Patellofemoral pain syndrome exercises

Are you a runner with patellofemoral pain syndrome (also sometimes called runner’s knee) stuck in a yo-yo cycle of pain and recovery?

Then, this article is for you.

While many treatments are available for this condition, exercise is at the heart of most successful recovery plans.

When you do the right exercises correctly, you can help your knee function and strength improve over time. This can help you get rid of the pain for good and get back to running confidently.

This article looks at what exercises are best, why they work for patellofemoral pain syndrome (PFPS), how to get the most out of them, and what to avoid for the best results.

Why exercises work for patellofemoral pain syndrome

Exercises help address the underlying causes of your condition, not only your pain.

In our runner’s knee overview article, we explained that there isn't one clear cause for patellofemoral pain syndrome. Instead, multiple factors likely contribute to it.

Your rehab program should address the combination of factors that contribute to your injury. So, selecting and performing your exercises correctly is essential for an effective recovery.

Getting your exercises right

To select the right exercises, you need to know what caused your patellofemoral pain. That way, you can determine your rehab goals.

Once you know your rehab goals, you can choose the best exercises to help you recover based on their aims. In patellofemoral pain syndrome, exercises generally have two primary aims:

1. Improving your biomechanics

This helps to keep your hips, knees, and ankles well-aligned (not turning in or moving inward excessively), reducing the strain on your patellofemoral joint.

1. Increasing your general quadriceps strength

This helps your knee absorb impact, support, and better protect your knee joints (including your patellofemoral joint).

Next, let's look at the most frequently prescribed exercises for patellofemoral pain syndrome.

Common exercises for patellofemoral pain syndrome

Note: The following exercises are only examples of exercises frequently recommended for PFPS. They do not constitute a complete rehabilitation program.

In addition, since everyone's injury, activity levels, and demands are different, you need to adapt each exercise to your circumstances.

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Lower-load exercises for patellofemoral syndrome

1. The Clam (with band)

This is a good low-load starter exercise. It helps improve your core and hip strength and control without straining your patellofemoral joint.

Instructions

1. Tie a resistance band around your thighs.
2. Lie on your side.
3. Bend your hips to about 60 degrees and your knees to 90 degrees.
4. Tighten your core muscles to help stabilize your upper body and pelvis.
5. Keep your knees bent and feet together, then lift your top knee up and away from the bottom one - so your leg opens like a clamshell.
6. Pause for a moment, then slowly lower your knee back down.
7. Aim to do 10 repetitions, but don't force it. If this is difficult, do as many as is comfortable and add more repetitions as you get stronger.
8. Rest for 60 seconds.
9. Do 3 sets on each side.

Check your technique: Your pelvis and hips should not roll backward as you lift your leg, and the movement should be smooth, not jerky.

2. Single-leg balance

This exercise helps improve your balance and builds a good sense of control around your ankles. In addition, it helps reduce excessive foot pronation (rolling in), which helps keep your lower leg and knee optimally aligned.

Instructions

1. Stand and gently tense your core muscles, then shift your weight to one side.
2. Lift your foot off the floor, keeping your pelvis level.
3. Balance on one leg.
4. Keep your foot as still as possible, not allowing it to roll in or out.
5. Work on this until you can easily balance for 30 seconds.
6. Switch legs and do the same on the other side.
7. Repeat 3 times on each leg.

Check your technique: Try keeping your foot still without letting it roll in or out. If this is difficult, slightly bend your knee or place one finger on a secure surface to steady yourself.

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Higher load exercises for patellofemoral pain syndrome

3. Squats (with band)

This exercise helps strengthen your quadriceps muscles while building your patellofemoral joint's load tolerance. It also works on your lower body (hip, knee, and ankle) alignment and coordination.

** Remember to continuously adapt your exercises to your recovery phase and symptoms. This type of loading can aggravate your knee if you start at too high a level for your injury.

Instructions

1. Stand with your legs close together and tie a resistance band around your knees.
2. Then separate your legs hip-width apart.
3. Turn your knees against the band's resistance, pointing them in line with the middle of your feet.
4. Stretch your arms out in front of you - this will help you balance.
5. Squat down by pushing your bottom out behind you (as if sitting on a chair) and bending your knees. Try to reach a 90-degree angle at your knees.
6. Check that your feet don't roll in as you squat down and your knees move in line with the middle of your feet.
7. Pause at the bottom of the movement and then return upright.
8. Aim to do 15 repetitions, but don't force it. If this is difficult, do as many as is comfortable and add more repetitions as you get stronger.
9. Rest for 60 seconds.
10. Do 3 sets.
    

Check your technique: The resistance band makes your glutes work harder during this exercise. Ensure your knees move in line with the middle of your feet to keep the correct form throughout the movement.

4. Single-leg box squat

This exercise is an excellent high-level all-rounder exercise for the final stage of PFPS rehab. It helps strengthen your quadriceps, improve your lower body alignment and control, and train your balance.

Instructions

1. Find a chair you can stand up from using only one leg. The chair should allow your knees to bend to 90 degrees while sitting. If this is too difficult, use a higher surface or pillows on the chair to make it easier.
2. Sit on the edge of the chair, keeping one foot on the floor and the other off. Have your hands at your sides or in front of you.
3. From sitting, slowly stand up using only one leg. Keep your pelvis level and knee in line with the middle of your foot as you move.
4. Slowly sit down again.
5. Aim to build up to 10 repetitions, but don't force it - gradually increase the repetitions over several sessions.
6. Switch legs.
7. Do 3 sets on each leg.

Check your technique: If this is too difficult for you, you can use cushions on the chair to make it higher. Or place your hand on a wall to stabilize yourself.

Tips for getting your knee exercises right (and what to avoid)

Pitch your exercises at the right level (at all stages of your recovery)

It's essential to adjust your exercises (type, position, intensity) to avoid worsening your pain but still build strength and promote healing. This is challenging, especially at first. It takes a lot of patience and trial and error to get right, but it can be done.

Know and monitor your baseline levels

To ensure you're working at the right level, you will need to know your baseline pain level and monitor it.

Your baseline pain is the normal level of pain you experience throughout the day when you don’t exercise.

As a guide, your pain shouldn't increase more than 3/10 (where 0=no pain; 10=worst pain ever) during any exercise or within 24 hours after.

We've designed the Exakt Heatlh app to help you quickly find your baseline and get the right balance between rest and exercise so that you can progress through your rehab more efficiently.

Avoid going back to running too soon

As a runner, the temptation to get back on the road when your pain starts to feel better will be strong, but this may not always be a good idea.

If you've rested and started with exercises and your pain has improved, that is excellent! It means your injury is settling, and healing has likely begun. But remember, complete recovery takes time, and your knee needs to get strong enough to handle the full impact of running before you get back to it.

Try your best to stick to your recovery program (even when your pain improves) and keep aiming for each rehab phase's goals. That way, you will help yourself progress and return to running sooner than you think (and in better condition).

Take care with quadriceps exercises

Quadriceps strengthening exercises form a very important part of your rehab, but they can sometimes irritate your patellofemoral joint.

This is because the more you bend your knee, the more you stretch your quadriceps muscle, which presses your kneecap deeper into your patellofemoral joint.

How to avoid aggravating your injury with quadriceps exercises

• Ease into quadriceps exercises - starting with low-load positions and building from there
• Avoid deep squats or knee bends (like in the picture below), especially during early rehab - this is when your knee is most likely to get irritated

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 PFPS have weak VMO muscles
• VMO exercises don’t improve PFPS 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 all PFPS cases.

While some VMO work may be helpful in certain cases, it is not as crucial as correcting training errors and improving movement control.

Stretching for patellofemoral joint pain syndrome

Stretches may not be as helpful for patellofemoral pain syndrome as many people think.

Instead of focusing on stretching, it may be more worthwhile to work on improving your biomechanics and overall strength, mobility, balance, and control.

That way, your kinetic chain (the interconnected parts of your body) is better aligned, your body moves more optimally, and your knee can bear load and function more effectively.

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 about patellofemoral pain syndrome discusses all this and more.

Good luck!