Stretching exercises. Strengthening exercises. We recommend seeking professional advice before beginning rehabilitation. The aim of Patellofemoral pain syndrome exercises is to correct tracking of the patella as the knee bends. Most commonly the patella tracks outwards laterally so the muscles on the inside of the thigh need strengthening.
The tight structures of the knee such as the lateral retinaculum need to be stretched and mobilized. Swith the your knee slightly bent. Glide or pulled your patella towards the inside of your knee. Hold for 20 to 30 seconds. Hold the foot of the leg to be stretched and gently pull up behind. It can be done in the standing position most common or lying down as shown. Aim to keep the knees together and pull the leg up straight not twisted.
The athlete should feel a stretch at the front of the leg. It should not be painful. Hold stretches for seconds. Repeat times. Important — if this stretch is painful for the knee then do not do it. Place the leg you want to stretch behind the other one. Put your weight onto your back leg, hold onto something to lean on if necessary.
To stretch the long groin muscles which cross the knee joint stand with the feet wide apart. To stretch the short groin muscles sit on the floor with the soles of your feet together. Place your elbows on the inside of your knees and gently press down until you feel a stretch. Exercises can usually begin as soon as they can be performed without pain. The aim of patellofemoral pain exercises is encourage normal patella tracking.
In particular, to strengthen the muscles on the inside of the knee vastus medialis obliques , as well as the gluteus medius muscle on the outside of the hip. Sit on the floor with a foam roller or rolled-up towel under the knee so that it is slightly bent. Place your hand on your vastus medialis muscle just above and to the inside of the knee cap.
This is so you can feel it contracting. J Multidiscip Healthc. Published online Oct Author information Copyright and License information Disclaimer.
This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome. Methods A systematic review of randomized controlled trials was undertaken. Results A total of ten randomized controlled trials were included in this review and from these trials 14 interventions arms were evaluated.
Conclusion Currently, the primary research on this topic supports the use of closed kinetic chain, strengthening exercises for musculature of the lower limb, combined with flexibility options. Keywords: patellofemoral pain syndrome, PFPS, repetitions, lower limb, musculature.
Introduction Patellofemoral pain syndrome PFPS is one of the most common knee conditions seen by physiotherapists, affecting one in four people of the total population. Open in a separate window. Figure 1. Abbreviation: RCT, randomized controlled trial. Abbreviation: PFJ, patellofemoral joint. Inclusion All randomized controlled trials from peer reviewed journals written in English, available in full text, and matching the above selection criteria were included in order to increase the rigor of the systematic review design.
Methodological assessment All included trials were critically appraised by two independent reviewers using the PEDro scale, 12 an eleven-point scale commonly used to rate the methodology of randomized controlled trials.
Data extraction Relevant data was extracted manually and entered into the data extraction table see Table 2.
Table 2 Characteristics of effective exercise interventions for patellofemoral pain. Actual exercises not specified. Results Search findings The literature search revealed ten studies meeting the systematic review criteria.
Quality of the studies included Studies meeting the inclusion criteria were scored using the PEDro critical appraisal tool. Figure 2. The interventions Table 2 details the exercise parameters used in each of the studies. Program duration and frequency All trials reported frequency per week and duration in weeks. Intensity Intensity ranged from varying percentages of maximum effort to failure to report.
Sets and repetitions The included trials reported a minimum of ten repetitions, except two studies 9 , 16 which involved lengthy isometric contractions repeated a lesser number of times.
Technique Although the majority of studies included specific instructions for aspects of the techniques applied, the overall explanation of the interventions was not mentioned. Stretching Stretching was included in eight of the ten trials. Table 3 Details of stretching and co-interventions reported. Discussion This review provides evidence-based recommendations to clinicians who wish to use exercise programs to improve pain and function in patients with patellofemoral pain.
Type of exercise The high frequency of both OKC and CKC exercises employed by the included studies indicates support for the use of both exercise types. Program duration The majority of the trials reported an intervention period of 6 weeks, except Witvrouw et al 4 and Bakhtiary and Fatemi, 7 which reported 5- and 3-week intervention periods, respectively.
Frequency and intensity The majority of studies eight out of ten prescribed 5 or more days of exercises per week. Strength Strength as a target of treatment was explicitly stated by nine of the ten studies.
Flexibility Stretching of various lower limb musculatures was included as an adjunct to exercise in eight of the ten trials. Sets and repetitions The review revealed a minimum of 20—40 total repetitions should be considered when prescribing exercises for patellofemoral pain. Limitations This review focused on exercises undertaken as part of a structured exercise program rather than general exercises such as walking and unstructured exercises such as Pilates. Conclusion Implications for practice This systematic review builds on the current body of evidence which supports the use of exercise in reducing pain and increasing function ability in patients with PFPS.
Last amended June 21, Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. McConnell J. The management of chondromalacia patellae: a long term solution.
Aust J Physiother. What are effective therapies for anterior knee pain. In: Wright JG, editor. Fagan V, Delahunt E. Patellofemoral pain syndrome: a review on the associated neuromuscular deficits and current treatment options. Br J Sports Med. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study.
Am J Sports Med. Management of patellofemoral pain targeting hip, pelvis and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther. Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. Bakhtiary A, Fatemi E. Open versus closed kinetic chain exercises for patellar chondromalacia. Herrington L, Al-Sherhi A.
A controlled trial of weight-bearing versus non-weight-bearing exercises for patellofemoral pain. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomised controlled pilot study. Clin Rehabil. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening.
Man Ther. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. Physiotherapy Evidence Database. Reliability of the PEDro scale for rating quality of randomised controlled trials. Phys Ther. The efficacy of treatment of different intervention programs for patellofemoral pain syndrome — a single blinded randomised clinical trial.
Pilot study. Scientific World J. Physiotherapy for anterior knee pain: a randomised controlled trial. Ann Rheum Dis. Physical therapy for patellofemoral pain. Foam roller: These are great. A reasonably dense Foam Roller preferably. Lying on your side as shown. Quads stretch:. Tip: you do not need to lunge forward, to add more stretch, tuck your bum in under you or put back foot up on something eg.
Note: if this hurts the knee even with padding then stop doing it and wait a couple of weeks before building it in. Often it is not the knees fault all this pain and discomfort happens, so to treat this condition it is important to look above quads, ITB, hip and below foot, calf.
Follow this advice for at least 12 weeks yes three months, you NEED to be serious about this to decrease the risk of early knee arthritis and ongoing pain. Glute activation, the missing link. Quick stability and balance test. A good research paper if you want more info on PFPS research. Hi there and thank you so much for this resource! I was just wondering, would you recommend doing any low resistance cycling on top of this at all?
And what is your opinion on McConnell taping?
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