Quick Guide: Best Exercises for Patellofemoral Pain Syndrome
1. Quad Stretch
- Stretches the quadriceps muscle in the front of your thigh
- Hold this stretch for 10 seconds and repeat 10 times
- Perform this stretch 2 times per day
- Best stretching Strap in the link below
2. Hamstring Stretch
- Stretches the hamstring muscles on the back of the thigh
- Hold this stretch for 20 seconds and repeat 5 times
- Perform this stretch 2 times per day
- Best stretching strap in the link below
3. Calf Stretch
- Stretches the calf muscle on the back of the lower leg
- Hold this stretch for 20 seconds and repeat 5 times
- Perform this stretch 2 times per day
- Best slant board in the link below
4. Long Arc Quad
- Strengthens the quadriceps muscle on the front of the thigh
- Perform this exercise 15 times and repeat for 2 sets
- Perform this exercise 1-2 times per day
- Best adjustable ankle weights to add to this exercise in the link below
5. Step Down
- Strengthens the quadriceps muscle on the front of the thigh
- Targets the quadriceps muscle in a more functional position
- Perform this exercise 10 times and repeat for 2 sets
- Perform this exercise 1-2 times per day
- Best stepper for this exercise in the link below
6. Goblet Squats
- Strengthens the quadriceps muscle on the front of the thigh
- Targets the quadriceps muscle in a more functional position
- Perform this exercise 10 times and repeat for 2 sets
- Perform this exercise 1-2 times per day
- Best hand weights to boost strength for this exercise in the link below
7. Sidelying Clamshell
- Strengthens the outer hip (gluteus medius) muscles
- Perform this exercise 10 times and repeat for 2 sets
- Perform this exercise 1-2 times per day
- For the best adjustable ankle weights or resistance band kits see in the link below
8. Sidesteps with a Resistance Band
- Strengthens the outer hip muscles and glute muscles
- Perform this exercise along the side of a countertop or in a hallway, moving along the length of the space and back to starting position 3-4 times
- Perform this exercise 1-2 times per day
- For the best resistance band kit see the link below
9. Single Leg RDL
- Strengthens the hip muscles, quad muscle and challenges your balance
- Perform this exercise 10 times and repeat for 2 sets
- Perform this exercise 1-2 times per day
- For the best hand weights to use for this exercise see the link below
Bonus equipment for treating Patellofemoral Pain Syndrome: Massage Table or Yoga Mat
- Provides a firm but comfortable surface to perform your exercises
- The massage table is collapsible and portable
- The yoga mat is a good budget option and can be used anywhere
- Best Massage Table and Yoga Mat in the links below
Disclaimers and Disclosures: All information in this article is for informational and educational purposes only and should not be taken as individual medical advice. Additionally, this article contains affiliate links, meaning when you make a purchase, we make a small commission at no additional cost to you. For more information, see our full Disclaimers and Disclosures.
Intro: Are you looking for the best exercises for treating your patellofemoral pain syndrome?
If you’re looking for the best exercises for patellofemoral pain syndrome so you can get back to the activities you love without the pain in your knees, then you’re in the right place! Patellofemoral pain syndrome (PFPS) is a common cause of pain in the front of your knees, and we treat hundreds of patients with this condition every year.
Below is a treatment guide, with exercises, equipment, and tips and tricks we use with our patients every day. In this article you will find a little more information on what patellofemoral pain syndrome is, what causes PFPS, and the key elements you need to target in order to treat this condition. We also included a few pieces of equipment that we find helpful and patients are always asking us about for performing these exercises at home.
If you are looking for a path to get started on quickly to begin relieving your anterior knee pain, above you will find a quick guide that highlights the exercises and equipment we recommend for treating patellofemoral pain syndrome. Later in the article, we explain in more detail how to perform these exercises and professional tips we share with our patient to get the most out of each exercise.
What is patellofemoral pain syndrome (PFPS)?
Patellofemoral pain syndrome (PFPS) is a condition where your patella or knee cap, is causing pain on the front of your knee. The patella sits in a groove formed at the end of your femur (thigh bone), called the trochlear groove. With normal movement of the knee, when you bend your knee the patella glides downward and when you straighten your knee the patella glides upward. If your knee cap is not properly sliding in the groove, this will cause additional compressive forces to the patella which leads to pain on the front of your knee.
Often, patellofemoral pain syndrome is broadly called anterior knee pain. This is an accurate description due to the location of pain with PFPS being located anteriorly, or on the front of the knee. However, there are other conditions, such as patellar tendinitis, patellofemoral arthritis, or injury to the cartilage beneath your knee cap that may also cause pain in the same area. These other conditions, although they may cause anterior knee pain, are painful due to a different structure or mechanical problem when compared to patellofemoral pain syndrome.
For example, if your pain is on the front of your knee but a little lower than your knee cap, then you may be suffering from patellar tendonitis rather than PFPS. If you think you might have patellar tendonitis instead of patellofemoral pain syndrome, then check out our article on the best exercises for treating patellar tendonitis.
How do I know I have patellofemoral pain syndrome?
Patellofemoral pain syndrome can, at times, be a little trickier to diagnose compared to other knee injuries. Our best tool in diagnosing PFPS is getting a thorough history from the patient on what activities cause pain and the timeline of pain.
Often, when you have patellofemoral pain syndrome your knee pain gradually worsened over time with no specific injury to the knee. PFPS can feel like a deep ache on the front of your knee with prolonged sitting or you may notice more pain with activities such as running, squatting and activities that place more load through the patella.
In the clinic we may evaluate the movement of the knee cap and assess for pain along the sides or beneath the knee cap. We also may rule this diagnosis in with the absence of pain in other surrounding structures in the knee such as the patellar tendon or the meniscus. Additionally, with PFPS there is typically minimal or no swelling in the knee compared to an injury of a ligament or intra-articular (inside the joint) structure of the knee.
How do we decide what the best exercises for patellofemoral pain syndrome are?
The best exercises for patellofemoral pain syndrome can be broken down into three categories to achieve the best results for improving your knee pain. If the muscles surrounding your knee joint are too tight or weak this may alter the mechanics of your patella, due to excess strain or insufficient support of the patella causing it to move abnormally and generate pain.
The first category is stretching the quadriceps, hamstring and calf muscles which surround your knee joint and allow the knee and patella to move properly when they are flexible. The second category is strengthening the quadriceps muscles of the thigh, which provides the greatest support and function of the knee. The third category is strengthening the hip muscles that contribute to the proper alignment and movement of the leg with functional activities.
In Depth Descriptions of the Best Physical Therapy Stretching and Strengthening Exercises for Patellofemoral Pain Syndrome
Stretching Exercises for Patellofemoral Pain Syndrome
The best stretching exercises for PFPS are the quad stretch, hamstring stretch, and the calf stretch on a slant board. These stretches should be performed two times per day, every single day for eight weeks or until your symptoms resolve.
1. Quad Stretch
How to perform the quad stretch with a strap exercise for patellofemoral pain syndrome.
Begin by lying on your belly with both knees straight and the strap looped around the middle of your foot. Bend your knee towards your bum, using the strap to help pull your foot towards you. Once you begin to feel a stretch in the front of your thigh or the front of your hip, hold this position for about 10 seconds and repeat 10 times
Professional Tip: If you need an even better stretch, roll up a thick towel or pillow and place it under your knee and then perform the stretch as described above. You should feel an even stronger stretch on the front of your thigh when you do it like this.
What is the best strap for the prone quad stretch exercise?
We love the stretch out strap for performing the quad stretch. We have tried many different yoga or stretching straps, but this strap continues to be a crowd favorite for ourselves and our patients in the clinic. The stretch out strap is awesome because it is 6 ft long making it long enough for people of many sizes to use for a variety of stretches and allowing enough slack to comfortably reach and hold the strap. Additionally, the stretch out strap has loops along its length which provide an easier grip and a comfortable position to hold the strap for each person.
2. Hamstring Stretch
How to perform the hamstring stretch with a strap exercise for patellofemoral pain syndrome.
Begin lying on your back with both legs straight and loop the strap around the middle of your foot. Keep your knee straight and use the strap to pull your leg straight up until you feel a stretch in the back of your leg. Once you feel a stretch, hold this position for 20 seconds and then lower the leg back down to the starting position. Rest for a few seconds and repeat 5 times.
Professional tips: Having a slight bend to the knee is ok when first beginning this stretch, but over time the goal is to work on getting the knee as straight as possible for the best and most effective stretch.
What is the best equipment for the hamstring stretch?
We use the same stretch out strap as we do for the quad stretch! We love this stretch out strap as it is versatile for all of our stretches. As mentioned above, the features that make this strap our favorite include the loops along the entire strap which provide comfortable handles to hold the stretch and its long length allows it to be versatile for people of all heights.
3. Calf Stretch on a Slant Board
How to perform the calf stretch exercise for patellofemoral pain syndrome.
Place the slant board against your countertop or stable surface so you have something to support your upper body and hold on to. Begin by placing the front half of your foot onto the slant board with your heel on the ground. Keeping your knee straight, gently lean forward until you begin feeling a stretch in the back of your calf. Hold this stretch for about 20 seconds and repeat 5 times.
Professional tip: Begin with a low incline to start and as the stretch begins to feel easier or you feel you need a deeper stretch, you may gradually increase the incline of the slant board.
What is the best equipment for the calf stretch?
We consider the slant board the best way to stretch tight calves. We love to use this adjustable slant board for stretching the calves because it provides support to the whole foot, while also providing a deep stretch. We have this slant board at home and use it daily! The slant board we linked below is our favorite because it has several adjustments to best suit each person’s needs and flexibility levels and can be easily stowed at home.
Best Quad Strengthening Exercises for Patellofemoral Pain Syndrome
The best quad strengthening exercises for PFPS are the long arc quad, step down and the goblet squat. These exercises should be performed once a day, every single day for eight weeks or until your symptoms resolve.
1. Long Arc Quad
How to perform the long arc quad exercise for patellofemoral pain syndrome.
Begin by sitting in a chair or on the edge of your bed with your knees bent. Slowly kick out your foot until your knee is fully straight with your thigh still resting on the surface of the chair or bed. Once your knee is fully extended squeeze your quad and pause in this position for a second or two before returning to the starting position. Repeat this exercise 15 times and perform 2 sets, with a rest break in between.
Professional tip: When first starting this exercise, I always advise to start with no weight on the ankle. However, as the exercise begins to get easier, if pain free, you may add a light ankle weight to progress strengthening the quadriceps muscle.
What is the best equipment for the long arc quad?
For this exercise, we like to eventually progress to using ankle weights. We love these ankle weights because they are comfortable on the ankle and have adjustable amount of weight, so they may be increased as your strength continues to improve! These ankle weights are highly rated and sold in pairs, so you can add a weight to the other ankle if you are doing these exercises for both knees, or double up on one ankle if you need a little extra boost of weight!
2. Step-Down
How to perform the step-down exercise for patellofemoral pain syndrome.
Begin by placing a low step next to your counter or a stable surface to hold onto for balance as you perform the step-down. Begin by standing with your hurting leg on the step and your good leg hanging off the step. Slowly bend the affected (hurting) knee lowering your good leg to gently tap the floor, then return to a standing position. This exercise is working the hurting leg that is staying on the step by performing this mini squat or step down on one leg.
This exercise can be challenging to perform properly, so two areas to pay attention to while performing this exercise are the position of your knee and your hip. When slowly lowering your leg to the ground, try to ensure your knee remains facing forward as you bend it, trying to prevent the knee from bending in towards the other leg. Lastly, as you perform the step down, we want to keep the hips as level as possible, only bending at the knee and not tilting or moving the hips to bring the foot to the ground.
Perform 10 repetitions of this exercise, take a 30 second break and repeat for a second set.
Professional tip: Begin with a low step to start, allowing you to master the movement and control of the exercise and then you may progress to a higher step if the movement becomes easier and is pain free. I like to begin with a 4-inch step and progress by 2 inches as my patient is able.
What is the best equipment for the step-down?
For this exercise, we recommend using a stepper that is durable and has good traction with the ground, so it does not slide as you are using it. The stepper below is the one we use in the clinic every day and love because of its adjustable heights, durability, and portable nature.
We recommend a stepper for this exercise at home rather than a standard step due to the adjustable height. Whereas a standard step is usually much higher (usually about 8 inches) and being able to move the stepper to a location that gives you a surface to hold on to while performing your exercises will be helpful.
3. Goblet Squats
How to perform the goblet squat exercise for patellofemoral pain syndrome.
Begin with your feet slightly wider than shoulder width apart and hold the weight in both hands at chest height. As you are performing the squat, pretend you are sitting back into a chair by pushing your hips back. Slowly lower into a squat position and then return to your standing position. We usually begin with a lighter dumbbell and progress to a heavier weight as the exercise gets easier. Perform 10 repetitions of this exercise and complete 2 sets.
Professional tips: You may adjust the position of your feet as you perform the goblet squat to allow for what feels most comfortable for your hips and knees. Typically, we want the feet facing forward, but if it feels better to have the feet pointed slightly outward this is ok too! All bodies are slightly different so small adjustments may make the movement more comfortable while still targeting the quadriceps muscle.
What is the best equipment for the goblet squat?
We like to use a heavier hand weight for the goblet squat to provide a sufficient load to the quad muscle as you are squatting. We love these hand weights because they are durable and comfortable to hold against the chest, while providing a heavy enough load to challenge the quads.
Best Hip Strengthening Exercises for Patellofemoral Pain Syndrome
The best hip strengthening exercises for PFPS are the sidelying clamshell, sidestepping with a band and the romanian dead lift. These exercises should be performed once a day, every single day for eight weeks or until your symptoms resolve.
1. Sidelying Clamshell
How to perform the sidelying clamshell exercise for patellofemoral pain syndrome.
Begin lying on your side with the affected (hurting) hip facing the ceiling and both knees bent. Keeping your feet together, lift the top knee towards the ceiling, pause for a few seconds and then return to the starting position. Perform this exercise 10 times and repeat for 2 sets.
If this exercise begins to feel too easy, you may add an ankle weight or resistance band above the knee to increase the challenge. The addition of a resistance band or weight can help to improve your gluteus medius strength quicker.
Professional tip: When you are lifting the top leg, make sure to keep your hips in place and avoid opening the legs so far that you rock backwards. The goal is to feel the burn and fatigue on the outer side of the hip and bum.
What is the best equipment for the sidelying clamshell?
Adjustable ankle weights or resistance bands are very helpful in providing a graded external resistance to quickly improve the strength of the gluteus medius muscle. Below you will find a resistance band set and adjustable ankle weights that we find comfortable, easy to use, and helpful for progressing this exercise.
Both the resistance band kit and the ankle weights are a nice option, as they can both be used for many other exercises as well. The resistance band kit comes in a set with increasing tension, making it easy to progress and build strength. The ankle weight is also a nice option because it is adjustable so you can progress the weight as you wish!
2. Sidestepping with a Resistance Band
How to perform the sidestepping with a resistance band exercise for patellofemoral pain syndrome.
Place the resistance band above the knees and begin standing with knees slightly bent. Begin by stepping to the side, with one foot and following with the next. I usually have patients perform this exercise along a hallway or countertop at home. Once you reach the end of your space, stay facing the same direction and sidestep back to the starting position. Repeat this exercise across the length of your space about 3-4 times, performing more laps until you feel a little fatigue or burn in the outer hips.
Professional tip: Ensure that your feet remain facing forward during your sidestepping to best target the outside of the hips. Also, as you are sidestepping, try to keep tension on the band during the whole exercise, by not bringing your feet completely together with each step.
What is the best equipment for sidestepping with a resistance band?
We love this resistance band kit with a variety of different bands! It allows you to progress to heavier resistance bands as your strength improves. Plus, it comes in a few fun color options!
3. Single Leg Romanian Dead Lift (RDL)
How to perform the RDL exercise for patellofemoral pain syndrome.
Begin by standing on your hurting leg with a slight bend in the knee. In the hand opposite of your affected or hurting knee, hold a light hand-weight. Next, slowly reach towards the ground with your arm keeping your hips and low back in line. As you extend forward towards the ground, your opposite leg, or non-hurting leg, will lift towards the ceiling. Then slowly return to a standing position. The goal of this exercise is to feel the burn in the glutes on your standing leg. Perform 8-10 repetitions of this exercise and repeat for 2 sets.
As this exercise becomes easier and your balance improves, you may increase the weight in your hand to increase the challenge and further strengthen your glute muscles.
Professional tips: I always tell my patients to think of this movement as if they were tipping over like a teapot, keeping the hips, trunk and lifted leg all in line.
What is the best equipment for the RDL?
In order to best load the glute muscles for this exercise, we recommend using a hand weight. We love this set of hand weights as there are many sizes to best suit your starting strength level, they are affordable, but durable and easy to clean! For this you can double up and hold two weights in one hand if the exercise is getting easier or grab a few different weights to progress at your own pace.
Final Thoughts on the Best Exercises for Patellofemoral Pain Syndrome
The key to treating this condition is often starting slowly and progressing the difficulty of the exercises as they become easier and pain free. We know patellofemoral pain syndrome can be limiting for many of your normal sport-related and daily activities, but we hope that these exercises can give you a graded approach to begin improving your knee pain and getting back to what you love!
Frequently Asked Questions About Patellar Tendonitis Exercises
Does taping help patellofemoral pain syndrome?
Yes! Depending on the taping method, this can be helpful for your patellofemoral pain in the short term. We have found that McConnell taping can be very helpful for pain relief in patients with PFPS. It is especially beneficial when trying to get back into more functional activities or movements that put more load or force through the knee.
Often times, patellofemoral pain stems from the knee cap placing excess force on the outside or lateral part of the knee. The goal of McConnell taping is to glide or move the knee cap medially, to relieve pressure and unwanted forces on the lateral knee. When the tape is holding the knee cap in this slightly adjusted position, it is able to relieve pain in the front of the knee, especially for activities that typically put more load or force through the knee.
You can assess whether the patellar taping is helpful for you by trying a step down or a squat before and after taping the knee and evaluating if your pain is eliminated or diminished with use of the tape. However, because the pain is only usually eliminated while wearing the tape, we always encourage patients to use the tape as their quad is getting stronger and then eventually wean from using the tape for their sport or functional activities as it becomes easier and less painful.
Below are links to the tape we use with patients in the clinic.
Can I run with patellofemoral pain syndrome?
You may run with patellofemoral pain syndrome, but this could aggravate your symptoms. I advise my patients to avoid running until they have a few weeks of targeted strengthening and stretching under their belt, then gradually begin returning to their running routine.
Can I do CrossFit with patellofemoral pain syndrome?
CrossFit is an excellent source of functional training and involves movements that are awesome for promoting quad and hip strength as well as general mobility. However, because many movements in CrossFit involve deep squatting or lunging, I would modify the movements that are causing pain.
You can do this by performing fewer repetitions of the exercises, performing the exercises in a limited range or picking a different movement entirely to substitute if the program involves an exercise that is causing you pain. My guideline is generally to tailor the workout so it is not causing or aggravating your knee pain. If it challenges the muscles or causes fatigue this is ok, but if it is painful, I would avoid that movement until you are able to perform it pain free.
Is it ok to walk with patellofemoral pain syndrome?
Yes! Walking is also a wonderful form of exercise and is something I encourage all my patients to prioritize each day, in the ways that work best for them. However, if walking is worsening your knee pain, I would modify the distance or the terrain to make the activity pain free.
What is the fastest way to cure patellofemoral pain syndrome?
The fastest way to cure patellofemoral pain syndrome is to take a combination approach! Exercises targeted to strengthening the quad and hip muscles, in addition to stretches to the surrounding structures, have been shown to greatly reduce forces on the patellofemoral joint and help the knee return to functioning properly.
In addition, I would encourage icing the knee especially after more rigorous activity to calm any inflammation or irritation. Lastly, modifying or avoiding the activities that aggravate your symptoms can be helpful in the short term for improving your patellofemoral pain syndrome until you have had the opportunity to appropriately rehab the knee.
Should I wear a knee brace for patellofemoral pain syndrome?
I typically do not recommend a knee brace for patellofemoral pain syndrome. We want the muscles surrounding the knee joint working and engaging to get stronger! Knee braces lend additional support to the knee, which allows the muscles surrounding your knee to take a break and rest. Although this may make the knee feel a little less painful in the interim, I prefer for those muscles to be working to help get the knee feeling better sooner!
But wearing a brace should not aggravate the knee pain, so if it helps you and you feel more comfortable with the brace on, you may wear it! The knee brace that we have heard the most positive reviews from our patients about is in the link below.
Patellofemoral pain syndrome can certainly go away! Patellofemoral knee pain can definitely fully resolve with targeted strengthening and stretching exercises. These exercises will work to allow the quad and knee joint as a whole to function properly and decrease unwanted or abnormal forces through the knee cap, which will improve your pain.
Although patellofemoral pain syndrome can completely resolve, it is possible for it to return again at another time if the muscles or structures surrounding the knee lose strength or flexibility. That being said, our goal is always to keep you feeling good long term and provide you with a program to refer to if those symptoms do one day pop up after a new exercise class!
How long does it take PFPS to heal?
As any condition, healing times for patellofemoral pain syndrome vary for each individual. Some factors that may play a role in healing time may include the length of time the knee pain has been going on, the degree of strength or flexibility deficits or the activities you would like to eventually return to.
If your PFPS has been bothersome for a longer period of time, it may take a longer time to improve your symptoms. The same is true if your strength or flexibility deficits are more involved, then it may take a little longer to strengthen and stretch those areas. Lastly, if you wish to get back to activities that place more demand onto patellofemoral and knee joint, it may take more training and time to return to these higher-level activities.
However, we have found patients typically start feeling better in a few weeks and pain resolving in about 6-8 weeks.
Does physical therapy work for PFPS?
Absolutely! We treat patients with patellofemoral pain syndrome in the clinic every day and have a lot of success in improving their pain with this condition.
Why you can trust Physical Therapy Simplified for treating PFPS.
At Physical Therapy Simplified, our mission is to provide an easily accessible and highly reputable source of physical therapy information that anyone can understand, follow, and benefit from. We want you to feel confident that you are getting the best content and information that will help to reduce your pain and restore you to your highest functional potential.
The author of this article, Erica Harkins, DPT, is a licensed physical therapist and received her Doctor of Physical Therapy degree from the University of Pittsburgh. She is an expert in the field of physical therapy and specializes in treating orthopedic conditions throughout the entire body.
Erica has had multiple internships in outpatient orthopedic clinics and currently works at the University of Pittsburgh Medical Center, Rehabilitation Institute. She has significant experience working with patients who have patellofemoral pain syndrome. The treatments in this article were created by Erica and have been used on multiple patients to alleviate symptoms caused by PFPS.
