the experience of living with patellofemoral pain.

Design: Qualitative study design using semi-structured interviews, and analysed thematically using the guidelines set out by Braun and Clarke.

Setting: A National Health Service (NHS) physiotherapy clinic within a large UK teaching hospital.

Participants: A convenience sample of ten participants, aged between 18 and 40, with a diagnosis of patellofemoral pain and on a physiotherapy waiting list, prior to starting physiotherapy.

Results: Participants offered rich and detailed accounts of the impact and lived experience of patellofemoral pain, including: loss of physical and functional ability; loss of self-identity; pain related confusion and difficulty making sense of their pain; pain related fear, including fear-avoidance and ‘damage’ beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future.

Conclusions: These findings offer an insight into the lived experience of individuals with patellofemoral pain. Previous literature has focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain related fear for people with patellofemoral pain. The current consensus that best-evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, ‘weakness’ and ‘patellar mal-tracking’ and its impact and interpretation by patients.
Original languageEnglish
Article numbere018624
JournalBMJ Open
Issue number1
Early online date23 Jan 2018
Publication statusPublished - Jan 2018


  • Patellofemoral Joint
  • Knee
  • Pain
  • Perceptions
  • Lived experiences

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