Did you know that about 10.4 million people in the United States suffer from knee pain? And those are just the ones who seek medical attention for their pain. Now, not all of these are PFPS knee pain, but if you are active, it is one of the most common issues.
Knee pain is a common complaint for all Americans. If it isn’t the back, it’s the knee. The condition doesn’t exclude anyone.
The knee is a complex body part. It has bones, cartilage, tendons, and nerves. Take your pick. Any one of them could be bothering you right now, which is why you have trouble walking, sitting, sleeping, and staying active.
Understanding Knee Pain
I see patients every day and talk to people who suffer from daily knee pain. Here are the most common symptoms people report to me about their knee pain:
- Crunching, grinding, or popping sounds and sensations
- Pain or stiffness when straightening the knee
- Instability and slipping
- Redness and inflammation
- Puffiness around the knee
- Sharp pain in the knee cap
- Throbbing around the outside of the knee
The pain can lead to several visible and physical concerns. Serious knee problems prevent you from walking or bearing and weight on the knee, restricted or absent flexion, and deformities. If you experience any of those concerns.
You must see your physical therapist.
Why does my knee hurt?
When people tell me about their knee pain, the next question is: “why does my knee hurt?” Well, there are many causes, and they are diagnosed only after a complete exam.
Here are a few causes of knee pain many Americans experience:
- ACL injuries
- Cartilage degeneration
- ITB (iliotibial band) syndrome
- Fractures and sprains
- Meniscus tears
- Stress and pressure on the knee
And Patellofemoral Pain Syndrome (PFPS)!
You are at an increased risk for knee pain if you have had knee pain or injury in the past. You’re also at risk if you play sports, stand all day or work on hard surfaces, aren’t physically active, or are overweight. Any one or more of these factors increase your risk of PFPS.
At my clinic, where we see active people, PFPS is the most common non-specific cause for knee pain.
Exercises For PFPS Knee Pain
Before you get started working out again or changing your workout routine, make sure you are cleared to do so. Rule out any dangerous knee pain complications before you hit the gym. Go ahead. I’ll wait.
You MUST use proper technique when you do any exercise. Find a personal trainer who can show you the exercises and guide you through your plan.
Now, let’s talk about which exercises to avoid with knee pain and what you can do instead.
When you’re ready to get moving, you PFPS knee pain plan must include the following:
- A warm-up
- Hip mobilization
- Ankle mobility
- Glute activation
- Strengthening the glutes and hamstrings
- Flexor length
1. Glute Bridge
This exercise is excellent for core stability and strength, and it takes pressure off the knee while you do it.
Make sure you activate your core as you move through the movements. When the hips are strong, the rest of the leg doesn’t have to work as hard and your back benefits from better support. This means less pressure and risk for injury in the knees.
2. Reverse Lunge
Jeff Cavaliere, Physical Therapist and trainer
Avoid the front lunge if you have knee pain, but don’t avoid the lunge altogether. Trainer Jeff encourages you to modify your exercise. Do the reverse lunge to eliminate pain and strengthen the knee. When you go back, the force of the movement does not shoot up to the knee.
Start low if you are in pain. You want to be in control of the movement. As you strengthen your knee overtime, you can increase the height of your step.
Make sure the knee you want to strengthen is the one that starts out on the step first. Step up slowly as you count to three. Then, step back down slowly for the same count. Do this three times.
4. Nordic Hamstrings Curl
Nordic hamstring curls are a great way to get a good hamstring workout with a partner. Get onto your knees, except this time your partner stands behind you on the backs of your feet and you brace the core while falling forward.
If done correctly and with no bending of the spine, Nordic hamstring curls are a healthy way to strengthen the stabilizing muscles in your back and your hamstrings.
Put your hands out in front of you to catch yourself if you fall forwards. As with the kneeling fallbacks, start off with small falls and work yourself up to larger ones. Challenge yourself but know your body and your limits! Once again, back straight, don’t bend it if you go too far!
This is one of the first videos by our trainer Coach Chris Barber and he hates it! Obviously, knowing his disinterest for the video (as it was before he lost a ton of weight, read about his 4 year journey here), I have to include it in this piece 🙂
You need to lie on your side on the ground for the clam exercise. Bend your knees and stabilize your body. Lift your knee while you keep your feet together. This requires you to remain stable and controlled, therefore strengthening the knee.
6. Ankle Proprioception Training
Proprioception is the ability of the joint to sense it’s position in space. Many people lack ankle proprioception, making balance and strength of the lower body difficult.
Poor proprioception and balance also increases knee and hip demand, as an unstable foundation rocks the house and the lower body is often the foundation of the leg. See a few proprioception exercises:
7. Learning to Land
Once pain has improved, it is crucial to acclimate the knee to daily and sporting stress.
Learning to land with simultaneous contact is necessary for various sports ranging from basketball to soccer. It is also important for everyday life as unexpected movements cross our path and could alter our gait.
Who hasn’t stepped off a curb awkwardly?!
Practice jumping, landing, and taking a hit.
8. TRX Single Leg Squat
The TRX single leg squat is a great exercise for transitioning into the single leg squat. It requires strength, flexibility, and mobility.
This athlete is still struggling with the skill, particularly the alignment of her leg, something we are working on to prevent PFPS knee pain.
9. Single Leg Squat
The TRX or assisted single leg squat is an understandable transition to the actual single leg squat. This skill is arguably the most important for those with PFPS. Remember, PFPS is often an issue of muscular imbalance and alignment, the single leg squat works on both areas, forcing strength, alignment, and mobility.
10. Abdominal Bracing
Ignore the silly Mo-vember mustache and sink your teeth into one of our staple exercises for PFPS knee pain, as well as nearly every other exercise. It looks easy and the directions look simple, but take your time and do it correctly.
Lie on your back with your knees bent. Posteriorly tilt your pelvis, “tucking under” to maximally contract your abdominals.
Do not let that position change AT ALL during the exercise.
Stop if the exercise causes ‘your pain’. Stop if you can’t keep the correct back position.
11. Hip Hinge
Movement competency in every plane of motion creates athleticism and prevents/improves injury.
The posterior sagittal plane (moving behind oneself) challenges many, likely due to our excessive sitting. If you are unable to do this, you are unlikely to load your hamstrings and have them react to everyday movement and demand. Learn to move from the hips, fire the hammys and glutes and be ready for athletic endeavors.
12. Towel hamstring curl
The towel hamstring curl is another exercise that looks simple but has pain-relieving effects for those who suffer from knee pain. This exercise retrains the hamstrings and fires up the glutes by getting your hips off the ground to stabilize your body.
13. Hip Thrust
While performing the hip thrust, it is important to make sure you do not jerk the weight off the floor but use a fluid motion instead. I can’t stress this enough – you want a smooth hip thrust, not a spastic hip thrust.
Once you follow the steps above and are in the correct starting position, take a deep breath, brace the core, and drive through the heels, keeping the knees in line with the toes.
- Focus on moving the weight with the glutes and not the lower back or hamstrings
- When you approach the top of the movement, finish the lift by contracting your glutes hard and pushing your hips forward. Do not overextend the lower back
- Finish the movement with your hips as high as possible while maintaining a neutral spine. At the top of the movement your torso should be parallel to the ground with hips pushed through
- Lower the weight under control keeping tension on the glutes
- Repeat for desired number of reps
You can perform repetitions by touching the floor on each rep or by reversing in mid-air. There are benefits to both options.
By touching the floor on each rep, you can “reset” each rep and ensure that you’re using full hip ROM. However, by reversing in mid-air, you keep constant tension on the glutes, which can lead to greater burn and a better glute pump.
Some lifters, especially shorter lifters or those with shorter torsos relative to their leg length, will find that the mid-air reversal is much more comfortable for their bodies.
There’s nothing wrong with reversing in mid-air. Many women prefer this option, whereas many men prefer to touch the ground on each rep. Tinker around to find what works best for you.
14. PFPS Knee Pain Taping
Try this simple taping procedure and see if it helps your PFPS knee pain:
-White tape to medial patella and lateral patella
-1st portion on lateral ridge of patella and lay down McConnell tape
-Push with thumb and make wrinkles with hand
-2nd portion on outside edge and push with thumb and make wrinkles with hand
15. Fitball Flexion (Swiss Ball Flexion)
Lie on your stomach and have your partner place a Fitball (or Swiss Ball) on your glutes. Next, bend your knees, one at a time, and press into the ball. Make sure you don’t sporadically kick the ball, but bend the knee and push hard into the ball.
You may alternate legs or use both legs at once, if desired.
16. Sliding Lateral Lunge
On a hardwood surface, place a towel under one foot. Slide the foot with the towel to your side, away from your body, as you break from the hips and the knees to sit down. Keep the spine straight as you come up, then return up.
17. Anti-Rotation with Band Walkout
Building anti-rotational core strength prevents excessive side-to-side motion, which may overstress the spine, hips, and knees. During this exercise, keep an erect spine and don’t deviate from the centerline.
18. SMR the TFL
Use self-myofascial release techniques to massage the knee and areas around the knee. The TFL is the most common tight area for cases of PFPS knee pain. Try this and see if it helps your PFPS knee pain today!
Conclusion: Final Thought on PFPS Knee Pain
Pain doesn’t have to be a part of life. Actually, it shouldn’t be a part of life at all! If you have frequent knee pain, regardless of how mild it is, seek help.
Pain now creates costly issues and can diminish your quality of life, performance in your sport or at work, and your daily activities. When you start a knee pain regimen, make sure you do so under the guidance of a professional who want to help you ease your pain without guiding you to surgery and pills.
Don’t change your life to accommodate your knee pain. Seek professional help to address it and correct it. If you know what causes your knee pain, take steps to avoid those actions, but don’t give up physical activity altogether.
Physical therapists at COR in Santa Clara have experience working with desk workers, youth athletes, elite performers, and more. Now it’s your turn to live without exhaustive PFPS knee pain.
Schedule a complimentary physiotherapy assessment today and return to pain-free living and function!