Browsing Tag

knee exercises

Health, Knee pain

Torn Meniscus: Self-Treatment Exercises

• By

Often, surgery is not the best option – So what should home-rehab exercises look like for a torn meniscus?

In this second post in the series we look at your home rehab programme, covering exercises to reduce muscle spasm, improve balance and strength a well as an effective self-mobilization technique that will help you make big gains.

As we covered in the first post, a torn meniscus is a very common injury and there’s some important points when it comes to anatomy and surgery vs. conservative rehab, so make sure you have a read of that also.

Knee rehab exercises

NOTE: You can now get our comprehensive KNEE Injury rehab guide – a full rehab guide that you can download with the click of a button!

So, here is your self-treatment:

Rehab for a torn meniscus needs to cover four things:

  1. Muscle spasm
  2. Balance and muscle activation
  3. Graduated strengthening
  4. Joint mobility and meniscus healing

This is the order we need to start them in as well as the first step of your rehab is to settle the secondary symptoms, which is mainly muscle spasm and muscle switching off. This initially reduces pain, improves the range of motion and starts you being able to use it more – which speeds up recovery by helping you optimally load the knee.(1)

RICE injury treatment, heal strong and fastStep 1: Ease pain and improve range

First 72 hours:
As with most acute injuries, you need to first look after it, to allow initial healing – basically where the “scab” forms and to allow it to settle down.

Step 2: Switch the muscles back on, decrease spasm and improve balance

After the first 72 hours, it is important to prevent loss of muscle mass and get your muscles switching on again using some simple proprioceptive and stretching exercises:

  • Bosu ball, wobble board ankle and calf re-training rehab quickSingle-leg balance: The knee loses proprioception very quickly when injured (you can think of this as the “feeling” or the balance). So to get it back, you need to challenge your balance.
    • Level 1: Stand on one leg on the floor, when comfortable for 1 minute, progress…
    • Level 2: Fold up a towel and stand on this, when easy for 1 minute, fold it up thicker or
    • Level 3: Either roll a towel up tight or use a Balance Board or BOSU ball
  • calf stretch , soleus, gastroc - self treatment for shin splintsCalf stretch: Hang one heel off a step for 30 seconds at a time. Once per side.
  • Inner range quads torn meniscusInner range quads / Extensions: With knee injuries we lose activation of the distal thigh muscles, just above the kneecap very quickly. This is a nice and easy one (but still very important!). Sitting in a chair, or in bed with a towel under the knee, extend the knee by lifting the foot up to full extension or pain. Repeat this 20 times, every 2 hours.
    • Note: Do not force it, and take it nice and slow

Step 3: Start strengthening the knee

This is where it finally starts getting less boring! Start step three when it is comfortable to do the above exercises and remember not to push into pain.

  • correct squat form, strong and safeSquats. Yes these are great for getting your leg stronger again but it is important to start at the right level for you and progress from there through the following:
    • Level 1, Wall squats: Lean against a wall, with your feet shoulder width apart and out from the wall. Slide down the wall 1/2 range and no more. Hold this for 5-10 seconds and repeat 10 times. Tip: make this a bit easier on your knee by having a large round ball or Foam Roller between you and the wall.
    • Level 2, Double Leg Squats: Again, fee shoulder width apart. squat up and down within the comfortable range. repeat 10 times for 3 sets.
    • Level 3, Single Leg Squats: Now, standing on one leg, perform squats, within a comfortable range, 10 reps, 3 sets. Note: with this one you won’t be able to squat very low, and that is perfectly fine!
    • Technique: To take pressure off your knees, don’t let your knee/s go forward past your toes and it helps to stick your bum out further!
  • Cardio: Keep your fitness up and boost healing by utilizing:
    • Biking on a Exercycle ideally is great once you have over 90 degrees range in your knee
    • Swimming is a good one for un-weighted exercise, just stay away from breaststroke
    • Walking, as able. When you are able to walk pain-free for 1/2 hour, you can try a short jog and build from there.

Step 4: Gain full knee range

MTSS shin splints self treatmentThere are three things that will limit range mainly at this point: Joint stiffness, muscle tightness and the knee still healing.

The knee should continue healing, as long as it isn’t overloaded, so let your body get on with that.

Muscle tightness can be addressed by stretching out muscles such as your calf, hamstring and quads and also by foam rolling.

Last but not least, joint stiffness can be helped by self-mobilization to improve it’s bending and get the joint oiled-up. See the below video for a short and easy demo:

YouTube player

Health, Knee pain

How to Prevent ITB syndrome: IT band exercises

• By

ITB syndrome can be painful and difficult to treat, BUT with the right pre-hab and IT band exercises, YOU don’t have to worry about any of that!

Prevention = Cure!

ITB syndrome is all too common, with up to 12% of long distance runners affected and a huge 22% of US marine recruits suffering from this, it is a very, very important problem to not only treat right but prevent. This leads to less time out from sport, training and work  – and more time doing what you love!(1,2)

So to prevent this, we need to sort out the risk factors – lessening the chances of you having to take time out.

For more information on how ITB syndrome happens and the latest and greatest treatments, see our recent post here

The main risk factors are:

  • Downhill running(4)
  • Weak or inhibited lateral gluteal muscles (you hip stabilisers e.g.Gluteus medius)
  • Running around a track a lot in one direction
  • And greater than normal weekly mileage(3)

Now from that you can likely see that three of those points are easy to sort out. You can decrease downhill running and vary up your training more. you can run in both directions around a track, if you run n one. And you can make sure you don’t increase your training miles by more than 10% per week – No problem.

But having weak lateral hips – That’s something we really need to work at.

When your hip stabilisers don’t fire up or are weak, this leads to poor control of your pelvis ad hip abduction. Because of this, other muscles have to compensate for this deficit, leading to tight muscles and poor hip extension. This is a big problem, particularly in runners and studies have shown that runners with ITB syndrome do have weaker abductors in the affected leg.(5)

ITB syndromeOne of the muscles that takes over is your tensor fascia latae (TFL) – meaning it is working harder, often leading to spasm and tension. The clincher is that your TFL attaches into your ITB – That means if TFL tightens up, this tensions the band, making it tighter and tighter – causing compression at the knee and pain for you.



So here is the IT band exercises that we need to do:

  • Strengthen your lateral hip muscles
  • Improve glut activation
  • Loosen off and stretch compensatory muscles – e.g. TFL


The following exercises will do this and put you well on your way to being injury free!

1. Side plank

side plank for core strengthening


Level 1: Rise up into the position shown and hold for 30 seconds. Each time hold it for a little longer so that eventually you can hold it for two minutes.

Level 2: When you can easily hold it for two minutes, try doing side plank leg raises. This is where you rise into the side plank and then lift your top leg straight up and down. Begin this with 3 sets of 5 repetitions and build up, until you can do your goal of 30 in a row! (easily)

Note: If level one is too hard – bend your knees, so that you are lifting off your elbow and knee.

The side plank is great to getting your lateral gluts firing together with your obliques – just make sure you do not stick your bum out – bring it forward so that your body is straight.

2. Donkey kicks

Donkey kicks improve glut activation

Start on your hands and knee as shown and kick your leg out behind your slightly up towards the roof.

Perform 3 sets of 8 reps.

Note: to make this harder your can be on your toes instead of your knees on place your elbows on a gym ball.



3. TFL myofascial release

tensor fascia latae and itb myofascial releaseasis anterior super iliac spineThe TFL is, as you can see the image below a little muscle at the side of your hip. to find it, place your fingers on your ASIS which are the bones on either side of your pelvis at the front. From the side of these, drop down a couple of inches and you should be right on it!

I want you to lie on your side and place a ball under your TFL – you can use any ball you like, massage ball, lacrosse ball, tennis or golf ball. Then slowly roll the ball around that area, working out all the knots and tight spots – this can take 2-5 minutes but is well worth your time!

And remember, a bit of trigger point pain is expected here.


Interesting note for runners: Having a higher cadence (quicker strides) has been shown to lower the risk of ITB syndrome. This is because when you increase your cadence (which should ideally be 180 steps per minute) your land with your knee bent more and your foot below your knee – decreasing the force through the knee and making for more economical running.(5) This also links in with downhill running being a risk factor – when running downhill we land with our legs much straighter a position, placing a lot more force on our knees and hips.


And remember. You are much better off-putting in a little bit of time now that spending a lot of time AND money when you do get injured.

Invest in  yourself



Knee Sprain Treatment – Rehab Exercises to Heal Fast and Strong

• By

knee sprain treatmentManaging a knee sprain the right way, means faster healing, stronger healing and you get back to what you love faster – how could you say no to that!

Following on from the first post in this knee sprain series, where I outlined what you must do in the first 72 hours, I want to outline the knee sprain treatment and rehab exercises that will fully rehab your knee, the right way.

Knee Sprains Rehab with Non-Operative Treatments

Sprained knee, heal fast and strongThe medial collateral ligament (MCL) is the most frequently injured ligament of the knee, so it is important that YOU have the know-how, to rehabilitate it right from the start.

It is important for you to know and have peace of mind that knee sprains (when other structures aren’t also injured) do respond very well to non-operative treatment and rehab.

As Phisitkul et al state: “Nonoperative care has been proposed as the mainstay treatment for the majority of isolated MCL injuries regardless of severity”.

Treatment with early protected range of motion exercises and progressive strengthening has been shown to produce excellent results and a high rate of return to sports”

So let’s go through what your knee sprain (LCL or MCL) rehab involves and what the exercises are that will get you back faster and stronger.

Knee Sprain Treatment 

Effective knee sprain treatment must include:

  1. RICE – for the first 72 hours
  2. Brace (for high-grade tears)
  3. Proprioceptive re-training
  4. Range of motion exercises
  5. Strengthening exercises

If one of these aspects are missed or ignored, you could be left with ongoing, nagging pain or heal weaker, leading to future injury. Not ideal right?

Your rehab needs to be gradually progressed so that you body has time to adapt and get stronger. Our body is continually adapting to the forces that we put through it – So if you put the right controlled forces though your injured leg, it will get stronger and stronger.

We have talked about the first two components of sprained knee rehab and treatment in our earlier posts. For this post we will talk about the other three aspects, starting with Proprioception Re-Training.

1. Proprioception Re-Training:

Proprioception is the ability for you brain to know where you body is in space. If this is decreased, you have poor balance and increased chance of re-injury.

If you aren’t sure what proprioception is – extend one arm out to the side, close your eyes and mirror it exactly with the other arm – you could do this with your eyes closed because of proprioception.

Single leg standing (SLS):

Begin by standing on one leg on a solid surface (you can put one finger on the wall if you need to start with). When you can do this for 60 seconds, you can progress it by:

  • SLS on a folded up towel, layers of towels are great to use as you can easy progress this by adding layers and then finally rolling it up, tighter and tighter. Progressing each time when you can easily do it for 60 seconds. NOTE: Have a bench in front or to the side to grab onto if need be – but only if you have to!
  • You can also use Wobble boards, Bosu balls and balance boards when towels become to easy (or boring!) – Bosu ball are fantastic rehab tools if there is one available to you!

Continue to progress this through all phases.

2. Range of motion (ROM)

We recommend performing multiple exercises in a couple of phases to regain range of motion and  strengthening of muscles.

Phase one (first 1-2 weeks)

Due to pain, inflammation and limping, we lose range of motion (flexibility) very quickly and it is important to get this back as soon as possible to normalize movement and prevent secondary injury.

Note: continue to ice after use if there is pain, discomfort or swelling.

heel slides– Heel slides

  • Lying on your back or sitting
  • slide your heel up and down (bending knee up)
  • Do not push into pain
  • 3 sets, 10 reps
  • Do not push through pain

SLR-– Straight leg raise

  • Keeping leg straight
  • Lift leg 5-6 inches off the surface
  • 3 sets, 10 reps

inner range quads, quads setting for knee rehab– Quads setting

  • Roll a towel up and place under your knee
  • pushing your knee down into the towel
  • Lifting the feel up as shown
  • hold for 5 seconds, 10 reps

Progress to phase 2 when you can complete phase 1 exercises with little or no pain or swelling

Phase 2 of ROM and Strengthening:

*Continue to ice as needed

calf stretch , soleus, gastroc - self treatment for shin splints– Calf stretch

  • Hang your heel off the edge of a step, hold for 30 seconds
  • Do not push into knee pain – you should just feel a calf stretch

– Quads stretch

  • Hold for 30 seconds
  • As pain allows

hamstrinhamstirng stretch, knee pain rehab stretch– Hamstring stretch

  • Hold for 30 seconds
  • A little pain is OK, no more

Single leg Squat, hip stability and strengthSingle leg squats

  • Quality, not quantity here – control it
  • 3 sets, 10 8 reps
  • Hold onto a pole/broomstick if needed
  • Don’t push into pain, just go down in a comfortable range

Bridge - increase leg strength, glute activationa dn decrease back pain. physiotherapy exercises for everyone

– Bridges

  • Bend your knees up, place feet on the ground
  • push through your heels and lift your bottom up
  • 3 sets, 12 reps

Progress this to single leg bridges when this is easy and pain-free:

Bridge 1 leg - glute activation, leg strength and core stability. the best exercise for hip stabiltiy, great for runners

  • 3 sets, 12 reps

– Begin walking/jogging program

Want more?

More more detailed information, advice and a step by step rehab guide that makes you your own Physical Therapist, check out our downloadable knee rehab guide HERE

Fore more detailed information, for those of you that enjoy research articles, have a read of this good review of anatomy, biomechanics and management

Persevere with this knee sprain treatment until your knee is 100% and remember, physio treatment can help speed up recovery by reducing swelling, muscle spasm and increasing ROM.

If you have any questions, make use of the comments section and don’t forget to like and share!

Health, Knee pain

ACL Injury: Strengthening and Rehab Rules

• By

acl mechanismInjured your ACL? Strengthening and rehabilitating the right way after ACL injury means less arthritis, faster return to sport and a more stable knee – So why wouldn’t you?

First and foremost, an ACL injury needs to be confirmed and then you need to ask yourself: Do you really need surgery?

Most likely, you won’t need surgery unless you are a high-level athlete or want to return to pivoting and high demand sports – the above post explains this in more detail and will help explain your options.


Why does a knee need to be strengthened following ACL injury?

acl anatomuThe ACL is right in the middle of the knee and prevents the tibia sliding forward on the femur and prevents excessive rotation. It is one of the four main  ligaments in the knee that give passive stability

So, simply, if you have an ACL injury – you have less passive stability in the knee and need to make up for this. This is done by improving the active stabilizers – Your muscles.

This is the same whether you have done a partial or full rupture – If partial, you need to unload the ACL and support the knee while it is healing. If you have ruptured it, then you need to replace this loss with increased muscle supports.


Why hamstrings are your savior:

hamstrings action in protecting the aclTo better understand a few of the below rules of rehab, it is important to know about the role of the hamstrings. The ACL works to prevent your tibia (the shin bone) sliding forward, when landing, kicking, twisting etc. Luckily the hamstring also does a similar job – they travel down the


ACL Injury Rehab Rules:

1. Closed-chain before open-chain exercises

Why: First of all a quick explanation of open and closed chain exercises for those of you who don’t yet know:

open and closed chainOpen chain: Simply, your hand or foot is free to move in the air while doing open chain exercises – the chain is not continuous. Such as bench press, biceps curls, and hamstring curls.

Closed chain: This is when your hands or feet and planted, in constant contact with a surface. Such as a push-up, squat or leg press.

A study investigating the tensile forces placed on the ACL during a range of exercises found that there is significantly less force through the ACL during weight-bearing (closed chain) exercises when compared to open chain exercises – hence unloading the ACL and putting less forward pull on the tibia.

For example:

  • 0 Newtons of ACL loading during barbell squat, leg press, wall squat, front or side lunge (closed chain)
  • 59 Newtons of ACL loading during single leg squat (closed chain)
  • Seated knee extension (open chain): 396 newtons

The exception of this is seated knee flexion (hamstring curl) this is an open chain exercise but produces 0 ACL loading – this is because as discussed earlier, the hamstrings support the ACL by holding the tibia back in place.

It has also been shown that closed chain exercises recruit important stabilizing muscle groups of the hip which play a big part in knee alignment and proprioception.

hamstirngs squat2. Lean forward at the hips

Why: Because the hamstrings originate from your sitting bones (ischial tuberosities) at the back of your pelvis – If you tilt forward at the pelvis more as shown here it acts to lengthen out the hamstrings. Thus increasing hamstring tension. As we now know that the hamstrings are important in stabilizing an ACL deficient or injured knee – this is what we want! So don’t try to keep your body straight up and down (it is pretty hard to squat like that anyway). Actually, the optimal forward trunk tilt was shown to be 30 degrees as this increases hamstring muscle activity and force – Ideal!

Don’t stretch your hammies

3. Balance it out: Don’t stretch your hamstrings or idolize your quads

Why: Your quadriceps and hamstrings play a tug-of-war on the knee – the quads pulling the tibia forward (increasing ACL tension) and the hamstrings pull the tibia backward (decreasing ACL tension). You need to make sure there is a balance here by making sure your hamstrings stay tight and strong and when strengthening your quads – only do this in closed chain exercises in order to get co-activation of the hamstrings and hip stabilizers.

4. Keep your heels down

Squatting with your heels off the ground causes 3 times more ACL loading compared to squatting with your heels flat – so when possible (ie if you haven’t got incredibly tight calves) keep your heels flat on the ground. This is because having the heels raised up increases how far forward the knees go during a squat. As your knees go further forward the top of the tibia/ shin bone slopes down more – increasing the force on the ACL.

Note: This also applies to your shoes – If your wear shoes with big fat cushioned heels when working out – this can increase the shear force on your knee also.

5. Do not do resisted knee extensions

This is a pet hate of mine as it puts a huge amount of force through the the ACL and increases anterior tibial shear. The reason for this is because as an open chain exercise, it is working the quadriceps muscles in near-isolation, pulling the tibia forward and increasing ACL strain – Not what we want.

There are a lot of other exercises that would be far better to do such as leg presses, various forms of squats, lunges etc – these all have better co-contraction of knee stabilisers and importantly the hamstrings, leading to great ACL protection. When you are stronger and healing nicely it is important to do sports specific and functional rehab and so open chain exercises will be needed to have a strong knee – your Physio can progress you and guide you on to this as every knee is different.


For more specific information and data on ACL tensile forces during exercises, see this great paper by Escamilla et al.

Thanks for reading and good luck strengthening your knee!

Remember this is just a guideline to help your achieve your best and nothing is better than getting hands on input from your local Physio.

Health, Knee pain

ACL tear – Do you really need surgery?

• By

ACL tear non contact
When can I play again? Do I need surgery? These are the questions emotionally asked after anterior cruciate ligament injury. In this post i am going to answer these questions and more!

Torn your ACL and now wondering, do you really need surgery? The simple answer is: No – Only if you are a high level athlete, wish to return to pivoting/high demand sports OR have an unstable knee.

In this first post we will explore the difference in outcomes between surgery and conservative treatment and what that means for you: 

How do you know if you have an ACL tear?

If you heard a pop, snap or tear, the injury should be suspected as a ACL tear until proven otherwise. You may have felt something pop out or move  in the knee, this is sometimes confused for patella/knee cap dislocation but is most often an ACL tear.

You may or may not also feel clicking and locking which would indicate meniscal damage. Meniscal injury occurs in at least 40% of all meniscal tears(1).

Swelling will occur within an hour of injury, if swelling occurs a few hours later it points more towards meniscal tear.

But it is always best to get it thoroughly assessed by your local Sports Physiotherapist – It is not worth relying on Doctor Google or hoping it will go away!

Brief anatomy:

acl anatomuThe knee is formed by three bones, making up two joints. One joint is where the patella (knee cap) glides on the femur as you bend your knee. The other is formed by the tibia and the femur – This is the main joint that the ACL is in the middle of.

There are four main ligament that connect the femur and the tibia together and form this large hinge-like joint. These are the medial collateral(MCL), lateral collateral(LCL), anterior cruciate(ACL) and posterior cruciate(PCL) ligaments.

The ACL is right in the middle of the knee and prevents the tibia sliding forward on the femur and prevents excessive rotation.

Between the smooth articular surfaces of the tibia and femur and the menisci – the lateral and medial meniscus act as the shock absorber of the knee to prevent body injury, absorb shock and offer a smooth, rounded surface to move on.

Causes of ACL tear:

ACL injuries occur when the bones of the leg twist in opposite directions under full body weight, either during contact, or non-contact:

Non-contact ACL injury makes up about 70% of all ACL injuries, The two main mechanisms of non-contact injury are:

  • acl mechanismHigh impact jump-landing with a under-flexed (too straight) knee or valgus position (knee going laterally)







  • acl non contact 2Forceful rotation of the knee with the foot planted on the ground. This often happens when turning, side-stepping, pivoting etc.






acl tear contact

Contact ACL injuries:

The other 30% of ACL tears are due to contact and so are more random and due to a less preventable mechanism – There are often just plain unlucky.





Risk factors for ACL injury:

  • Poor sports specific conditioning
  • Muscle imbalance – The main one here is a low hamstrings-to-quadriceps strength ratio
  • Poor technique and awkward body movement
  • Poor neuromuscular coordination and balance

Risk factors that are hard to change:

  • Female gender
  • Joint laxity
  • Reduced ACL size and strength
  • Increased female sex hormones



In the USA alone, about 250 000 ACL injuries occur annually. This translates into a 1 in 3000 chance that a member of the general population will injure their ACL.(2)

And over half of these injuries are full ruptures of the ACL!

So that means an estimated 175 000 ACL reconstructions costing over US$2 billion each year.(3) That is a huge cost – especially if extrapolated world-wide! Unfortunately I can’t get a number on this but I’m sure you can appreciate that it is absolutely gargantuan.

This represents a huge financial cost for the health system AND for you with nearly half of ACL injuries undergoing surgery!

So imagine if it was found that there was no significant difference in outcome between surgery and conservative rehab?

Conservative rehab Vs Surgery – What are the outcomes? 

Re-Injury rate after reconstruction:

One of the big concerns following surgery is re-injuring the ACL or surrounding structures (e.g. meniscus or cartilage) upon returning to sport. This is because the re-injury rate IS HIGH – studies looking into this have found it can vary from 2.3% to 13%.(4) The reason for the reasonably large range here is because it does depend on the sport or activity that the player returns to.

The re-injury rate is in the higher spectrum if playing a pivoting sport. The re-injury rate is 12% when playing a pivoting sport such as rugby and football/soccer – This is an unacceptably high rate giving an almost 1 in 8 chance of re-injury!

Risk of Osteoarthritis:

Often patients are recommended surgery so that the risk of osteoarthritis (OA) is reduced, but this is simply not true.

The rate of return to sport, treatment method or how much loading the knee takes in the years after injury are not the main factors contributing to OA – The initial injury itself is the important factor contributing to OA. This is due to bleeding within and inflammation of the joint after injury that, although your symptoms resolve gradually (pain, limited range etc) and tears can be repaired surgically, trigger a remodeling process. This chronic remodeling triggered in the cartilage and other tissues in the joint leads to OA in the majority of cases.(7)

This results in roughly half of all ACL inured knees showing OA after 10 years and nearly 100% after 15-20 years.

Some studies have actually found that following re-construction there is more OA. Kessler et al 2008 found that although there was better knee stability after a re-con, there was significantly more OA when compared to conservative treatment (42% vs 25%).(6)

It is also worth mentioning that sports participation itself – without prior injury moderately increases the risk of hip or knee OA.

Conclusion: There is NO evidence to suggest that ACL repair prevents future arthritis.

So when is surgery called for?

People who SHOULD under-go reconstruction are those that:

  • Have on-going symptomatic instability, eg knee giving out
  • Are elite athletes


  • Wish to return to high-risk sports (pivoting sports)

The main reason for ACL reconstruction is to give an athlete a stable knee – So do not rush off to the surgeon if you do not have an unstable knee!

Follow this link for great information on:


Please Like, Share and Comment to let me know how you go and check out the below link to check your hip stability! Your hip controls the knee so this is very important!



Knee pain, running

Patellofemoral Pain Syndrome: Home rehab and exercises

• By

patellofemoral pain knee cap pain exercisesCommon names for Patellofemoral Pain Syndrome (PFPS) are Chondromalacia patella, anterior knee pain, runners knee, patellofemoral tracking disorder.

*Now just a quick clarification: Chondromalacia Patella is not PFPS. Chondromalacia Patella is commonly over diagnosed and is when the articular cartilage on the undersurface of your knee cap is damaged. The prevalence of this is far less than Patellofemoral pain syndrome but generally occurs if PFPS is left too long as the cartilage gradually softens and degenerates. This can be confirmed with an MRI. The below rehab exercises and advice for Patellofemoral pain WILL HELP this also, it will just be a longer recovery period.

Patellofemoral pain syndrome. self treatment and rehab at home to decrease pain and get you back to it!What: Patellofemoral pain is felt at the front of the knee and typically comes on gradually typically comes on gradually. Normally the patella (your knee cap) glides in a groove in your femur when bending your knee. It is believed PFPS results from abnormal Patella tracking (not gliding smoothly in the groove) causing excessive compression on the under surface.

This mal-tracking can be caused by:

  • Quadriceps weakness (particularly poor activation of your VMO/inside quads) causing an imbalance.
  • Excessive knee soft tissue tightness
  • Tight Quads and Iliotibial band
  • An increased quadriceps angle (Q-angle)
  • Hip weakness (particularly Hip abductors and external rotators)
  • Altered foot biomechanics eg. over-pronation

Generally, there is always a combination of these factors causing a significant imbalance of forces on the knee cap, leading it to be pulled to one side (like a tug of war!). It is generally pulled laterally.

Symptoms and signs

  • Anterior knee pain
  • Knee stiffness with prolonged knee flexion eg. sitting in movie or driving.
  • Activity-related pain: Running, squatting, stair climbing (especially going down), kneeling, cycling, swimming breaststroke.
  • Tenderness/pain on compression if the knee cap
  • Crepitations or Grating sensation
  • Giving way
  • Swelling around the knee cap

Risk Factors:

  • Female gender
  • Iliotibial band syndrome (ITB syndrome)
  • Training: Long distance running, training on hard surfaces, hills, stairs

Note: it is important to remember that muscle dysfunction and repetitive loading of the Patellofemoral joint rather than fixed biomechanical factors and the major contributors to PFPS(Baker and Juhn 2000) and so there is a lot that can be done to help.

Prognosis: Depends on co-existing conditions, but poor if causative/aggravating factors and not addressed. If symptoms have been there for over 12 months you will have a poorer prognosis but do lose heart, it can get a lot better, you just need to persevere and stick at it 🙂

Test yourself! To see how stable your hips are.

Self Treatment:


Bridge - increase leg strength, glute activation and decrease back pain.Bridge - increase leg strength, glute activation and decrease back pain. improve your athletic and sporting performance with stronger posterior muscle strength and activation1. Single leg bridges: 

Action: 10 x 3-5 second holds on each leg.

Tip: alternate legs and switch your core on.



Heel raised squat for VMO and glute activation for knee pain

2. Decline mini squats:

This squat is great for VMO (your inner quad) activation but it also increase glute activation. I have used a phone book here just to show that you can use anything at all that is 1-2 inches.

Action: Do not push into pain (if it is sore, don’t go as low), you do not need to go below parallel. Squat like you are going to sit down in a chair and do not let your knees go past your toes.

Perform 3 sets of 12, nice, slow and controlled.

Tip: look up to the top of the wall to help your balance.



Foam roller for ITB syndrome, knee pain

3. Foam roller: These are great. If you haven’t got one, get one! (A reasonably dense Foam Roller preferably)

Roll all the way from the knee to the hip, making sure you do it slowly.

Spend 2 minutes on the side as shown and then 2 minutes on the front/quads.

Tip: try to keep your feet off the ground and DO NOT LET PAIN PUT YOU OFF, it will get easier.



Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strength4. Clams:

Lying on your side as shown. keeping your ankles together, lift your top knee 20cm, then lower down again (don’t drop it!)

Goal = 1 set of 50, if you are doing them right, you will need to build up to this.

Tip: Keep your top elbow down on the ground and hips rolled forward.



Hip flexor and quads stretch to decrease back pain, improve posture. great exercise from a trained Physiotherapist5. Quads stretch:

Hold this stretch for 1 minute.

You may need to put a cushion or towel under the planted knee!

Tip: you do not need to lunge forward, to add more stretch, tuck your bum in under you or put back foot up on something (eg. wall or foam roller).

Note: if this hurts the knee (even with padding) then stop doing it and wait a couple of weeks before building it in.


Do these exercises two times daily.



Other things that may help:

  • Brace: while rehabbing your knee, a brace can help keep you moving, such as a Patella Tracker
  • Orthotics: the use of Orthotics reduces PFPS in the short to medium term and addresses bio-mechanic deficiencies on the foot.
  • Ice: after exercise, after a long day or when there is any pain ice minutes for 10 -15 at a time (no longer).
  • Rest, give it a couple of weeks rest. this gives you a great time to get a head start on the exercises and really start the rehab off well.
  • Altering training: shorter distance, get off hard surfaces, cross-train.
  • footwear: throw out old shoes, stay away from shoes with poor support eg: Flip-Flops, jandals, sandals, slippers.

Often it is not the knees fault all this pain and discomfort happens, so to treat this condition it is important to look above (quads, ITB, hip) and below (foot, calf).

Follow this advice for at least 12 weeks (yes three months, you NEED to be serious about this to decrease the risk of early knee arthritis and ongoing pain.)

If you have any questions feel free to comment below.

Please share, comment, follow and let me know how you get on!


You may also like:

Lower Limb rehab

Glute activation, the missing link

Quick stability and balance test

A good research paper if you want more info on PFPS research

Get 25% OFF all Rehab Guides for a limited time (use code: TAKE25)