Patellofemoral Pain Syndrome Exercises: How to Use PT Knee Exercises for Recovery

But why does the kneecap get malaligned in the first place? It’s due to imbalances in your muscle output, which can be from tightness or weakness anywhere in your kinetic chain.

One muscle that keeps the kneecap in the correct position - the VMO muscle (Vastus Medialis Oblique) - is particularly important. When there is pain in the kneecap, the VMO often reduces its output or completely switches off, in response to these pain signals. This causes further imbalances in the muscle output, which makes the kneecap malalignment worse, leading to more pain.

So, in Runner’s Knee self-care, it’s crucial to stop this vicious cycle, and make sure it doesn’t kick in again with properly sequenced exercises.

Physical therapy exercises are effective for Patellofemoral Pain Syndrome, because they directly address the root causes of the condition: tightness and weakness in the kinetic chain.

Multiple muscles work together to keep the kneecap in the correct position. The major ones are the quadriceps (which includes the VMO) on the front of your thighs, the hamstrings on the back, as well as your calf muscles. Weakness or tightness in any of these muscles can cause the kneecap to drift out of place, leading to Runner’s Knee pain.

A well-designed PT exercise program for Patellofemoral Pain Syndrome targets each of these muscles in isolation, then as a group. Stronger, better-balanced muscles can keep the kneecap in the correct position where it can move smoothly; they can also take on more of the load of your movements, protecting the injured knee against further aggravation.

(PT exercises for knee pain also strengthen tendons, ligaments, and other tissues involved in the healthy functioning of the knee joint.) 

In short, strengthening exercises resolve the root causes of Patellofemoral Pain Syndrome, and that’s what keeps this condition from flaring up again when you resume your favorite activities.

This is true in other exercise programs (for example, in our best Plantar Fasciitis exercise post, we talk about the importance of sequencing), but it’s particularly important in Patellofemoral Pain Syndrome, because it’s caused by the VMO muscle’s response to pain signals. Poorly structured exercises can reinforce the pain signals, which can keep you in pain longer, despite all the work you put in. Let us explain.

Chronic pain changes the way your brain and body react to pain signals. When you repeatedly experience pain from certain movements, you start anticipating pain, and that anticipation is a part of what switches off the VMO muscle. In order to strengthen this muscle so that it can better support the knee joint, we have to rewrite that “pain narrative.”

By sequencing the exercises right, you give your brain and body a string of successful experiences of movements (i.e., movements without pain). These successful experiences overwrite the expectation of pain, and that’s how we start rewriting the pain narrative and help the VMO activate when needed.

The VMO is located on the inside (medial side, toward the center of your body) of your thigh, close to your kneecap.

To “wake up” this key muscle before your exercise routine, give it light, quick strokes with the Massage Blade. You don’t need to put a ton of force into the massage to activate the muscle; the sensation (that’s different from pain) activates and engages the muscle.

You may need a bit more tissue work on the painful parts to get ready, or you may need a rest day. It’s normal to occasionally have one or two “bad days” when you are working on resolving Patellofemoral Pain Syndrome with progressive strengthening exercises. Don’t be discouraged when you have to take a break - but make sure to try again the next day!

Once your knee is ready for the day’s exercises, start with low-impact, simple moves that work on one part of the kinetic chain in isolation.

When we say simple, we really mean it. In our Runner’s Knee Guided Recovery Program (included in the Runner's Knee Essentials with the Massage Blade), the first few moves in the early levels are designed to simply warm up and activate your thigh muscles.

For the more active among you, these may not feel like “exercises,” but they still count! They are important, effective steps toward taking control of your knee pain.

As these moves become easy, you can progress to more challenging moves that may engage multiple muscles, tendons, or ligaments. To get the progression right, it’s best to follow a physical therapist’s guidance, or use a structured progressive strengthening program like our Runner’s Knee Guided Recovery Program, designed for Runner's Knee treatment at home.

When you have to go to a physical therapist’s office for your exercises, it’s impractical to do them every day, but if you are using an at-home Runner’s Knee treatment program, we recommend sticking to a daily schedule. Consistent daily work significantly improves your outcomes, and shortens your Runner’s Knee recovery time.

Soreness like you’d experience after any workouts or even a little bit of discomfort are to be expected during your recovery work. However, if you start experiencing knee pain during or after your PT exercises, it’s your body’s signal that you might be overdoing it.

When this happens, go back to the previous level of challenge for a day or two, and see if you can get over the hump. If the pain continues or worsens, you may want to get professional help. If you are using our program, let us know, and we’ll help you!

In general, know this: chronic pain recovery is rarely a straight path. Many physical therapy patients see relatively quick improvements at the beginning, followed by a plateau before they see another stepwise improvement with consistent work.

With Runner’s Knee in particular, we know you almost have to expect a setback that can last 1-3 days after a few weeks of making steady progress. When your exercise routine triggers pain, dial it back a little, but keep doing the work at an easier level. You should be able to get back to improving again within a few days.

Alleviate was founded by a patient-and-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With the Runner's Knee Essentials, you can use the Alleviate Method to recover from Patellofemoral Pain Syndrome at home. No physical therapy appointments required!