Rehabilitation of Patellofemoral pain syndrome varies slightly from case to case, depending on the factors causing the individuals case. However, in most cases, tight lateral quadriceps muscles and weaknesses in VMO and the hip abductors contribute and so should be addressed.

Stretching exercises

Stretching of the quad muscles in particular is very important in reducing the outward pull on the knee cap. Stretching the IT band may also be helpful.

Quad stretch

Standing up, keep the knees together and bend the knee of the leg you wish to stretch so that the ankle moves towards the buttocks. Pull the ankle further in using your hand until a stretch is felt at the front of the thigh. Tilting the hips backwards will help to increase the stretch. Hold for 20-30 seconds, rest and repeat 3-5 times.

IT band stretch

In a standing position, take the leg to be stretched behind the other and out to the side as far as possible. Keep this leg straight and push the hips out the other way, imagine lengthening the outside of the back leg. When a stretch is felt, hold for 20-30 seconds, rest and repeat 3-5 times.

Strengthening exercises

VMO (vastus medialis oblique) is commonly weak in cases of PFPS. Alternatively it may be that muscle firing is delayed on knee extension and so this should be improved.

VMO strengthening

Sit on the floor with the legs out straight and a rolled up towel or foam roller under the knee. Use two fingers to feel the VMO muscle (the 'tear drop' muscle, just above and to the inside of the knee cap). Push the knee downwards into the towel to extend the knee (the foot should lift up). It should be possible to feel the VMO muscle contract under the fingers. If this contraction is not strong or if it does not happen as soon as movement is initiated then this exercise can be used to improve this.

Squat with ball squeeze

Stand with a ball (such as a football) between the knees and the feet pointing straight forwards. Perform a small squat whilst squeezing the ball between the knees. This helps to activate VMO.

Lunge

Using a resistance band tied around the knee and to a stationary object just to the inside of the body (at a distance so the band is taught), take up a lunge position, with the knee to be worked in front. Perform lunges whilst maintaining the front thigh in a straight line, avoiding the band from pulling the knee inwards. This uses the VMO and hip abductor muscles.

Clam

In a side-lying position, bend the knees to 90 degrees and make sure the back is straight with the top hip directly over the bottom one. Keep the feet in contact as you raise the top knee away from the bottom one. Make sure the movement comes from the hip and the back and pelvis stay still. This works the gluteus medius muscle.

Please see the Virtual Sports Injury Clinic for more information on how to treat Patellofemoral Pain Syndrome