If you have been diagnosed withpatellofemoral 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.
Before starting this, or any other, exercise program, check with your healthcare provider to ensure that exercise is safe for you to do.
Anatomy of the Knee
1Quadriceps StrengtheningResearch indicates that weakness in yourquadriceps 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 thequad 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.Theshort arc quadis 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.
1
Quadriceps StrengtheningResearch indicates that weakness in yourquadriceps 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 thequad 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.Theshort arc quadis 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.
Quadriceps Strengthening
Research indicates that weakness in yourquadriceps 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 thequad set exercise.
To do the exercise:
Theshort arc quadis another exercise that can help improve the way your quadriceps muscle supports your kneecap.
To do this:
Repeat each exercise 10 to 15 repetitions, twice a day.
2
Straight Leg Raises
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:
Straight Leg Raise Exercise Progression
3
Clam Shell
Clam Exercise - glute medius activation.E. Quinn
The clamshell is a great exercise to do to improve the strength of your hip muscles, specifically thegluteus medius.Your glutes help to control the position of your knee, and weakness of these muscles can lead to PFSS.
To perform the clamshell:
4Isometric Gluteal StrengtheningBrett Sears, PTIsometric 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.Isometric Gluteus Medius Training
4
Isometric Gluteal StrengtheningBrett Sears, PTIsometric 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.Isometric Gluteus Medius Training
Isometric Gluteal Strengthening
Isometric gluteus medius strengthening can help to keep your legs and kneecaps in proper alignment.
To perform the exercise:
Isometric Gluteus Medius Training
5
Advanced Hip Strengthening
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.
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.
Advanced Hip Strengthening Exercises
6PlyometricsJohn Fredele/Getty ImagesRunning 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:Double leg hopSingle leg hoppingDiagonal hoppingThese 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.
6
PlyometricsJohn Fredele/Getty ImagesRunning 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:Double leg hopSingle leg hoppingDiagonal hoppingThese 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.
Plyometrics
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.
7
Advanced Balance Exercises
Zero Creatives/Getty Images
Many people with PFSS have impaired balance andproprioception(position sense), so working on your balance may be an important part of your PFSS rehab exercise program.
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.
Exercises for Patellar Tendonitis
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Peters JS, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.Kaya D, Doral MN, Callaghan M.How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome?.Muscles Ligaments Tendons J. 2012;2(1):25-32.Chan MK, Chow KW, Lai AY, Mak NK, Sze JC, Tsang SM.The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles.BMC Musculoskelet Disord. 2017;18(1):313. doi:10.1186/s12891-017-1674-2Burnet EN, Pidcoe PE.Isometric gluteus medius muscle torque and frontal plane pelvic motion during running.J Sports Sci Med. 2009;8(2):284–288.Gong W.The effects of the continuous bridge exercise on the thickness of abdominal muscles in normal adults.J Phys Ther Sci. 2018;30(7):921-925. doi:10.1589/jpts.30.921Keller JL, Fritz N, Chiang CC, et al.Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis.J Vis Exp. 2016;(107):e53449. doi:10.3791/53449Davies G, Riemann BL, Manske R.Current concepts of plyometric exercise.Int J Sports Phys Ther. 2015;10(6):760-86.Janssens L, Brumagne S, Mcconnell AK, et al.Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.PLoS ONE. 2013;8(3):e57949. doi:10.1371/journal.pone.0057949
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Peters JS, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.Kaya D, Doral MN, Callaghan M.How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome?.Muscles Ligaments Tendons J. 2012;2(1):25-32.Chan MK, Chow KW, Lai AY, Mak NK, Sze JC, Tsang SM.The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles.BMC Musculoskelet Disord. 2017;18(1):313. doi:10.1186/s12891-017-1674-2Burnet EN, Pidcoe PE.Isometric gluteus medius muscle torque and frontal plane pelvic motion during running.J Sports Sci Med. 2009;8(2):284–288.Gong W.The effects of the continuous bridge exercise on the thickness of abdominal muscles in normal adults.J Phys Ther Sci. 2018;30(7):921-925. doi:10.1589/jpts.30.921Keller JL, Fritz N, Chiang CC, et al.Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis.J Vis Exp. 2016;(107):e53449. doi:10.3791/53449Davies G, Riemann BL, Manske R.Current concepts of plyometric exercise.Int J Sports Phys Ther. 2015;10(6):760-86.Janssens L, Brumagne S, Mcconnell AK, et al.Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.PLoS ONE. 2013;8(3):e57949. doi:10.1371/journal.pone.0057949
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Peters JS, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.Kaya D, Doral MN, Callaghan M.How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome?.Muscles Ligaments Tendons J. 2012;2(1):25-32.Chan MK, Chow KW, Lai AY, Mak NK, Sze JC, Tsang SM.The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles.BMC Musculoskelet Disord. 2017;18(1):313. doi:10.1186/s12891-017-1674-2Burnet EN, Pidcoe PE.Isometric gluteus medius muscle torque and frontal plane pelvic motion during running.J Sports Sci Med. 2009;8(2):284–288.Gong W.The effects of the continuous bridge exercise on the thickness of abdominal muscles in normal adults.J Phys Ther Sci. 2018;30(7):921-925. doi:10.1589/jpts.30.921Keller JL, Fritz N, Chiang CC, et al.Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis.J Vis Exp. 2016;(107):e53449. doi:10.3791/53449Davies G, Riemann BL, Manske R.Current concepts of plyometric exercise.Int J Sports Phys Ther. 2015;10(6):760-86.Janssens L, Brumagne S, Mcconnell AK, et al.Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.PLoS ONE. 2013;8(3):e57949. doi:10.1371/journal.pone.0057949
Peters JS, Tyson NL.Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review.Int J Sports Phys Ther. 2013;8(5):689-700.
Kaya D, Doral MN, Callaghan M.How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome?.Muscles Ligaments Tendons J. 2012;2(1):25-32.
Chan MK, Chow KW, Lai AY, Mak NK, Sze JC, Tsang SM.The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles.BMC Musculoskelet Disord. 2017;18(1):313. doi:10.1186/s12891-017-1674-2
Burnet EN, Pidcoe PE.Isometric gluteus medius muscle torque and frontal plane pelvic motion during running.J Sports Sci Med. 2009;8(2):284–288.
Gong W.The effects of the continuous bridge exercise on the thickness of abdominal muscles in normal adults.J Phys Ther Sci. 2018;30(7):921-925. doi:10.1589/jpts.30.921
Keller JL, Fritz N, Chiang CC, et al.Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis.J Vis Exp. 2016;(107):e53449. doi:10.3791/53449
Davies G, Riemann BL, Manske R.Current concepts of plyometric exercise.Int J Sports Phys Ther. 2015;10(6):760-86.
Janssens L, Brumagne S, Mcconnell AK, et al.Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.PLoS ONE. 2013;8(3):e57949. doi:10.1371/journal.pone.0057949
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