Management of Patellofemoral Pain Syndrome (PFPS): Exercises, Treatment & Prevention

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What is PFPS?

Patellofemoral Pain Syndrome (PFPS)—often called runner’s knee—is a common cause of anterior knee pain. It results from irritation of the patellofemoral joint due to poor patellar tracking, muscle imbalance, overuse, or biomechanical faults.

Goals of Management

  • Reduce pain and inflammation

  • Correct biomechanical and muscular imbalances

  • Improve patellar tracking

  • Restore function and prevent recurrence

1. Conservative (First-Line) Management

A. Activity Modification

  • Reduce aggravating activities (running, squatting, stairs)

  • Avoid prolonged sitting with bent knees (theater sign)

  • Gradually return to sport with load management

B. Pain & Inflammation Control

  • Rest from painful activities

  • Ice therapy: 15–20 minutes, 2–3 times/day

  • NSAIDs (short term, if prescribed)

2. Physiotherapy (Cornerstone of Treatment)

A. Strengthening Exercises

Focus on muscles that stabilize the patella:

  • Quadriceps (especially vastus medialis obliquus – VMO)

  • Hip abductors & external rotators

  • Core muscles

Examples:

  • Straight leg raises

  • Mini-squats

  • Clamshells

  • Step-down exercises

B. Stretching

  • Hamstrings

  • Quadriceps

  • Iliotibial (IT) band

  • Calf muscles

C. Patellar Taping / Bracing

  • Helps improve patellar alignment

  • Reduces pain during activity

3. Footwear & Orthotics

  • Proper, supportive shoes

  • Foot orthoses for flat feet or overpronation

  • Avoid worn-out footwear

4. Posture & Biomechanical Correction

  • Correct abnormal gait patterns

  • Address knee valgus (inward collapse of knee)

  • Improve running technique and landing mechanics

5. Weight Management

  • Reducing excess body weight decreases stress on the knee joint

6. Patient Education

  • Importance of exercise compliance

  • Gradual progression of activity

  • Avoid sudden increases in training intensity

7. Advanced Options (If Conservative Treatment Fails)

  • Injections (rare; only in selected cases)

  • Surgery (very uncommon, reserved for structural abnormalities)

Prognosis

  • Most patients improve within 6–12 weeks with proper physiotherapy

  • Early treatment prevents chronic pain and recurrence

Key Takeaway

PFPS is best managed conservatively, with exercise-based physiotherapy being the most effective treatment. Consistency, correct technique, and gradual return to activity are essential for long-term relief.


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