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Patellofemoral Pain- 3 Best Exercises


Patellofemoral pain, Anterior knee pain, Runners’ knee.

All different phrases for the same phenomenon.

Whilst there is a large variance in the names, the experience is mostly universal. A gradual increase in knee pain around the kneecap, worse with stairs, kneeling, squatting, lunging and critically running. At times Patellofemoral pain is unrelenting and can make you question your long-term prognosis.

You may be asking yourself if you will ever run, squat or hill walk again.

If any of this sounds familiar, read on to learn more about the problem and for my 3 top exercises for helping you keep this pain at bay.


The Issue

Patellofemoral pain syndrome is considered one of the most common forms of knee pain. Its prevalence is quoted to be somewhere between 15-45% of all knee pain disorders. The key feature of Patellofemoral knee pain that is worth remembering is that it is generally non- traumatic in nature.

Most Patellofemoral pain cases we see in clinic can be traced back to a change in loading.

This may be an increase/ decrease in normal exercise load, a change in the biomechanical stress (footwear change, technique change, increased weight), or a completely new activity being performed.

The human body has a fantastic ability to adapt to stress when it is gradual.

Think of the Greek tale about the training regime of ‘Milo of Croton’

It has been said that as a child Milo carried a baby cow on his shoulders every day until the cow was a fully grown Ox.

This is progressive overload in its most simple form and highlights that when stress is gradual. The body adapts.

Issues arise when we do not adhere to the basic principles of progressively overloading exercise.

Although this is a huge simplification it does highlight nicely the main culprit for the development of Patellofemoral pain.

Spiking exercise load. (Not carrying cows).


It affects anyone within the general population, but it is suggested to have higher incidence rates amongst adolescents, military personal and active people.

It is worth noting that one of the primary risk factors for developing Patellofemoral pain is poor quadriceps strength. If you are an endurance athlete that has ignored gym work or someone who is new to exercise in general. The importance of strength training cannot be overlooked.

Specifically for Patellofemoral Pain.

The Diagnosis

Patellofemoral pain syndrome is classified by the presence of pain behind the kneecap whilst performing knee specific loading movements (squatting, stairs, lunging, running, jumping).

You may also note the following features

· Crepitus or cracking from behind the knee when moving it.

· A small amount of swelling

· Pain when straightening the knee after being still for a while

· Pain with prolonged sitting when your knee is bent (driving/ cinema)


The Management

It is highly advised that you seek Physiotherapy or medical support if you think you have Patellofemoral pain syndrome as recent studies have highlighted that this issue can keep returning over a number of years unless you rectify the underlying cause.

However, the main aim when treating this issue is to combine efforts of activity modification to ensure a low level of aggravation. Alongside having a thorough strength programme that addresses quadriceps and hip strength.

This needs to be a graduated process as mentioned above and it does not need to be 100% pain free. Aiming to keep pain under 3 out of 10 on your pain scale is advisable.

A Physio will issue you with the progressive steps of how to go from a painful state into resuming all normal activities. This can at times be coupled with accessory methods of treatment such as taping, blood flow restriction, orthoses and neuromuscular electrical


Massage and copious amounts of stretching have been shown to have little value.

I have put together 3 exercise demos that I use regularly when rehabbing clients with patellofemoral pain syndrome.

These primarily load the quadriceps but would always be part of a more rounded programme.

Patellofemoral pain problems do not get better overnight. However, if addressed early enough and the correct programme is issued you should be expecting a resolution somewhere between 6 weeks to 6 months.


1. Beast Position Banded Terminal Knee Extension

3 sets

15 reps

Hold the straight knee position for 3-5 seconds

2. Cyclist squat with loaded counterbalance

3 sets

8 reps

Tempo @3311

3. Heel raised Split squat- focus on driving knee forwards

3 sets

8 reps

Tempo @3311

If you have any questions regarding Patellofemoral Pain or Pain in general, please get in touch



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