Exercise Program for Patellofemoral Syndrome

If you have been diagnosed with patellofemoral stress syndrome (PFSS), also known as runner's knee, you may be referred to a physical therapist (PT) for treatment. Exercise is one of the main treatments for PFSS.

With PFSS, the kneecap rubs against the lower part of the femur (thighbone), causing pain. 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. The prescribed exercises focus on improving the 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 with your healthcare provider to ensure that exercise is safe for you to do.


Quadriceps Strengthening

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 strengthen your quads is with the quad set exercise.

To do the exercise:

  • 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:

  • Lie on your back with one knee straight and one knee bent.
  • Tighten the muscle on the top of the 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 of your hip muscles, specifically the gluteus medius. Your glutes help to control the position of your knee, and weakness of these muscles can lead to PFSS.

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 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 it 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 another 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 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 for treating 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 (position sense), 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 ball.

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 to get back on track to running with no pain.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.