[caption id="attachment_1620" align="alignright" width="215"] Adam Levko, PT, DPT[/caption]Many people that exercise regularly, or are returning to some form of exercise, begin to experience anterior knee pain. There are several reasons a person can experience pain in the front of the knee. Patella Femoral Syndrome (PFS) results from pain under the knee cap (patella) that is caused by tracking improperly on the long bone in the thigh (femur). Many studies and medical professionals suggest that this tracking issue is due to a relative weakness of the Vastus Medialis Oblique (VMO), as compared to the Vastus Lateralis (VL). This relative weakness would result in the VL pulling the patella laterally, or toward the outside of the leg, while it tracks on the femur. The back of the patella has a ridge, like the hull of a boat, and is supposed to track directly in a groove (like a canal) on the femur. If the hull of the boat is continually being pulled over the edge of the canal, this will cause significant irritation, inflammation, and even damage to the cartilage that covers the bone over time.