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FACT CHECKEDDo you have pain in the front of your knee whenever you run or squat? Does it hurt even when you do simple things like walk up stairs or sit down for too long? If the answer is yes, you may very well have patellofemoral pain syndrome…
Before we start, the good news is if you have patellofemoral pain syndrome (front/anterior knee pain), you can cure it with simple home treatment and targeted patellofemoral pain syndrome exercises.
In this article, we will cover the following:
Patellofemoral pain syndrome relates to anterior (front) knee pain that is a result of issues between the patella (knee cap) and the femur (thigh bone). It can occur bilaterally or unilaterally (in one knee or both knees).
The pain typically comes on gradually. It is likely to increase when sitting for too long, during excessive use (i.e. walking, running, jumping), during or after weightlifting (i.e. squats) or ascending and descending stairs.
Patellofemoral pain syndrome is most common in people who regularly participate in sports, such as runners, basketball players, football players, and anyone who does vigorous athletics and training.
Patellofemoral pain syndrome can also occur in non-athletes too.
All in all, it is believed to be caused by overuse and problems with the alignment of the kneecap, among other contributing factors.
Fortunately, with simple home treatments, you can ease the pain of patellofemoral pain syndrome, and for most people, cure it completely. In this article, we are going to teach you exactly how to do that.
Now, it’s important to note that “runner’s knee” is a common term used for multiple conditions of the knee - including patellofemoral pain syndrome - which we will get into after we run through the causes, risk factors, and symptoms of PFPS specifically.
Doctors are still unsure what causes patellofemoral pain syndrome, however, it is linked to the following:
Although PFPS can occur in anyone, there are a few risk factors for certain groups of people.
When first developing PFPS, the pain comes on gradually.
The pain is typically dull and aching and it is located at the front of the knee. It can also show itself behind the knee. That said, many individuals have trouble pinpointing the location of the pain.
Some people will describe the pain by signing a circle around the patella. This is known as the “circle sign”.
Another sign is called the “movie sign”, as pain arises when sitting for prolonged periods of time.
Overall, the pain from PFPS is aggravated by:
Now, some of the symptoms of PFPS may overlap with other conditions. So, let’s compare other knee problems so we can differentiate and make sure we have patellofemoral pain syndrome before treating it, as treatments vary depending on the culprit.
Chondromalacia patella is occasionally used interchangeably with PFPS. Yet, the general consensus by doctors and health professionals is patellafemoral pain syndrome applies only to people without cartilage damage.
Patellar tendinitis is different than patellafemoral pain syndrome, but both are called "runners knee". Patellar tendinitis pain is located in either the bottom edge of the kneecap or the tibial tuberosity (where the tendon attaches to the shin bone). Moreover, with patellar tendinitis, the pain typically decreases during activity because the tendon warms up.
All in all, tendinitis is an inflammation of the tendon, whereas patellofermoral pain syndrome doesn’t have to do with inflammation necessarily, it has to do with the nerves. That said, PFPS can lead to inflammation of the synovium and pain in the underlying bone if not treated or continuing activity through the pain.
First off, we are speaking of osteoarthritis, which is caused by mechanical wear and tear of the joint. Not rheumatoid arthritis, which is an autoimmune disease. Osteoarthritis is the most common form of arthritis, so let’s stick to that.
Osteoarthritis of the knee occurs mostly in people over 50. And while you may have early-onset osteoarthritis, if you are a young individual, it is most likely not the case.
Moreover, with osteoarthritis, you will have swelling and a feeling of warmth in the joint. Your knee will also feel stiff, especially in the morning, and you will have less mobility. If you refer back to the symptoms of PFPS, you should be able to differentiate between the two fairly easily.
A torn meniscus is one of the most common injuries of the knee. However, it is hard to confuse with patellofemoral syndrome. A torn meniscus happens suddenly, as a result of an activity that causes you to twist or rotate your knee forcefully. After you tear your meniscus, you will feel a popping sensation. Your knee will swell and become stiff. It will be painful when twisting or rotating it, and it will be difficult to straighten your knee. It will feel like it is locked in place when you try to move it.
So, when considering all the above about PFPS you can easily see the difference. PFPS develops over time, and the symptoms are much different.
Osgood-Schlatter is a common inflammatory disease that occurs during growth spurts in childhood. It usually goes away when the child stops growing. Osgood-Schlatter Disease causes a painful bump under the knee. It worsens during activity and gets better with rest. It causes a “flare-up” that can last a few weeks to months. It can affect one or both knees.
Although both PFPS and OSD can occur in adolescents, the differences in symptoms are considerable, so you should be able to differentiate between the two.
Patellar Tracking Disorder (PTD) is a tracking or alignment issue with your knee, and while Patellofemoral Pain Syndrome (PFPS) can be caused by tracking issues, the two aren’t synonymous.
Patellar tracking disorder refers simply to the alignment and tracking problem, and it may or may not even cause pain. However, if it does cause pain, it will be very similar to PFPS.
All in all, if you notice that your knee is often shifting out of place in a noticeable way, then you should see a doctor.
If you want to avoid a doctor, at least for now, use the above comparisons to first get an idea of what is causing your knee pain. This will help you narrow down the reason for your knee pain.
A doctor will determine your knee pain with an X-ray if necessary.
After assessing your knee pain with the above information, if you are quite sure you have patellofemoral syndrome, you can move on to the treatment. The good thing is, our self home treatment will be safe, as the first part involves rest/RICE, and if the pain doesn’t get better, then you can’t move on to the exercise section and we recommend that you see a doctor. So, you are safe with the below patellofemoral pain syndrome treatment in any case.
Of course, if you have a meniscus tear or pain that occurred suddenly during exercise, sports or another activity, then you should surely go see a doctor straight away.
Before we begin the home treatment for patellofemoral syndrome, we’d like to answer some common and important questions people usually ask.
Now, that we’ve diagnosed our knee pain as PFPS, let’s go over the steps to recover and treat patellofemoral pain at home. There are 3 steps to follow (in order).
The following steps should help you improve, heal, and even cure PFPS so you can get back to your normal activities ASAP.
First, the worst therapy for patellofemoral pain is “stay active”. While this may be the case for some issues in our body, it is not the case with PFPS. So, the first thing we must do if we have knee pain that goes beyond just a rare, fleeting incident, is rest.
All in all, RICE is a very effective method for treating knee and joint pain when done within 72 hours of significant knee pain. Pretty much everyone knows RICE, but not everyone applies it to their painful joint problems. RICE should be done for a few days, especially the “rest” portion, and then your pain should be gone.
If your pain is still persisting after 3 days, it is time to see a doctor.
If your pain is gone, it is time to move on to the next step, which is exercises for patellofemoral syndrome knee pain.
When your pain stops, the best patellofemoral knee pain exercises to start with won’t be very strenuous. You don’t want to just jump right back into your normal workouts/exercises.
The goal of exercising for patellofemoral pain syndrome recovery is to stretch and strengthen the muscles that function on the knee. These exercises can also help reduce any lingering pain.
You will want to strengthen your knee muscles (the ones that act on the knee), quadriceps, hamstrings, glutes, and hip muscles. We will show you the best strengthening exercises to start with below. These will be strengthening exercises that will not put your knee at risk of PFPS returning.
Note: The exercises for the knee are considered stabilization exercises. What they do is strengthen the thigh muscles that support your knee. There will also be knee extension exercises to strengthen the knee.
You are going to want to stretch your quads, iliotibial tract (IT Band), hamstrings, calves, hips, glutes, and lateral retinaculum (fibrous tissue on the outer side of the kneecap).
For both strengthening and stretching exercises, it's important to do a variety of exercises for your front thigh muscles (quadriceps) and back thigh muscles (hamstrings) to ensure that each individual muscle within those muscle groups are targeted effectively. The same concept goes for your calves, hips and glutes.
We are going to list off the best patellofemoral pain syndrome exercises to strengthen your knee so you can prevent future patellofemoral pain. We will explain how to do each exercise and the muscles that they target.
All the exercises require is your body weight. No equipment needed.
Tip: If you hold the top position for a long time, you will be training isometrically, which is great for strengthening the muscles.
Muscles worked: Abductor muscles of the hips, inner thighs, glutes, hamstrings, and obliques.
Increase difficulty by placing a folded towel under your working knee. It will require you to press and squeeze harder.
This is an isometric exercise, so it is going to build up strength in your quads, which is vital as your quad muscles control the knee (as do the hamstrings).
Muscles worked: Quadriceps strengthening.
This is an isometric exercise.
Muscles worked: Quadriceps.
If you want a harder variation of the ham curl, try a lying ham curl with a towel. You lay flat on your back with your heels under a towel and then slide your feet towards your glutes so that your legs are at 90 degrees. You will need a smooth surface for this one so the towel can slide easier.
Muscles worked: Hamstrings and glutes.
The wall sit is an isometric exercise, which means you are contracting your muscles without movement.
Muscled worked: Quads and glutes.
The glute bridge exercise involves both isometric and concentric/eccentric contractions.
Muscles Worked: Glutes, hamstrings and core.
This is one of several effective hip abductor exercises.
Muscles worked: Hip abductor strengthening (outer hips and glutes).
This is an isometric hip adductor strengthening exercise, as you are holding the tension to create force rather than moving to create the force. Here are some more hip adductor exercises.
Muscles worked: Adductor muscles of your hips.
Do these exercises for 3 sets. If the exercise focuses on one leg, then do both sides! Even if only one knee hurts. This will make sure you don’t create any imbalances, and it can help fix any too.
You can do these every day or every other day as they are not taxing on your body. Do these exercises for 4 weeks, along with the below knee exercise and lower body stretches and you should be ready to return to your normal activity in no time!
Even only a few minutes of exercise for each major lower body muscle group a day can make a big difference!
The following resistance band knee exercises are fantastic stabilization and strengthening exercises for curing and preventing patellofemoral pain.
Related: Best Resistance Bands to Buy
Lower body stretches will help to prevent tight muscles and patellofemoral pain, aka runner's knee. In many cases, tight muscles around the knees and hips lead to knee pain, so let’s get ahead of this issue by making sure we are properly stretched (yet not too stretched/laxed).
This is the first calf exercise in our home treatment for patellofemoral pain syndrome. Calf stretches are very helpful for reducing tension related to patellofemoral syndrome.
There are various ways to stretch your calf, so give other variations of calf stretches a go too. That way you can hit all the muscles in your calves.
There are two ways to easily stretch your hamstrings while standing.
For those who are less flexible, simply put one leg forward and keep it straight, and have the other leg's knee slightly bent. Then lean forward, but don’t arch your back.
For a deeper stretch, place one leg up on something like a bench. Keep that leg straight, as well as your leg that’s on the ground. Then lean forward with your hands placed on your hips.
Everyone knows this leg stretch. The key is to make sure you are doing it correctly. Your knee should align with your hips, or even slightly behind even with your hips, and you should be standing straight up. If you have trouble balancing, hold on to something. Be sure to stretch both your left thigh and right thigh equally.
Note: This stretch targets your quads AND your lateral retinaculum.
Sit on the floor with one leg bent at 90 degrees and your foot flat to the ground and your opposite leg fully extended forward. The leg at 90 degrees should be crossed over your extended leg right next to your knee.
Rotate your trunk towards the opposite way of your crossed leg. Use your elbow to gently push your crossed leg, as to get a deeper stretch.
With one leg crossed over the other and your feet together or a few inches apart, lean in the direction of the back leg.
Note: A tight IT Band is commonly the cause for knee pain, so we gave you two IT band stretches to prevent patellofemoral pain syndrome from happening again. These two IT band stretches will also target your piriformis muscle and your outer hips.
Lie down on the floor with both legs extended forward then bring one leg’s knee up to your chest and pull it using your hands to get a deeper glute stretch.
This exercise is essentially a hip and buttock stretch, which means it targets your glutes, hamstrings, hip muscles, and lower back.
Lie on your back and cross your foot over your opposite leg’s quad. Hold the underside of your crossed leg and gently pull it toward your chest. When you feel a comfortable stretch, hold the stretch there.
This patellofemoral pain syndrome stretch targets your glutes, hips, hamstrings, and lower back
This is a stretch taken from Yoga. It is a great one to end your stretching routine as it can be relaxing. Simply lay in this position with your right and left heel touching and legs opened out to the sides, then let gravity do its work. For the other stretches, you are going to hold them for 15 to 30 seconds and do a couple sets, but for this one, you can go as long as you want really. 30 seconds to 2 minutes or so is good.
Muscles stretched: Inner thighs, hips, and groin
Except for the last one, you should hold these stretches for 15 to 30 seconds on each leg. If 15 seconds is hard, start there and work your way up over time.
Do 2-3 sets for each.
These are good to do a few times a week. Say every other day or every couple of days.
Even after your patellofemoral pain is far in the past, you should continue doing these stretches weekly as they are beneficial for more than just patellofemoral pain syndrome, plus they will help prevent it from happening again!
Now you are ready to get back to your normal activities, which includes taxing workouts, running, and everything else you love to do.
However, there are a few things you should avoid and things you should do to prevent PFPS from coming back!
Here are some tips to following once you are back to your normal routine.
These are bad exercises for people with a history of patellofemoral pain syndrome:
While you can still do these if you so please, just pay attention to how your knee feels and make sure you are warmed up for them! If your knees feel painful, stop immediately.
We all know squats are the king of leg exercises, but you don’t need to go deep for them to be effective!
If you feel misalignment or muscle imbalances are a cause of your PFPS, then wear a knee sleeve, knee brace or tape your knee during strenuous activity that involves your knee. This can help prevent it from happening again.
If you are feeling pain again, but it’s not too bad. Try heat and cold therapy after a workout or a run. Then, take a rest for a couple of days.
If you are overweight, losing some pounds will make a big difference to the pressure on your knees.
Focus on high reward low-risk exercises that strengthen your quads, hamstrings and glutes. Do unilateral exercises as well, as to work on muscle imbalances and improve balance and stabilization.
As with strengthening your muscles, continue stretching them. Just make sure you don’t overstretch, as you don’t want to be hyperflexible. You just want to have normalcy in your muscles. Put simply, don’t overdo it.
Here are some answers to frequently asked questions about patellofemoral pain syndrome...
With rest and proper physical therapy, whether done on your own or with a professional, you can slowly work your way back to normal and continue with your normal activities. However, for some people, it can be a chronic pain problem that needs to be dealt with on a regular basis as PFPS can be very treatment-resistant.
Patellofemoral syndrome is not likely to cause permanent damage if managed correctly. However, if you tough it out, and work through the pain regularly, you can cause structural changes as you will be changing the way you move to compensate for the discomfort and pain. So, it’s best to treat PFPS seriously and not to “tough it out”.
If you continue to overuse your knee(s) or work through the pain, patellofemoral syndrome can lead to other issues such as tendon inflammation and structural changes. It is recommended that you rest and recover and treat the issue before continuing regular activity to avoid this. This is not a condition that you want to "keep active" while experiencing pain.
Patellofermoral syndrome can go away on its own if you stop doing the activity that causes it, which can be hard to identify in some cases. For runners, if you stop running for a while and treat PFPS in the right manner, it should go away. For others, it will be a chronic pain issue that needs constant treatment, such as rest if it starts hurting, knee exercises, and wearing knee sleeves when training.
Typically it can last for weeks and even months. With proper treatment, around 90% of people suffering from patellofemoral syndrome can become pain-free. Use our treatment method below to achieve a pain-free knee!
Patellofemoral syndrome can affect one or both knees. It can occur in both children and adults as well.
This depends on your pain tolerance. The pain is usually aching and dull and manageable. However, if you continue to overuse your knees, it can become quite painful and even debilitating.
Absolutely! If your knee is back to feeling good, go for it. But there are a few things you should do:
It is not likely to cause hip pain, unless you are compensating your movements due to knee pain, which then causes hip pain.
That said, dysfunction at the hip may be your cause or a contributing factor in PFPS! The muscles around your hip may not be keeping your kneecap properly aligned. You also may have too much rotation in your hip while running. So, it would be advantageous to strengthen your hip muscles and work on coordination and postural improvements if you have patellofemoral pain syndrome.
In the long run, any activity that you do that puts a lot of wear and tear on your joint can cause osteoarthritis (not rheumatoid arthritis as that is an autoimmune deficiency). If you are young, this is not something you should be concerned with. Take the steps to fix your patellofemoral syndrome first, and be sure to treat your knees well, that way you can avoid arthritis.
As with hip pain, you can have back pain with a bad knee if you are changing and compensating the way you move. Your body has a kinetic chain, from your ankles up to the top of your spine. For example, if you change the way you walk/run due to knee pain, you are affecting all the joints from your ankle to your knee to your hips and back. Thus, this change can cause pain in any of these joints as your body is not used to the altered walking/running pattern. So, you must treat your knee pain rather than compensate for it by changing the way you move.
Unfortunately, it absolutely can, and for many people it often does. However, a lot of people don’t treat their patellofemoral knee pain as seriously as they should. If you follow the above steps, you should be able to keep patellofemoral pain syndrome at bay for good.
Resistance bands are not just great at treating and strengthening your knee if you have patellofemoral pain syndrome, they are also great for working out after you've recovered from patellofemoral pain syndrome. Why? Because they are easy on your joints!
They will allow you to have an effective workout in a way that is safe on your knee joints. Moreover, bands can be used in all the same ways that free weights can - squats, presses, deadlifts, etc. So, if you want to workout and not risk PFPS coming back, bands are a great option.
We hope this article will help you cure your patellofemoral knee pain. We'd love to hear your story on how it goes. Feel free to leave a comment below or shoot us an email. We'd love to hear from you!
If you have any concern, please contact your doctor or physical therapist.
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