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

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.

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.

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.

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

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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.

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.

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 physiotherapist can guide you on this.

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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.

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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