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Patellofemoral pain syndrome treatment exercises - Do's and Don'ts

Strength and control exercises can help treat patellofemoral pain syndrome.
Kim Van Deventer
Kim Van Deventer
Nov 13, 2023
Medically reviewed by
Maryke Louw
Exercise is a powerful tool in recovering from patellofemoral pain syndrome. Learn what exercises work, what to avoid, why, and how to get it right for the best results.

Exercises work for patellofemoral pain because they address the underlying causes of your condition, not only your pain.

When choosing treatment exercises for patellofemoral pain syndrome, knowing what to avoid is just as important as knowing what to do. So, before we demo the exercises you should be doing, let's quickly look at what to avoid and why.

Exercises like deep squats often aggravate patellofemoral pain syndrome and are best avoided during the early rehab stages.
Exercises like deep squats often aggravate patellofemoral pain syndrome and are best avoided during the early rehab stages.

Common exercise pitfalls to avoid

The most common mistake people make (therapists included) is choosing exercises that don't match the knee's current strength and sensitivity.

Rehab exercises only work if they match your injury's stage of healing. If they are too advanced, they will overload the injured area and cause your patellofemoral pain to worsen.

The 2 most important factors to adjust for patellofemoral pain syndrome are...

1
The angle of your knee
As you bend your knee, your kneecap presses increasingly against the bones beneath it. When you have patellofemoral pain syndrome, this can worsen your pain (similar to pressing on a bruise). This is why avoiding exercises like quad stretches and limiting how far down you squat is essential during the early stages of recovery.
2
How you load your knee
When you squat, all the muscles in the leg share the load. When you use the leg extension machine, only your front thigh muscles (quads) do all the work. Because the kneecap sits inside the tendon that attaches the front thigh muscles to your lower leg, this causes it to compress forcefully against the bones beneath it. This can increase your pain, so the squat movement is better than leg extensions.
Your kneecap (patella) sits inside the tendon that connects your quadriceps muscles (quads) to your shin bone.
Your kneecap (patella) sits inside the tendon that connects your quadriceps muscles (quads) to your shin bone.
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Adapting your exercises to your patellofemoral pain syndrome recovery stage

Early rehab

When your knee's still easily irritated, it's usually best to focus on exercises that improve core and leg strength but don't move or load the knee.

Once your patellofemoral pain settles a bit, the high wall-sit exercise is often a good option to get the quads working, as it doesn't load the patellofemoral joint much.

Taping your knee can also help reduce your pain and allow you to better progress with your exercises.

Examples of early-stage exercises for patellofemoral pain syndrome

You can find a more detailed discussion about stretching and example stretches for patellofemoral pain syndrome in here.

Top tip!

Check out the tips section of the individual exercise instructions for why we've chosen that specific exercise and how to adapt it if it causes pain.
Clams work well as a low-load exercise for patellofemoral pain syndrome because they don't load the knee joint.
Clams work well as a low-load exercise for patellofemoral pain syndrome because they don't load the knee joint.

Mid-stage rehab

Your early-stage rehab exercises must slowly increase in intensity until you're ready to start the mid-stage exercises safely.

It is usually best to still avoid loading the knee in positions that strongly compress the kneecap against the thigh bone (greater than a 90-degree knee bend), as that can easily cause a flare-up. Slowly build to using weights and moving into lower positions.

Examples of mid-stage exercises for patellofemoral pain syndrome

Want help with your rehab? The Exakt Health app guides you through the rehab process step by step. It provides straightforward advice on when to progress, maintain, or take your exercises back a level — helping to minimize flare-ups and keep you on track with your recovery.

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Woman using the Exakt Health app to treat her patellofemoral pain syndrome.

Late-stage rehab

Moving on to exercises requiring greater control, like single-leg squats, is important. These resemble the loads and movements we use when we run. Ease into them slowly and continue to limit the range to above 90 degrees knee bend to avoid flare-ups.

The exercises must match your goals

These examples are appropriate for people who want to get back to sports like running. They are unnecessary if you just want to walk and do your daily tasks pain-free.

Examples of late-stage exercises for patellofemoral pain syndrome

Sometimes, doing specific drills to improve your running form can also help.

The single-leg deadlift exercise helps treat patellofemoral pain syndrome by strengthening your glutes and hamstrings while improving your position sense.
The single-leg deadlift exercise helps treat patellofemoral pain syndrome by strengthening your glutes and hamstrings while improving your position sense.

Exercises to avoid in early treatment of patellofemoral pain syndrome

Why avoid them? These exercises create high forces in the patellofemoral joint. They can increase your pain if you do them during the early treatment stages of patellofemoral pain syndrome.

  • Quadriceps (front thigh muscle) stretches
  • Deep squats
  • Leg extension machine
  • Using heavy weights
  • Single leg squats
  • Lunges

This doesn't mean that these exercises are bad! As your recovery progresses, you can usually add them back in. Your physical therapist can guide you on this.

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Man using the Exakt Health app to treat his patellofemoral pain syndrome.
Quad stretches usually worsen patellofemoral pain if done too early into treatment or too forcefully.
Quad stretches usually worsen patellofemoral pain if done too early into treatment or too forcefully.

What about VMO exercises?

Previously, it was thought that weak inner quadriceps muscles (Vastus Medialis Oblique) lead to poor kneecap tracking, which could increase the strain on certain parts of your patellofemoral joint and cause patellofemoral pain syndrome.

As a result, targeted VMO exercises were usually prescribed to help treat the condition.

However, research shows:

  • Not all people with patellofemoral pain syndrome have weak VMO muscles
  • VMO exercises don’t improve symptoms more than general quadriceps strengthening exercises

Based on these findings, and that general quad strengthening is much easier for people to grasp than isolated VMO exercises, many experts have moved away from prescribing them for patellofemoral pain syndrome.

More about patellofemoral pain syndrome

Conclusion

Exercises are key to your recovery from patellofemoral pain syndrome. They can help you improve your biomechanics and strengthen your quadriceps to reduce the strain on your patellofemoral joint.

Knowing which exercises to do and how to start and progress your exercises correctly can mean all the difference for your recovery.

If you would like to learn more about patellofemoral pain syndrome, its causes, long-term effects, and other treatments, our overview article discusses all this and more.

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Woman using the Exakt Health app to treat her patellofemoral pain syndrome.
Kim Van Deventer
Kim Van Deventer
Kim Van Deventer is a freelance healthcare writer and digital content strategist for healthcare businesses and medical content agencies. She has a BSc in Physiotherapy and worked as a physiotherapist for more than 14 years, specializing in sports injury rehabilitation, chronic pain management, and women's health. Kim combines her clinical experience and digital marketing skills to create relevant and helpful content that improves patients' lives.
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