Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.


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Patellofemoral Pain Syndrome Physical Therapy Guide

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS) also called runners knee, is arguably the most common complaint amongst young adults and athletes. It is mainly an overuse injury which results from poor biomechanics. This is due to an imbalance of the forces controlling patella tracking (quadriceps), and results in pain gradually comes on at the front of the knee, around the knee cap (patella). Recent studies have demonstrated that patellofemoral pain is the most common single diagnosis among runners and within sports Physical Therapy clinics, accounting for up to 11% of musculoskeletal patients, and occurring in 16-25% of all injuries in runners. Individuals who suffer with PFPS typically describe a pain that is behind or underneath the knee cap, however sometimes the pain cannot be located. Patellofemoral pain syndrome has traditionally been considered to be a self-limiting condition. However, it may predispose individuals to the development of knee osteoarthritis, it is vital therefore that an appropriate rehabilitation programme is put into action to prevent secondary injuries from occurring.

What Causes Patellofemoral Pain Syndrome?

The most common cause of patellofemoral pain syndrome is the result of a sudden adaptation in training or increase in running mileage, which places a further stress on the knee joint structures that they aren’t capable of dealing with. The high load on the quadriceps and patella causes inflammation and pain. Of course mileage isn’t the only variable, it might be an increase in speed, or hill work, a change of running surface or how you space your runs out over the week. The most common causes of PFPS include:

  • Overload training: Doing too much activity that your body is not accustomed to can cause this injury.
  • Inappropriate or excessively worn footwear.
  • Attempting to much lower extremity resistance training (particularly squats and lunges)
  • Poor biomechanics

There are many risk factors that can predispose you to developing PFPS. The risk factors include: Malalignment of lower limb bones, poor muscular strength and flexibility and patella hyper-mobility.

What Are The Symptoms?

  • Knee stiffness: most evident when sitting for a prolonged period of time with the knees bent.The symptoms of patellofemoral pain syndrome are usually of gradual onset, although some cases can be caused by a traumatic event, and may even occur on both knees simultaneously. Common symptoms include:
  • Knee pain: with activities that load the patellofemoral joint, such as climbing or descending stairs, squatting, or running. The pain can be difficult for the patient to localize. The pain usually is described as “achy,” but it can be sharp at times.
  • Knee giving way: some patients may complain of the knee giving way due to patellar instability.
  • Swelling
  • Clicking sounds in the knee joint.
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KT Tape

Check out our review of KT Tape here!

KT tape can be used to reduce the pain and swelling around your knee joint by increasing lymphatic drainage and therefore aid in the healing process of your PFPS. Furthermore, tape can be applied to restrict unwanted patella movements and improve the bodies biomechanics whilst performing an activity. KT Tape also has a host of taping guides if you’re stuck and want some inspiration, you can find these on their website here! 

What Are My Treatment Options?

There are many treatment options available to people who suffer from patellofemoral pain syndrome! Your rehabilitation programme and recovery time depend entirely on how severe the knee pain is, and what caused it in the first place. Make sure you get a full assessment from your health care professional before starting any programme.

Rest & Time

Initially, you need to stop doing the activities that caused the patellofemoral pain in the first place and prevent agitating it further. Immediately following the injury you should commence the RICE protocols:

  • Rest. Rest, relax and protect your knee joint and surrounding soft tissue. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Cold packs will reduce pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice directly on to skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the lower leg with a compression sleeve will help decrease swelling and improve recovery time. You can find our favourite knee compression sleeve here!
  • Elevation. Elevate your feet to reduce swelling and bruising in your knees.

Physical Therapy

Although rest is a vital component of the recovery process, it doesn’t mean the affected leg has to be completely immobilised for long periods. In fact,  the muscle fibres need to be placed under tensile loads to grow and stay healthy.  The easiest way to strengthen your quadriceps and other leg muscles? Exercise! 

Patellofemoral Pain Syndrome Exercises

1) Static Quadriceps

Maintaining strength in the thigh and hip is extemely important for the knee to function properly and improve biomechanics, thus reducing the chances of PFPS returning at a later date. It will also allow you to get back to a normal walking pattern quicker. Static quads are the easiest exercise to strengthen the quads.

How to do it:

  • Place a towel under the straight (operated) leg.
  • Tighten your thigh muscles and imagine you are pushing your knee cap down into the towel.
  • Hold for 15 seconds and release.

Repeat multiple times throughout the day!

2) Eccentric Quadriceps

Eccentric exercises focus on working muscles as they lengthen, rather than as they contract. Completing eccentric quadriceps exercises will strengthening the weak muscle fibres whilst stretching them at the same time! Win win!

How to do it:

  • Start on all fours in a tabletop position, with your shoulders positioned over your hands and your hips over your knees.
  • Slowly straighten your knees whilst keeping your toes on the floor.
  • Very slowly lower your knees back down to the starting position

Repeat 10 reps, three sets, twice daily.

3) Step Downs

Step down exercises are a great eccentric quadricep exercise that encourages improvement in the function and range of motion of the ankle and knee. Step exercises should be performed carefully at home using a rail for support until the exercise can be performed confidently with no balance issues.

How to do it:

  • Standing on a step or a block facing downwards (hold a rail for balance).
  • Step down off the step very slowly, tensing the supporting leg as you do so.
  • Return back to the starting position

Repeat 10 reps on each leg, for 3 sets.

4) Quadricep Stretch (Standing)

How to do it:

  • Stand on the leg you aren’t stretching and grab the foot/shin of the “stretching leg” by bending your leg behind you.
  • Tuck your pelvis in, pull your ankle toward your bottom, making sure your knee is pointing to the ground. Try not to pull the knee backward or sideways.
  • Hold for 20 seconds and then switch sides.

Repeat 10 times throughout the day.

5) Dynamic Hamstring Stretch

Dynamic hamstring stretches involve gentle swings of the affected leg forwards and backwards gradually getting higher and higher each time. There is no set number of swings to achieve, aim to do more than 20. It is a great exercise to get the blood pumping to your hamstring and to lengthen the muscle fibres and tendons.

6) ITB Stretch

It is close to impossible to stretch the ITB due to its anatomical location, but this exercise gets the closest.

How to do it:

  • Stand upright facing a counter or worktop that you can rest on.
  • Cross your injured leg behind the other leg.
  • Lean slowly towards the opposite of the injured side with your upper body until you feel a stretch down your injured hip.
  • Hold stretch for 15 seconds.

Repeat 5 times

7) Adductor Squeezes

This exercise is also known as a “ball bridge”. Remember to briefly hold each position before slowly progressing to the next position. Focus on tensing your groin muscles together.

How to do it:

  • Lying flat on the floor, bend both of your knees to 90° with your feet flat on the floor.
  • Place an exercise ball between your knees and hold it there by squeezing your groin muscles gently.
  • Hold these groin squeezes for 5 seconds.
  • To progress, perform a glute bridge by lifting your bottom off the floor whilst squeezing the ball with your groin muscles.

Repeat 5 times, three times throughout the day.

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Foam Rolling Tight Muscles

Deep massage of the tight soft tissue around the knee is a (slightly) painful treatment intended to speed up the recovery process of Patellofemoral pain syndrome by eliminating the root cause. Deep massage is often used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep massage is to improve the mobility of the muscular tissue and prevent adherent scars forming from disuse. The massage is deep and can be very sore for people who have very tight muscles, however the movement encourages lengthening of the muscle fibres and will improve your recovery time.

You can buy our favourite roller here!