patellofemoral syndrome exercise program
Patellofemoral syndrome is the most common cause of anterior knee pain. It comes on gradually, usually in young adults. Pain is located just behind the knee cap, and is aggravated by squatting, stairs, kneeling, and walking. It is caused by the knee cap tracking improperly when it moves. Therapy involves stretching the muscles on the outside of the knee and strengthening the muscles on the inside of the knee to help the knee cap track better.1 The following exercise program should help improve your symptoms gradually over time. It should be done once through every day.
Stretching: 2,3
All stretches should be 3-5 minutes, held gently to the point of stretch but not pain, and should involve consistent pressure (no bouncing). They should be done 2-3 times per day.
Lateral hip stretch: start with your hip pushed towards your painful knee. Cross your good leg in front of your bad leg, placing your feet as wide as you can. Turn your back foot out so you are resting on the outside of your foot. Raise your arm on the good side and bend it over your head. Continue to push your hip out towards your painful knee. You should feel this in the outside of your hip.
Once this stretch becomes comfortable, perform the same movement but lean into a wall. Your arms on the painful side should be pushing into the wall and your hip should be pushing towards the wall as well.
Hip flexor stretch: stand in front of a chair. Put the top of the foot of the leg with the bad knee on the chair. Lower yourself down so your knee is on the ground. Make sure your torso is straight; your knee, hip, and shoulder should all be in a straight line. As this stretch becomes easier, move your knee inward toward the centre of your body to focus the stretch more on the outside of the leg. If the stretch it too challenging at first, place your knee on a few books to make it less intense, and slowly remove the books over time.
Strengthening:2,3
The goal for each exercise should be 3 sets of 10 repetitions. Perform these exercises even if you experience some discomfort, but stop if you have pain. You likely will not get to 3 sets of 10 initially, so do not get discouraged. Just do as many as you can. Do these exercises once daily.
Medial thigh strengthening: do a slow wall down with a ball between your knees. Squeeze the ball tight between your knees and come back up. Start by doing a very shallow squat (30°) and progress to a deeper squat (90°) as tolerated.
Step ups: Very slowly step up 6-8 inches (the height of one stair) onto a step with your bad knee. Step down back to the ground starting with your good knee. As you get more comfortable, progress to 12-16 inches.
Follow-up:
Please see your doctor again 6 weeks after starting this program. At that appointment they can check your progress. If you have had no improvement, your family doctor may decide you have more widespread dysfunction of the knee than a simple home exercise program can correct and may want to refer you to physiotherapy.3 They may also want to consider referring you to a sports medicine specialist if the diagnosis is unclear.
1. Barton CJ, Webster KE, Menz HB. Evaluation of the scope and quality of systematic reviews of non-pharmacological conservative treatment for patellofemoral pain syndrome. Journal of Orthopedic & Sports Physical Therapy. 2008;38:529-41.
2. Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med 2002;30:857-65.
3. Bhave A, Baker E. Prescribing Quality Patellofemoral Rehabilitation Before Advocating Operative Care. Orthop Clin N Am. 2008: 39;275-85.
