There are certain exercises that promote healing of runner’s knee and there are others that could cause further damage to the knee joint.
Throughout this article we will be looking at the following, to help you get back on track faster after being diagnosed with patellofemoral pain syndrome;
- Exercises to avoid
- Best exercises to promote healing
- Treatment for patellofemoral pain syndrome
- Are squats good for patellofemoral pain syndrome?
- Can you cycle with runner’s knee?
Exercises to avoid with runner’s knee
There are several forms of exercise that you should certainly avoid if you have been diagnosed with patellofemoral pain syndrome or runner’s knee.
For example, strong knee straightening, which is a heavily loaded knee extension that starts from a bent position, drastically increases the pressure between the kneecap and the femur. This presents a major risk factor for already injured knees.
This means that there are two specific thigh strengthening exercises that you should avoid if you have runner’s knee. Once recovery has begun you may want to slowly incorporate them back into your workout, but at the beginning it is best to avoid.
These are the leg press machine and any kind of squat, or deep knee bending.
Best exercises for patellofemoral pain syndrome
1. Standing hamstring stretch
Place the heel of your injured leg on a stool about 15 inches high. Keep your knee straight. Lean forward, bending at the hips until you feel a mild stretch in the back of your thigh. Make sure you do not roll your shoulders and bend at the waist when doing this or you will stretch your lower back instead of your leg.
Hold the stretch for 15 to 30 seconds. Repeat 3 times.
2. Quadriceps stretch
Stand an arm’s length away from the wall with your injured leg farthest from the wall. Facing straight ahead, brace yourself by keeping one hand against the wall.
With your other hand, grasp the ankle of your injured leg and pull your heel toward your buttocks. Don’t arch or twist your back. Keep your knees together.
Hold this stretch for 15 to 30 seconds.
3. Side-lying leg lift
Lying on your uninjured side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight and lower slowly.
Do 3 sets of 10.
4. Quad sets
Sitting on the floor with your injured leg straight and your other leg bent, press the back of the knee of your injured leg against the floor by tightening the muscles on the top of your thigh.
Hold this position 10 seconds. Relax. Do 3 sets of 10.
5. Straight leg raise
Lie on your back with your legs straight out in front of you. Bend the knee on your uninjured side and place the foot flat on the floor.
Tighten the thigh muscle of the other leg and lift it about 8 inches off the floor, keeping the thigh muscle tight throughout. Slowly lower your leg back down to the floor.
Do 3 sets of 10.
Stand with the foot of your injured leg on a support, like a small step or block of wood, 3 to 5 inches high. Keep your other foot flat on the floor.
Shift your weight onto your injured leg on the support straighten your knee as the other leg comes off the floor. Lower your leg back to the floor slowly.
Do 3 sets of 10.
7. Wall squat with a ball
Stand with your back, shoulders, and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 2 feet away from the wall and a shoulder’s width apart. Place a soccer or basketball-sized ball behind your back.
Keeping your back upright, slowly squat down to a 45-degree angle. Your thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall.
Repeat 10 times. Build up to 3 sets of 10.
8. Knee stabilization
Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie a knot in the other end of the tubing and close it in a door.
Stand facing the door on the leg without tubing and bend your knee slightly, keeping your thigh muscles tight. While maintaining this position, move the leg with the tubing straight back behind you.
Do 3 sets of 10.
Turn 90 degrees so the leg without tubing is closest to the door.
Move the leg with tubing away from your body.
Do 3 sets of 10.
Turn 90 degrees again so your back is to the door. Move the leg with tubing straight out in front of you.
Do 3 sets of 10.
Turn your body 90 degrees again so the leg with tubing is closest to the door. Move the leg with tubing across your body.
Do 3 sets of 10.
Hold onto a chair if you need help balancing. This exercise can be made even more challenging by standing on a pillow while you move the leg with tubing.
9. Resisted terminal knee extension
Make a loop with a piece of elastic tubing by tying a knot on both ends. Close the knot in a door at knee height. Step into the loop with your injured leg so the tubing is around the back of your knee.
Lift the other foot off the ground and hold onto a chair for balance, if needed. Bend the knee with tubing about 45 degrees. Slowly straighten your leg, keeping your thigh muscle tight as you do this.
Repeat 15 times. Do 2 sets of 15.
If you need an easier way to do this, stand on both legs for better support while you do the exercise.
10. Standing calf stretch
Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward.
Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf.
Hold for 15 to 30 seconds. Repeat 3 times and then switch the position of your legs and repeat the exercise 3 times.
Do this exercise several times each day.
11. Clam exercise
Lie on your uninjured side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your heels touching each other. Hold for 2 seconds and lower slowly.
Do 3 sets of 10 repetitions.
12. Iliotibial band stretch: Side-bending
Cross one leg in front of the other leg and lean in the opposite direction from the front leg. Reach the arm on the side of the back leg over your head while you do this.
Hold this position for 15 to 30 seconds. Return to the starting position. Repeat 3 times and then switch legs and repeat the exercise.
Frequently asked questions
How can I improve my patellofemoral syndrome?
Runner’s knee is generally seen due to overuse and overactivity. Therefore resting the joint is one of the primary treatment options for such an injury. This will help to treat the underlying problem.
You may try one of the following methods to help with the initial healing process;
- The RICE method: Rest, ice, compression, and elevation. You should wrap the knee in an elasticized bandage, or you may use a pull on compression bandage with the patella cut out. These will help to support the joint.
- OTC anti-inflammatory drugs: Ibuprofen and naproxen are good choices to reduce pain and inflammation with this condition.
- Special shoe inserts: Orthotics will help to support and stabilize your foot and ankle. They can be bought ready-made from the drugstore or specially made with a doctor’s prescription.
- Sports massage: This will relax the surrounding muscles and minimize their impact on being tight and causing pain to the area.
To prevent this injury from reoccurring, you may want to start by alternating your physical activity to avoid overuse. High-impact activities, such as running or contact sports, may want to be switched for lower impact sports, like swimming or cycling.
Make sure you wear supportive footwear and stretch before exercising.
If your runner’s knee is not responding to non-invasive treatments the doctor may suggest surgery to fix the underlying issue.
Arthroscopy is where a camera is inserted into the joint to remove damaged cartilage. This can also be used to release tightened tendons that pull the kneecap, allowing it to move into the groove where it belongs.
Tibial tubercle transfer is the process of realigning the kneecap. The tibial tubercle is removed, a portion of the shinbone, as well as the patellar tendon, to improve the alignment of the knee joint.
In most cases, these surgical options are not necessary unless the injury is severe. They will be the last point of call for any doctor or physician.
Can you squat with patellofemoral pain syndrome?
Squats do cause unwanted stress on the knee joint. If it is already damaged, such as with runner’s knee, then it should be an exercise generally avoided. However, most of the risk comes with poor form and can be corrected.
There are also squat alternatives as listed above that can take some of the stress off the knee while performing the squat.
You will want to ensure that you take the following tips into account so that you are performing squats the right way, and in turn minimizing the impact of this activity on your knees;
- Start by standing with your back against the wall, having your feet shoulder-width apart.
- Your heels should be around 18 inches away from the wall, and your knees should stay in line with your heels at all times.
- Take a deep breath in this position and squat as you exhale, sitting down as far as you can without dropping your bottom below your knees.
- Tighten your core muscles and push your back flat against the wall to return to the standing position.
- Inhale as you slowly raise your body to the original standing position.
- Make sure that you push from your heels and not the balls of your feet, as you want to use the muscles in the back of your legs.
Doing squats in front of a mirror will ensure that you can watch your form and correct yourself if you are making any incorrect movements.
If you belong to a gym you can also ask the staff there to watch your squat and help to correct any mistakes if you are in the improper form.
Is cycling good for patellofemoral syndrome?
With a minor or non-invasive treatment of patellofemoral pain syndrome, you can introduce cycling slowly into your exercise routine along with strength training knee exercises.
Cycling is a low-impact sport and therefore puts less pressure on the joints than football or other contact sports. The duration of your ride can be slowly increased over time.
After surgical treatments, you should avoid any athletic activities for several weeks or even months upon doctor’s instruction.
Some small changes you can make to your cycling in order to avoid knee pain include reducing the intensity and duration of your ride to begin.
You can also adjust the bike seat to a height where your knee is only slightly bent. You may ride in a lower gear to reduce knee strain and position your knee straight instead of leaning inward or outward.
If making the above adjustments still results in knee pain then you may need to take a temporary break from cycling. This will give your knees time to rest.
Taking this time out from cycling will allow you to see if this sport is impacting on your patellofemoral pain syndrome and prevent further damage from occurring during the recovery period.