Exercise Program for Patellofemoral Syndrome

If you are have been diagnosed with patellofemoral stress syndrome (PFSS), also known as runner's knee, there are a few things you should do right away to treat your condition. Visit your healthcare provider, and then check in with your physical therapist. Your PT can perform an examination to assess your PFSS to prescribe the right treatment for your condition. 

Exercise is one of the main treatments for PFSS. Many cases of PFSS are caused by tight muscles around the knees and hips or weakness in muscles that help keep your kneecap in its correct position. Sometimes balance or proprioception impairments may be a factor that leads to PFSS. Working to stretch and strengthen the right muscle groups can make a significant change in your condition.

Here is a step-by-step exercise program that a physical therapist may prescribe for someone with runner's knee. The exercises focus on improving flexibility and strength of the muscles that support your knee and help keep excessive stress off your kneecap.

Before starting this, or any other, exercise program, check in with your healthcare provider to ensure that exercise is safe for you to do.


Quadriceps Strengthening

Photo of the quad set exercise

Research indicates that weakness in your quadriceps muscle, specifically an area of the quad called the vastus medialis obliquus (VMO), may lead to patellar misalignment and PFSS. Working to strengthen your quad may be an important part of your exercise program for PFSS. 

One simple way to strengthening your quads is with the quad set exercise. To do the exercise, simply lie down with your knee straight and place a small towel underneath your knee. Press your knee down into the towel while tightening your quadriceps muscle on the top of your thigh. Hold your muscle tight for 5 seconds, and then release. 

The short arc quad is another exercise that can help improve the way your quadriceps muscle supports your kneecap. To do this, lie down and place a soccer ball or paper towel roll underneath your knee. Straighten your knee fully while keeping the back of your leg against the ball. Hold your knee straight for 5 seconds, and then slowly release.

Repeat each exercise 10 to 15 repetitions, twice a day.


Straight Leg Raises

Photo of the SLR.
Brett Sears, PT

Straight leg raises are a great way to strengthen your quadriceps and hips while maintaining your knee in a safe, pain-free position. During the straight leg raise, your knee joint should remain locked, decreasing stress and strain (and pain) around your kneecap.

To perform a straight leg raise, simply lie on your back with one knee straight and one knee bent. Tighten the muscle on the top of your thigh of your straight leg, and then lift your leg about 15 inches off the ground. Hold your leg straight up for a few seconds, and then slowly lower it down. Repeat the leg raise 10 to 15 repetitions.

You can work different muscle groups around your hips by performing the straight leg raise on your back, on your side, or while lying on your stomach. Each method will alter the exercise enough to keep it fresh and to work the various muscles that support your leg and knee.

You can make this exercise more challenging by adding a small cuff weight around your ankle. Usually two to three pounds is sufficient. Another way to add resistance is to place a resistance band around your ankles for the straight leg raises.


Clam Shell

Clam Exercise - glute medius activation exercise
Clam Exercise - glute medius activation. E. Quinn

The clamshell is a great exercise to do to improve the strength and recruitment of your hip muscles, specifically the gluteus medius. Your glutes help to control the position of your knee, and weakness here may be a cause of PFSS pain.

To perform the clamshell, lie on your side with both knees bent. Tighten your abdominals, and slowly lift your top knee up while keeping your feet together. Hold your knee up for a few seconds, and then slowly lower. Repeat the exercise 15 to 25 times.

You can make the ​clamshell exercise more challenging by placing a resistance band around your knees for the exercise. Your PT can help you get a suitable band for your condition.


Isometric Gluteal Strengthening

The isometric gluteus medius strengthening exercise.
Brett Sears, PT

Isometric gluteus medius strengthening is a great way to improve the neuromuscular recruitment of your hips. This can help to keep your legs--and kneecaps--in proper alignment.

To perform the exercise, lie on one side with your knees straight and with a belt wrapped around your ankles. Be sure it isn't too tight; you should be able to lift up your top leg.

Slowly lift your top leg while keeping it straight, and press into the belt. You should feel your hip muscle working to lift up your leg further, but the belt should be resisting your movement.

Press up into the belt for five seconds, and then slowly relax. Perform the exercise for 10 repetitions, and then repeat it on the other side.


Advanced Hip Strengthening

Photo of hip abduction exercise.
Brett Sears, PT

Once you become a pro at performing the clamshell and isometric gluteus medius strengthening exercises, it is time to move on to more advanced hip strengthening exercises.

Bridges are a great way to strengthen your hips and core while working to keep your knees in proper alignment. You can modify your bridging routine by adding a Swiss ball to the bridge or by performing the exercise with your feet on a pillow or other unsteady surface. 

Using a resistance band in standing is a functional way to improve hip strength and control while keeping your knees in proper alignment. This can help to teach your body where your kneecaps should be during functional activities like walking and running.​



Photo of an athlete doing a box jump.
John Fredele/Getty Images

Running involves flying through the air and landing on one foot. That foot and leg is then required to propel you forward to fly through the air once again. Repeat over and over again, and you are running.

Plyometric exercises may be helpful in helping you treat runner's knee. Your PT can help you progress from double leg to single leg exercises. Some exercises that you may do might include:

These exercises may be challenging, and if you experience pain in your knee, you must stop. Your PT can guide you in the correct way to progress plyometrics for running.


Advanced Balance Exercises

Photo of woman practicing yoga on the beach.
Zero Creatives/Getty Images

Many people with PFSS have impaired balance and proprioception, so working on your balance may be an important part of your PFSS rehab exercise program. You can start with simple balance activities like the single leg stance, and progress further with more dynamic balance activities like the T-stance or by working with a BOSU.

Your physical therapist can assess your balance and prescribe the best exercises for you to do to work on maintaining your knees in proper alignment to treat your PFSS.

A Word From Verywell

If you have runner's knee or PFSS, you should check in with your PT and get started on an exercise program - similar to this one - to get back on track to running with no pain.

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