PT Weekly: Exercise Program for Patellofemoral Syndrome

Patellofemoral stress syndrome (PFSS), also known as runner’s knee pain. This is common in athletes and most especially in females and young adult, but can also occur in non-athletes. Quite a number of things may contribute to the development of patellofemoral pain syndrome:

1. Problems with the alignment of the kneecap and
2. Overuse from vigorous athletics or training are often significant factors.

Patellar Malalignment

Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues.
Factors that contribute to poor tracking of the kneecap include:

  • Problems with the alignment of the legs between the hips and the ankles. Problems in alignment may result in a kneecap that shifts too far toward the outside or inside of the leg, or one that rides too high in the trochlear groove
  • Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh. When the knee bends and straightens, the quadriceps muscles and quadriceps tendon help to keep the kneecap within the trochlear groove. Weak or imbalanced quadriceps can cause poor tracking of the kneecap within the groove.

In many cases, patellofemoral pain syndrome is caused by vigorous physical activities that put repeated stress on the knee,such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity. This change can be in the frequency of activity such as increasing the number of days you exercise each week. It can also be in the duration or intensity of activity—such as running longer distances.

Other factors that may contribute to patellofemoral pain include:

  • Use of improper sports training techniques or equipment
  • Changes in footwear or running surface


The most common symptom of patellofemoral pain syndrome is a dull, aching pain in the front of the knee. This pain which usually begins gradually and is frequently activity-related. It may be present in one or both knees. Other common symptoms include:

  • Pain during exercise and activities that repeatedly bend the knee, such as climbing stairs, running, jumping, or squatting.
  • Pain after sitting for a long period of time with your knees bent, such as one does in a movie theater or when riding on an airplane.
  • Pain related to a change in activity level or intensity, playing surface, or equipment.
  • Popping or crackling sounds in your knee when climbing stairs or when standing up after prolonged sitting.

Symptoms are often relieved with conservative treatment, such as changes in activity levels or a therapeutic exercise program. Exercise is one of the main treatments for PFSS. Many cases of PFSS are caused by tight muscles around the knees and hips or weakness in muscles that help keep the kneecap in its correct position. Sometimes balance or proprioception impairments may be a factor that leads to PFSS. Working to stretch and strengthen the right muscle groups can make a significant change.

Here are few of the exercises program that a physical therapist may prescribe for someone with runner’s knee. The exercises focus on improving flexibility and strength of the muscles that support your knee and help keep excessive stress off your kneecap.

Before starting this, or any other, exercise program, check in with your doctor to ensure that exercise is safe for you to do.

1. Quadriceps Strengthening

Research indicates that weakness in your quadriceps muscle, specifically an area of the quad called the vastus medialis obliquus (VMO), may lead to patellar misalignment and PFSS. Working to strengthen your quad may be an important part of your exercise program for PFSS. One simple way to strengthening your quads is with the quad set exercise.

The short arc quad is another exercise that can help improve the way your quadriceps muscle supports your kneecap. To do this, lie down and place a soccer ball or paper towel roll underneath your knee. Straighten your knee fully while keeping the back of your leg against the ball. Hold your knee straight for 5 seconds, and then slowly release.

2. Straight Leg Raises

Straight leg raises are a great way to strengthen your quadriceps and hips while maintaining your knee in a safe, pain-free position. During the straight leg raise, your knee joint should remain locked, decreasing stress and strain (and pain) around your kneecap.

One can work different muscle groups around your hips by performing the straight leg raise on your back, on your side, or while lying on your stomach. Each method will alter the exercise enough to keep it fresh and to work the various muscles that support your leg and knee.

You can make this exercise more challenging by adding a small cuff weight around your ankle. Usually three to four kilogram is sufficient. Another way to add resistance is to place a resistance band around your ankles for the straight leg raises.

3. Isometric Gluteal Strengthening

Isometric gluteus medius strengthening is a great way to improve the neuromuscular recruitment of your hips. This can help to keep your legs–and kneecaps–in proper alignment.

To perform the exercise, lie on one side with your knees straight and with a belt wrapped around your ankles. Be sure it isn’t too tight; you should be able to lift up your top leg.

Slowly lift your top leg while keeping it straight, and press into the belt. You should feel your hip muscle working to lift up your leg further, but the belt should be resisting your movement.

Press up into the belt for five seconds, and then slowly relax. Perform the exercise for 10 repetitions, and then repeat it on the other side.


Running involves flying through the air and landing on one foot. That foot and leg is then required to propel you forward to fly through the air once again. Repeat over and over again, and you are running.
Plyometric exercises may be helpful in help

ing you treat runner’s knee. Your PT can help you progress from double leg to single leg exercises. Some exercises that you may do might include:

  • Double leg hop
  • Single leg hopping
  • Diagonal hopping

These exercises may be challenging, and if you experience pain in your knee, you can inform PT will surely guide you in the correct way to progress plyometrics exercises.

If you have runner’s knee or PFSS, you should check in with us at PCA and get started on an exercise program. We are always ready to give a helping hand.

One response to “PT Weekly: Exercise Program for Patellofemoral Syndrome”

  1. Onyinyechi Chukwu says:

    Nice article

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