Todd Kuslikis

Todd Kuslikis

MMT, MPA
Knee Pain Specialist and Injury Prevention Expert

Patellofemoral Pain Syndrome: How to Prevent and Get Rid of Knee Pain | Exercises and Stretches

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Many people suffer from patellofemoral pain syndrome but don’t know what it is or how to get rid of it. Patellofemoral Pain Syndrome (PFPS) is a condition that causes intense and chronic knee pain due to patellar maltracking.

The patellofemoral joint is a crucial “hinge” between the patella and femur. The patella is a bone in the knee cap, and a patellar tendon permits it to attach to the front of the tibia or shinbone. The patellofemoral joint connects to the front of the patella and inside of the patellar tendon.  Don’t worry too much about the anatomy.  The more important part is how to prevent or deal with it. 

Knee Anatomy

Pain in this area may be caused by inflammation or damage to these tissues, but that’s not always the case. If patellofemoral pain isn’t treated, patellofemoral osteoarthritis or patella tendon tears can occur. 

These are both extremely painful conditions that may be difficult to treat, so know the symptoms and get help if you think you might have these issues.  It’s always better to deal with it now than waiting for it to get worse before seeking help.

 

4 Common Causes of Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is a common knee injury that occurs when the cartilage behind your kneecap wears away. It can be caused by certain activities, but it usually happens randomly, without any known cause. Here are some of the most common contributors to patellofemoral pain: 

    1. Muscle Imbalances or Weakness

      PFPS can be caused by muscle imbalances or weakness in the quadricep muscles responsible for stabilizing the knee joint and controlling patella movement.

      The patella is the patellar tendon that lives within the patellofemoral joint.  This patellar tendon can become patellisthisopic and begin to wear away the cartilage in the patellofemoral joint.

      The patella will then no longer be tracking properly within the patellofemoral joint.  This is called patellar maltracking. 

      As a result of this happening, you may experience pnea symptoms such as pain or soreness when walking, sitting, or climbing stairs.

      Maltracking often occurs when the muscles in the front of your thigh are too tight or weak, causing your kneecap to rub against its groove on the femur bone.

      The good news is that by strengthening these muscles you can greatly reduce or even eliminate this problem!

    2. Overuse

      Vigorous physical activities like running, squatting, and climbing stairs can cause PFPS as well.

      It’s better known as ‘runner’s knees’. The name comes from the fact that the injury usually occurs while running or jumping up stairs.

      The key to preventing overuse injuries is knowing your limits and how often you can perform a certain activity safely.

    3. Injury or Previous Knee Surgery

      One of the main risks for developing PFPS is sudden impact injury to your lower extremity. This could happen when you are playing sports, getting into a car accident or even just walking down the street. 

      You may not feel any pain at first but over time it can start causing discomfort and lead to permanent damage.

    4. Weight

      Most people who are overweight suffer from PFPS. When someone is at an unhealthy weight, it puts more strain on the lower extremities which, in turn, worsens already existing conditions.

       

The Clarke’s Sign: A Simple At-Home Test for Patellofemoral Pain Syndrome

 

Still not sure you fit the description?  If you’re unconvinced whether or not your pain is caused by inflammation or patellar maltracking, try Clarke’s sign.

Clarke’s sign is a patellofemoral (knee cap) mobility and stability test. It concentrates on the patella movement in the patellofemoral joint.  Try this:Clarke's Sign Test for Patellofemoral Pain Syndrome

  • Stand in front of a table with your feet together and your toes pointing forward.
  • Place the webspace of the thumb on the part of the knee farthest in the direction of your head on the border of patella. In other words, just south of your kneecap.
  • Extend the quadriceps while applying pressure to the patella in a downward direction. 
  • Pain in the movement of patella or the inability to complete the test indicates presence of PFPS.

How Accurate is Clarke’s Test?

The Clarke’s test is often the first examination method when someone with PFPS visits a health professional. However, this test alone should not be relied upon to correctly diagnose the problem.


Common Symptoms of Patellofemoral Pain Syndrome

Knee pain when bending | Feel Good Life with Coach ToddWhat symptoms should you be watching for?  Patellofemoral pain syndrome is a dull, incessant ache deep in the front of your knee.

It can be made worse by any activity that places undue pressure on this area such as squatting or kneeling for long periods of time.

Common symptoms include:

  • Swelling around your kneecap and increasing pain with prolonged sitting or kneeling.
  • Difficulty bending and/or straightening your knee.

 

How To Get Relief from Patellofemoral Pain Syndrome Naturally

Suffering from Patellofemoral Pain Syndrome (PFPS) can keep you in chronic knee pain for years. If left untreated, your PFPS can lead to a lifetime of terrible discomfort and make it difficult for any level of physical activity. 

Rest, ice, compression and elevation (RICE) is often the go-to treatment for conditions involving pain, swelling or stiffness.

For PFPS sufferers, the use of RICE, when combined with therapy, has been shown to be more effective than simple rest or compression alone.

    1. Rest

      Rest for Knee PainIt is very important to rest your legs when you are suffering from PFPS.

      So, kick back with a good book and take a deep breath.  This will help to relieve some of the pain and discomfort that you’re feeling.
      Avoid putting any weight on the affected foot or leg for at least six weeks. That may feel like a lifetime, but it’s worth it.

    2. Ice

      Knee Ice CompressionIce is an effective treatment for PFPS. Ice can help reduce the pain and inflammation which will also provide immediate relief to the symptoms.

      It is recommended that ice be applied 4-5 times per day for 15-20 minutes at a time to painful areas.

    3. Compression

      Compression sleeves are an effective way to reduce symptoms of patellofemoral pain syndrome, because they provide support for the patella while alleviating some of the pressure on the area. Knee compression sleeve for PFPS

      The kneeling or squatting position can cause a lot of pressure on your knees, so sport knee sleeves help prevent this from happening.

    4. Elevation

      Elevation is a great way to reduce swelling and pain, which can be done by raising your knee higher than your heart.

      For those experiencing PFPS it’s important not only to elevate your leg but also keep the knees from extending up straight or being locked at all times. 

      Locking your knees will increase inflammation in the area as well as make symptoms more severe, so take caution when in this position!


Top 3 Exercises for PFPS (Patellofemoral Pain Syndrome)

 

 

      1. Wall Sits

        Wall Sit Exercise for Patellofemoral Pain SyndromeWall squats are a great way to work your quads and strengthen the muscles in your legs, while also engaging your glutes and hamstrings.

        It helps build strength and stability all around the hip area without adding pressure or weight on the knees.

        • Start with your back against a wall.
        • Bend your knees and move into a squat position.  Knees should be as close to a 90-degree angle as possible while back remains glued to the wall.
        • Keep your spine straight and do not allow any other part of your body to bend.
        • Keep your knees in line with your feet.  Knees shouldn’t ever move beyond your toes.  Slowly rise up from the squat position. Repeat.

        Wall squats not only strengthen the muscles in the thighs, but also build stability and strength in your hip joints.

        This is especially important for people with PFPS because they have trouble balancing on their knees due to pain. This eventually causes instability.
        If you’re experiencing knee pain during wall squats, try leaning on a chair or bench instead of the wall. Also, make sure you’re using good form.

      2. Straight Leg Raising

        Straight leg raising exercises are a great way to strengthen the muscles around your knees which will, in turn, help take some of the pressure off them.Straight Leg Raise Exercise for Patellofemoral Pain Syndrome

        • Lay on your back with your knees bent, and put your hands under your butt.
        • Raise one foot up to about where leg is in line with the opposite knee.
        • Hold for 10 seconds.
        • Lower down.
        • Repeat this action with the other leg.

      3. Clamshells

        Clamshells are designed to stretch and strengthen the patellar tendon.  It’s also used for treatment and prevention of patellofemoral pain syndrome (PFPS).
        Clamshell for PFPS

        • Start by laying on your side with both knees bent.
        • Keep your feet in contact with each other while rotating your top leg outward.  Think about squeezing your glutes and bringing your top knee towards the ceiling. Make sure you keep your spine in alignment and your hips don’t rock back!  Use a smaller range of motion if you think your back is moving during this exercise.
        • Rotate your top leg back down to the starting position.  Do several before switching sides.

         

  1. Mobility Stretches for PFPS


  2.  

    1. Kneecap Release Technique

      The kneecap release technique is a stretching and acupuncture technique used to help relieve patellofemoral pain syndrome.

      •  Sit on a couch with one leg straightened, supported by the cushions. You can also use two chairs facing each other. You’ll need your knee straight so that your knee cap (patella) can get the maximum range of motion. 
      • Place your thumbs at the top of your knee cap. Your fingers will drape around each side of your knee creating a cupping position.
      • Apply downward pressure so that your knee cap floats downward in the direction of your foot. Do this 5 times in the downward direction in one-second intervals. 
      • Now, place your thumbs on the side of your knee cap closest to your toes. Apply upward pressure on your knee cap and slide it towards you. Do this 5 times in one-second intervals.
      • Place both thumbs on the outside (lateral) side of the knee cap. Apply an inward (medial) pressure on the knee cap. Do this 5 times in one-second intervals.
      • Lastly, place your thumbs on the inner (medial) part of your knee cap. Apply outward (lateral) pressure 5 times in one-second intervals.

       

    2. Kneecap Shaking

      Kneecap shaking is yet another technique that can be used to relieve patellofemoral pain syndrome (PFPS).

      • Sit in a chair with your leg out in front of you.
      • Place your palm flat on the kneecap and gently press down while moving it up towards the hip.
      • Hold for several seconds before releasing. 
      • Repeat 2-3 times.

       

    3. Kneecap Stretching

Kneecap stretch technique is an effective stretching and acupuncture technique used to relieve PFPS.

  • Kneel on one knee and then bring your other leg forward with the heel on the ground.
  • Push your front knee further outwards while pivoting in the knee joint.
  • Hold for 30 seconds or until you feel a stretch.
  • Repeat 3 times for each side of your body.

 

Static Stretches for PFPS

Static stretches can help relieve your knee pain by increasing the mobility in the patella and supporting it to alleviate pressure on that area. They also increase the flexibility of the joint around the kneecap.

 

 

  1. Quadriceps Stretch

    The quadriceps stretch can help you find relief from painful and stiff quads. This exercise will not only help relieve your body from soreness and stiffness but it will also strengthen your quads which will provide relief for when you want to walk, run or stand up from a sitting position. 

    • Stand up tall.
    • Lift 1 foot off of the ground and place it behind you, keeping your leg straight.
    • Straighten your back as much as possible and hold that position for 20 seconds, breathing deeply.
    • Repeat with the other leg.

     

  2. IT band Stretch

    The IT band is a thick fascia ligament that begins on the outside of the hip and runs down to the outside of your knee. It provides stability when you run, walk, and turn. It also helps in pushing off of the ground to get up from a seated position. Needless to say, it’s an important piece of machinery.  Here’s how to keep it flexible:

    • Stand with your back against a wall, cross one leg in front of the other. 
    • Let your affected hip drop towards the ground and lean away from it until you feel tension on that side. 
    • Hold this stretch for about 15-30 seconds while breathing deeply.
    • Switch sides and repeat.

     

  3. Hamstring Wall Stretch

    A hamstring stretch is a great way to lengthen the muscle fibers and tendons in the hamstring. 

    • Start off by laying on the floor and placing one leg straight out on the ground. Raise the other leg to a 90-degree angle and rest it against a wall or couch in a straight position. 
    • Gently push forward with your heel of the raised leg so that you get as straight as possible and keep up pressure until you feel a good stretch. 
    • Do this for 10 seconds, then gradually work yourself up to 30 second intervals if needed!

     

  4. Calf Wall Stretch

    Stretching your calf muscles is also an important part of pain relief.  Try this:

    • Stand with both heels on the floor and your hands at about eye level. 
    • Put one foot behind the other, keeping it flat against the ground. 
    • Bend both knees as you lean forward into a stretch until you feel a good stretch in your calf muscles.
    • Hold for 30 seconds before switching legs.

     

Daily Walking for PFPS Relief

Looking for a more social and fun way to help to relieve knee pain caused by PFPS?  Try inviting some friends for a walk.  It will increase the mobility of and support the patella, alleviating pressure on the area.

Walking also increases flexibility of the joint around the kneecap. It’s been found that walking for two days a week can be enough to reduce pain, swelling, and stiffness caused by PFPS. 

So, get out there and enjoy the outdoors!  Or the treadmill if the weather isn’t agreeable.

 

4 Simple Adjustments to Activities to Prevent PFPS!

When someone has pain in their knees it’s important to be careful when doing certain activities, because they could result in further injury.

One of the best things people with PFPS can do is to modify activities of concern. Here are some simple adjustments that can help prevent PFPS:

    1. Avoid high-impact activities that cause a lot of pressure on the patellar tendon like running, jumping or squatting.
    2. Avoid prolonged periods of sitting.  Not only is it bad for your overall health, but it could lead to tightening up the muscles around your patella. And try not to cross your legs at the knees for long intervals.
    3. When you’re walking, limit the time and distance you walk each day and wear a brace if recommended by your doctor.  If you overdo it, the benefits you might otherwise gain from this could be negated.  Know your body.  Know your limits.
    4. Try to do exercises that involve repetitive bending and straightening of the knee like leg curls or straight leg raises.

 

3 Simple Tips to Prevent Patellofemoral Syndrome from Returning

There are many things you can do to help reduce your chances of getting PFPS in the first place, but if you’ve already got it there are some steps you can take to get relief. 

    1. Gradually increase running/exercise intensity instead of quick increase in mileage or weight. Also wearing a compression sleeve on your leg while running or walking will provide support and stability for the patella tendon.
    2. Make sure that when running or walking that you’re not over pronation (rolling too far inward) which can put more pressure on the knee.
    3. Keep up with Balanced Muscle strength and flexibility exercises, it is important to hold 30 seconds.

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4 Responses

  1. You are amazing! I am usually crippled with knee pain for almost 24 yrs and I try and do your exercises in the morning which gets me geared up to move through my day without a walker or canes.
    I am 74 and I can't thank you enough for not charging me and not making me sit through a two hour video about your personal life only to charge me for a book or a pill at the end!
    I pray God blesses you and yours a pain free life because of your time and generosity to us.

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