Patello-Femoral Pain Syndrome

As soon as you can walk without pain or limping, begin stretching protocol:
Hip flexor stretch
Kneel with affected knee on the ground, same side arm goes back causing
pelvis to shift forward, and back to extend. Hold for 20-30 seconds.
Repeat
3 times.
PrincetonUniversity
Athletic MedicinePatello-Femoral Pain Syndrome
Treatment includes activity modification, stretching, and strengthening
the affected limb. Immediately begin using:Make sure to elevate the knee
above heart level until swelling
subsides. Always be sure to ice
your knee down after you complete
your exercises using either
immersion in ice bath, or wrapping
a bag of ice. Apply ice for 20
minutes each time.
E
Elevation
Wrap an elastic bandage from
mid-calf to mid-thigh, using even
pressure. Wear this if swelling is
noticed until it decreases.
C
Compression
Place an ice bag over your knee, or painful area, for 15-20 minutes,
3-5 times a day for the flrst 24-72
hours. After 72 hours, ice the knee
after activity or exercises.
I
Ice
You should rest from all activities
that cause pain or limping. Use
crutches until you can walk without
pain or limping, if available.
R
Rest
© 1999 Floyd E. Hosmer
Patello-femoral pain syndrome is an inflammation to the front
of the knee joint caused by the patella (knee cap) not tracking
properly over the distal femur (thigh bone at the knee). The
patella normally rides in a groove on the femur. The patella is like
a fulcrum, it gives leverage to the big muscles on the front of the
thigh. These thigh muscles are called the quadriceps because they
consist of four muscles. With patello-femoral syndrome (PFS), you
get an imbalance in these muscles - usually the lateral or outside
muscle overpowers the inner medial muscle, and this pulls the
patella out of its normal groove. When the patella doesn't track
properly, it causes pain under the patella. PFS can have multiple
causes, which can include foot problems, such as foot pronation,
weak lateral hip muscles, genu valgum (knock-kneed), and a larger
Q-angle (the angle from the front hip to middle of the knee cap).
These can all affect the biomechanics of the patello-femoral joint.
When experiencing these problems with your knee, it's important
to find ways not to keep it irritated. Occasionally, the injuries start
with a clear-cut onset, like stepping in a hole or falling on your
knee. Usually, though, it feels like it comes out of nowhere. This
means that you've been gradually creating the injury over a longer
period of time like a few days or weeks. Something that you do
during the day sets it off, but it's commonly very hard to figure out was exactly is the aggravating activity. Nonetheless, you've overdone it. Try not to worry if you can't figure out
exactly why your knee got sore. That
may not be necessary to determine in
order to get better.
The more often you make your knee
sore, the longer it will take to get
better. The inflammation seldom
builds up to a level where it keeps you
in bed, so it's tempting to keep up and
about on it. This may keep it stirred
up. Try to avoid all the activities that
make it sore, i.e., sitting with your
knee bent for a long time, walking a
lot, going up and down stairs, or exercising. While it doesn't cause
more damage, it does keep the inflammation from going away.
You may find it helpful to sit with your knee straight or get up and
move around occasionally. Also, try stairs one step at a time using
your uninjured leg. These knee injuries can be very stubborn
before they get better. The sooner you stop aggravating it, the
sooner you can get back to the activities you like.
Adductor stretch
Prop the inside of your ankle up on a table, lean into the side you'r
e
stretching. Hold for 20-30 seconds. Repeat 3 times.
Hamstring stretch
Prop the back of your heel up on a table, keep your back straight, and l
ean
forward at the hips. Hold for 20-30 seconds. Repeat 3 times.
Dynamic hamstring stretch
Lie on your back, reach hands behind your knee, keep knee at 90-degree
angle, and kick up until you feel stretch. Repeat 15-20 times each si
de.
Sidelying ITBand stretch
Lie on your side, use a towel, or band and pull foot back as if stretchi
ng
quadriceps, use opposite foot to push down on distal part of leg. Hold t
his
stretch for 1 minute. Repeat as needed.
C stretch for ITBand
Standing, place affected leg behind the good leg, and lean away. Hold for
20-30 seconds. Repeat 3 times.
Glute stretch
Prop the outside of your ankle up on a table, make sure your leg is at 9
0
degrees, keep your back straight, and lean forward at the hips. Hold for

20-30 seconds. Repeat 3 times.

Begin these strengthening exercises in conjunction with the stretches:
Straight leg raises all 4 directions
Begin on your back, bring your foot towards you, so quadriceps muscle is

contracted and knee is straight. Raise leg into hip flexion. Repeat th
is on
your side for hip abduction, opposite side for hip adduction, and on you
r
stomach for hip extension. Do 3 sets of 15 each direction. As this gets
easier, you can add weight, or add repetitions.
Quad sets
Begin in a seated position, place a small towel or roll behind your knee
.
Bring your foot toward you and straighten your knee (to contract your q
uads)
so the back of your heel comes off the table. Make sure you are focusing

on squeezing your quadriceps as tightly as tolerable. Once your heel is
off
the table, hold the contraction at the top for 2-3 seconds. Do 3-4
sets of 20
each. You may repeat with a larger roll as well.
Once you have successfully completed the stretching and initial
strengthening exercises (performed correctly and without discomfort),
try these exercises:

Seated leg extensions on machine
This exercise is for quadriceps strengthening. Sit on the machine, make
sure
you begin with knee flexed slightly passed 90 degrees. Extend knee unt
il
it is completely straight. Make sure you are controlling the motion on t
he
way down, back into flexion. Begin with a light weight, and work your
way
up. Do 3 sets of 15-20 reps. The last few reps leading up to 20 shoul
d be
difficult.
Please be careful with this exercise as it can sometimes re-create
symptoms.
Seated hamstring curls on machine
This exercise is for hamstring strengthening. Sit on the machine, make s
ure
you begin with knee fully extended. Flex knee until it is slightly past
90
degrees. Make sure you are controlling the motion on the way up, back in
to
full extension. Begin with a light weight, and work your way up. Do 3 se
ts of
15-20 reps. The last few reps leading up to 20 should be difficult.
Hip abduction with foot externally rotated
On your side, with knee straight (quadriceps contracted), raise your l
eg into
hip abduction with leg slightly back, and point your foot toward the cei
ling.
Do 2 sets of 15.
Fire hydrant position
On your side, flex hip, and bend knee to 90 degrees, then lift leg upw
ard
towards ceiling. Do 2 sets of 20.
Hip circles
On your side, with knee straight (quadriceps contracted), complete 20
circles
to the right, and 20 circles to the left.
Lateral step-ups
Using a box or stair, stand next to the box and step up with affected leg.
Make sure your knee is aligned with your second toe while going up and
down on the box. Start with a box that is 2" high and gradually work
up to a
box that is the height of the pictured exercise. Do 3 sets of 15 reps. Please
be careful with this exercise as it can sometimes re-create symptoms if
the
box is too high.
Front step-ups
Using a box or stair, stand behind the box and step up with affected leg.
Make sure your knee is aligned with your second toe while going up and
down on the box. Adjust the height of the box in the same way as for the

lateral step up exercise. Do 3 sets of 15 reps. Try not to take a break during
reps, try completing all 15, doing continuous step ups. Please be careful
with this exercise as it can sometimes re-create symptoms if the box is
too
high.
Reverse lunge
Begin in standing position with legs shoulder width apart. Step back in
lunge position with right leg, followed by left leg. Do 2 sets of 10 eac
h
leg.
Please be careful with this exercise as it can sometimes re-create
symptoms if mechanics break down, or proper technique is not emphasized.