Exercising With Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome and Exercise

How to Exercise With Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS), also known as “runner’s knee,” is a common cause of anterior knee pain in active individuals. Patellofemoral pain syndrome is associated with tenderness and bony overgrowth at the inferior pole of the patella; pain that worsens with direct compression or kneeling and improves when weight bearing and knee flexion are limited.

Patellofemoral pain syndrome is caused by excessive pressure between the undersurface of the kneecap and underlying bone tissue, typically due to misalignment or excessive pressure from muscles pulling on the kneecap. Repetitive stress can result in damage to parts of bones where they attach to cartilage, including the underside of the kneecap. Initiating a running program or increase in training too quickly can also cause PFPS.

What Are The Symptoms?

Symptoms associated with patellofemoral pain syndrome include localized tenderness under the kneecap, particularly during climbing and descending stairs or hills; knee buckling or giving out frequently when running or cutting; crepitus (a crunchy feeling as the kneecap slides along its track) especially during squatting, kneeling, sitting straight up from a lying position, and climbing/descending stairs; swelling of the knee joint; and pain that is relieved by resting or after applying cold to the knee for a short time period. The symptoms of patellofemoral pain syndrome usually become aggravated during activities such as squatting, kneeling, running, and stair climbing.

How is Patellofemoral Pain Syndrome Diagnosed?

A physical exam by a physician or other health care professional can help diagnose patellofemoral pain syndrome. Imaging studies may be recommended to rule out a fracture or tumor in the knee. Treatment should be started without delay if there are signs of any degenerative changes in the joint because these could worsen with time.

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome Exercises: What Should I Do?

Once you get your diagnosis from a qualified healthcare provider, an appropriate treatment plan will depend on which component of PFPS is present (i.e., improper tracking or malalignment problems). A combination approach is usually best so as to address all components of the problem. The following patellofemoral pain syndrome exercises are a good starting point.

1. Quadriceps Strengthening: You can do this via either closed kinetic chain or open kinetic chain exercises (described below). We recommend that you focus on strengthening the vastus medialis oblique (VMO), which is commonly underactive in people with PFPS. It may be difficult to target this muscle through traditional squats, leg press or lunge type exercises because your knee may buckle inwards during these movements (i..e they exacerbate the symptoms of PFPS) especially if there is an associated flat foot condition present. Our favorite quad-strengthening exercise for PFPS is single leg “half squats”.

To perform this exercise, stand on one leg and squat down with control until your thigh is almost parallel to the ground. The key is to make sure that your knee does not collapse inwards; if it does, you are likely strengthening your VMO. For best results, do 3 sets of 15 reps daily or every other day.

2. Tensor Fasciae Latae Muscle Strengthening: This muscle attaches just outside the hip joint and helps pull the kneecap laterally when running. If it is tight, it can pull the kneecap off-track so strengthening exercises are important if present. These muscles typically respond well to lying leg lifts. Lie on your back with both legs extended (you can bend your knees if needed to relax your hips) and lift one leg by contracting the buttock muscles. The key is to use no momentum, perform the movement slowly with control and repeat 20 times on each side daily or every other day.

3. Gluteus Medius Muscle Strengthening: This muscle also attaches at the hip joint but helps move the thigh outwards so strengthening this muscle can help reduce knee pain by bringing it into correct alignment under the kneecap. We recommend doing side lying hip abduction exercises with either a resistance band or light dumbbells. Do 2 sets of 25 reps daily or every other day.

4. Tibialis Anterior Muscle Strengthening: This muscle attaches just below the kneecap and helps pull it up into correct alignment under the knee. We recommend doing calf raises by standing flat footed and then raise up and down onto the balls of your feet . Perform 3 sets of 15 reps daily or every other day.

5. Flexibility Exercises: We recommend that you stretch your calves, hamstrings, quads, hip flexors and IT bands if tightness is a problem because this will help reduce stress on the patella tendon during activity and improve biomechanics. A good stretch for your IT band is commonly called a “runner’s lunge” or you can use a foam roller to perform the Iliotibial band roll under your knee. Repeat each stretch 20 times on each leg daily or every other day.

6. Helpful Shoes: To successfully reduce stress on the patella tendon during activity, tall heel shoes with a rocker-bottom platform can help bring your kneecap into correct alignment under the knee joint so that it tracks correctly during walking and running. This reduces pressure on the patella tendon which will help reduce or eliminate your knee pain. We recommend that you look into the EVO running shoes because they have this rocker-bottom platform which is very helpful for people with PFPS.

7. Activity Modification: This means taking a break from high impact activity (running, jumping, etc.) to allow your patella tendon to recover and strengthen until symptoms resolve. You need to be symptom free before attempting any of these activities again. It may take weeks, months or years depending on the severity of your case so it’s important to remain patient during this time period. Generally, if you feel pain within the first 15 minutes of performing an exercise then stop immediately; you are likely pushing yourself too hard and should lower your intensity level or amount of repetitions.

8. Bracing for PFPS: We recommend that you only wear a patellofemoral brace while resting because it will likely prevent you from doing any of the exercises listed above which are very important for your recovery. Therefore, during exercise, we strongly recommend wearing only a well-fitted knee sleeve instead if you feel support is needed.


We hope this article has provided you with some valuable information on how to get started treating your patellofemoral pain syndrome at home. We wish you all the best of luck in your recovery!

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