Exercises for patellofemoral pain syndrome may include both stretching and strengthening, particularly of the thigh muscles at the front of the leg.
Most commonly the patella tracks outwards (laterally) so the muscles on the inside of the thigh need strengthening and the muscles on the outside of the knee usually require stretching. We recommend seeking professional advice before beginning rehabilitation. The following are examples of stretching and strengthening exercises which may be used as part of a patellofemoral pain rehab program.
The tight structures of the knee such as the lateral retinaculum need to be stretched and mobilized. The athlete sits with the knee slightly bent. The kneecap is glided (pulled) towards the inside of the knee and help for 20 to 30 seconds.
Quadriceps stretch - 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 20-30 seconds. Repeat 3-5 times. Important - if this stretch is painful for the knee then do not do it.
Iliotibial band stretch - 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. Hold for 20-30 seconds, repeat 3-5 times and do this at least three times a day. It is a lot of stretching but it is worth it in the end if you want to be rid of this injury. Never bounce when stretching, always ease into it gently and try to relax. If it is painful you are not doing it properly
Long adductor stretch - To stretch the long groin muscles which cross the knee joint stand with the feet wide apart. Bend the knee that you don't want to stretch and lean away from the one you are stretching. Hold for 20-30 seconds and repeat 3-5 times, at least 3 times a day.
Short adductor stretch - To stretch the short groin muscles the athlete is sat on the floor with the soles of the feet together. The elbows are placed on the inner knees and a gentle downward pressure is applied until a stretch is felt. Hold for 20-30 seconds, rest and repeat 3-5 times, 3 times a day.
Patellofemoral pain exercises for strengthening the muscles which help correct patella tracking. Exercises can usually begin as soon as they can be performed without pain. The aim of patellofemoral pain exercises is usually to strengthen the muscles on the inside of the knee or vastus medialis obliques as well as the gluteus medius muscle on the outside of the hip.
Isometric quadriceps - This is suitable for the athlete that has pain and is unable to perform standing exercises. The athlete sits on the floor with a foam roller or rolled up towel under the knee so that it is slightly bent. The hand is placed on the vastus medialis muscle (just above and to the inside of the knee cap) so the athlete can feel it contracting.
It is essential that the athlete learns to isolate the vastus medialis muscle and feel it being used for strengthening to be effective. Turning the foot outwards may increase the load on the VMO. A muscle stimulator or tens machine can help in the early stages. Contact the muscles, hold for 3 to 5 seconds, relax and repeat 10 times. The foot should lift up off the floor as the knee straightens. This exercises should be performed 3 to 5 times a day if pain allows.
Heel drop exercises
A more advanced exercise than a static contraction. Again it should be emphasized that the knee should be kept pointing forwards throughout the exercise and the athlete should be aware that it is the vastus medialis on the inside that is working.
The athlete drops down off the step as far as is comfortable (this does not always need to be all the way down) and returns to the starting position. Repeat 10 times and aim to perform a number of sets throughout the day.
Lay on your side with the knees bent to 90 degrees and feet in line with your spine. Lift the top knee away from the bottom knee. Make sure you keep the lower back and pelvis still and don't rock backwards. You should start to feel the Gluteus Medius muscle at the back, top of the hip working. Start with 2 sets of 10 repetitions and gradually increase to 3 sets of 15-20.
This exercise should be started as soon as pain will allow. Tape the knee if necessary to avoid pain. Stand one foot in front of the other, the injured knee forwards. Bend the front knee enough to feel the vastus medialis is working. Aim to keep the knee pointing forwards - don't let it fall inwards. Return to starting position and repeat. Aim for 3 sets of 10 repetitions. Again it may be better to perform a number of sets throughout the day, especially in the early stages of rehabilitation or for a particularly weak muscle.