Patellofemoral Pain Syndrome (PFPS) is often called by several other names -- including Runner’s knee (because runners often get it) and Chondromalacia Patella (Latin words to say the knee cap is softened or thinning out). It’s often not a serious condition, but it can be very painful and a big nuisance for the person affected. People with this condition often complain about knee pain especially when going up and down steps. The pain will be at the front of the knees. It can be dull or sharp and excruciating (like someone has jabbed a screwdriver in your joints). It’s common in young people (like teenagers) but it can affect anyone of any age -- and especially runners. If you are older (above age 40) you should see your doctor to make sure you don’t have a form of arthritis called Patellofemoral osteoarthritis. The guys in the video below explain it well (ignore the bit about taping, which we will talk about later).
I think I have got PFPS. Should I go and see my doctor?
Yes. We know how painful and upsetting this condition can be and how it can stop you from doing things. So -- go and see a doctor to see whether it is this and get proper advice and possibly a referral to a physiotherapist who can show you exercises to make things better.
What’s actually happening in Patellofemoral Pain Syndrome?
In front of your knee is a protective bone (that looks like a shield) called the Patella -- you will know it as your knee cap. That knee cap moves up and down a groove in your knee when it bends -- the idea is to protect your knee. Different muscles around your knee tighten to different degrees to keep that knee cap in that groove (yes, our bodies are that amazing!). But in some people (for example runners or people with some leg muscles stronger than others), the knee cap doesn’t slide up and down this grove so smoothly and instead, bumps into the sides. When it bumps into the sides, it causes pain -- the pain of Patellofemoral Syndrome.
What can I do about it?
- Basically, you need to do some exercises to build up those muscles which are probably weak but are important in keeping that knee-cap on track when your knee bends.
- Some people find taping your knee helpful.
- Tablets called NSAIDs (like ibuprofen or naproxen) can help reduce the inflammation and pain. These are available from your doctor. Be careful, long term use of these can cause stomach ulcers.
- If you have got flat feet -- go to a foot specialist to see if you need shoe inserts.
- Think seriously about what you do that wrecks your knee joints. The following sports are really bad for the knees and may lead to early worn out knees -- running, squash, jumping sports, ski-ing and football.
Even if you find taping or NSAID tablets provide wonderful relief, you still need to work on the cause of the problem -- which are the muscles. In other words, this problem WILL NOT GET BETTER IF YOU DON’T DO THE EXERCISES.
There are two types of exercises you should do that will help.
- MUSCLE STRENGTHENING EXERCISES -- exercises to build certain muscles to make them stronger (and keep the kneecap in place when it moves).
The muscles that you need to work on are…
- The quadriceps (or quads for short) -- this is a group of muscles at the front of your thighs.
- The vastus medialis -- a very important muscle for the knee cap to work properly that is found on the inner front of your thigh
- The gluteus muscles -- which are basically muscles in your bum.
- MUSCLE STRETCHING EXERCISES -- exercises to stretch muscles in order to loosen them up (because people with Patellofemoral Pain Syndrome often have very tight leg muscles).
The main muscles you need to loosen up are
- The quadriceps
- The iliotibial band (ITB) -- which is a strong ligament band that fans from the outside of the hip down to the outer part of the shin.
The VMO is a particularly important muscle
Watch this video to understand it in more detail.
Muscle Strengthening Exercises
You need to work the (i) buttock muscles (the gluteals), the (ii) front thigh muscles (the quads) and ESPECIALLY the (iii) the VMO muscle. The VMO is often referred to as the tear shaped muscle. I’ve provided numerous video clips to strengthen the VMO in case some don’t suit you.
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For each of the following weights machines, do the standard 14 reps, 3 sets. If you find the last 4 reps a bit hard to do, then you’ve got the right weight. In fact, this is a good tip for any weights machine.
- Use the leg press -- works on quads and buttock muscles.
- Use the leg extension machine -- works purely on the quads. The bigger the range of movement, the more the muscle is going to work. If you find this one too uncomfortable to do, then don’t do the whole range -- just work the last 30 degrees of movement.
- Use the leg curls -- works on buttock muscles.
- Use the abductors -- to build the buttock muscles
- Use the adductors -- to build the inner thigh muscles
- Demonstrations of each of these below.
How to use the leg extension machine to specifically work the VMO (see the last exercise in this set of three)
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Click on the video clips below to see what to do. You don’t have to do all of these. Pick one for the buttocks, one for the quads and one or two for the VMO.
If you don’t want to go through all the videos below but just want 3 quick exercises, then click on this video.
Otherwise here’s a comprehensive set of video exercises.
Clam exercise (for buttock muscles)
Kneecap dance (for quads)
Straight Leg Raise (for quads) & Side Leg Raise (buttocks) & External Rotation Straight Leg Raise (Vastus Medialis)
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Select one or two of the following to do regularly (not all).
Knee straightening exercise (VMO)
External Rotation Straight Leg Raise
Bridge Lift (VMO)
VMO Squats (if you are strong enough)
Sit-Stand VMO technique
Squeeze ball technique 1 (VMO)
Squeeze ball technique 2 (VMO)
Squeeze Ball Technique 3 (VMO)
Step Down Technique 1 (VMO)
Step Down Technique 2 (VMO)
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As I said before, the muscles in the leg are often tight in people with Patellofemoral syndrome. The stretches in the video below not only feel nice but will loosen you up and help with the condition resolve.
Iliotibial Band Stretches
Using a foam roller (they cost about £20) -- for ITB and quads
Patellar release technique -- stretches the lateral patellar retinaculum which is tight in PFPS
What about taping?
The taping method that works is called The McConnell taping method. It works by keeping your knee cap pulled in; this stops it from moving too far outwards and bumping into the outer sides of the knee groove when your knee bends. Click the video below to see how to do it.
Look for Leukotape P Combi pack -- available on eBay. (DO NOT put Leukotape directly onto the skin, use the Hypafix first).
For those of you who want to develop an even deeper understanding….