Exercises for Patellofemoral Pain Syndrome in Runners

What is Patellofemoral Pain Syndrome?

Is patellofemoral pain syndrome, “PFPS”, a cool new slang term, OR a common condition costing thousands of runners valuable training time each year? 75% of runners get injured every year, and a good percentage of those injuries occur at the knee. In this article we’re going to get to the bottom why this happens and give you some exercises you can try for your patellofemoral pain syndrome. Patellofemoral pain syndrome just is a fancy-pantsy way of saying “pain somewhere near where the kneecap (patella) meets the end of the thigh bone (femur)”. Sometimes you’ll hear it called “runner’s knee.” As one of the more common running injuries, there’s a solid chance you, or a runner you care about, has been knee-capped (pun intended) by this painful affliction at one point in time.

Disclaimer – Not all mechanisms of PFPS will be covered in this article.

What causes Patellofemoral Pain Syndrome?

Let’s imagine the patella is a train and the femur its tracks. In a perfect world, the train sits squarely on the tracks and glides up and down as you walk, run, jump, climb, whip, nay-nay, or dougie. The kneecap remains firmly seated in both tracks (inside thigh and outside thigh) equally and minimal friction occurs between the kneecap and thigh bone as the former excurses in the later during knee bending and straightening.

To extend this already over-extended metaphor even further, this is tantamount to a mag-lev train.

Efficient and near-frictionless- a thoroughly happy train, tracks, and passengers.

How PFPS affects runners

Enter PFPS…in which that happy train situation becomes more akin to an NJ transit commuter line 45 years in disrepair and being used as gathering place for nightly feral racoon…parties.

Unhappy train, unhappy tracks, and especially unhappy passengers.

As our feet contact the ground, they enter pronation (roll inward) in order to propulse us forward and prevent us from collapsing towards the ground. That energy travels up the kinetic chain. Just as the grandfather of modern medicine, Hippocrates, certainly never said, “the shin bone is connected to the knee bone, the knee bone is connected to the thigh bone…” So, pronation at the feet begets inward rotation of the shin bone, the thigh bone, the pelvis, etc… up the kinetic chain. Each of these components has an “ideal” amount of rotation inwards it contributes to the whole-body phenomenon that IS pronation.

In a “happy” kneecap situation, the shin bone rotates in just the right amount, with the thigh bone rotating just the right amount on that shin bone, etc… In that case, neither the inner compartment NOR the outer compartment of the patellofemoral joint is subjected to increased stress.

However, patellofemoral pain can show up when the shin bone is pre-positioned in an overly rotated inward state (flat foot) OR an overly rotated outwards state (high arch) with the thigh bone then attempting to rotate inwards in either one of those conditions. Additionally, we can also have a well-positioned foot/shin bone but a thigh bone that is “starting” with rotation in one direction (commonly due to trunk / upper body mechanics). Either of these cases will result in a kneecap that rides “too hard” on one side of the tracks, inducing unhappiness.

Exercises for Patellofemoral Pain Syndrome

Determining the source of your patellofemoral pain syndrome takes a highly trained eye and is beyond the scope of this article, but there are a few simple exercises you can do to re-teach your body how to appropriately rotate a thigh bone over a well-positioned shin-bone. Here are some of the best exercises for PFPS to help you prevent injury.

Arch Doming. In this exercise , we’re using the position of the foot to get more “outside spin” of the shin bone.

Hip Hydrants + Donkey Kicks: In the above activity, we’re encouraging more “outside spin” of the thigh bone.

Single Leg Squats: This encourages more “inside spin” of the thigh bone, and helps strengthen the quads, a critical component of knee health. Now, obviously these are just the exercises. For sets and reps that match your current level of patellofemoral pain, and instructions to make sure you’re doing everything with correct form, download the Recover Athletics app!

Dr. Tim Richardt, DPT Tim is a Denver-based Physical Therapist and runner who specializes in running biomechanics and gait analysis. Interested in working with Tim to get out of pain and improve your mechanics? Check out timrichardt.com to learn more! He can also be reached at richardtphysicaltherapy@gmail.com OR via his Instagram.

Want to learn more about healthy running? Check out out our other injury prevention articles here. – Am I injured? The 6 Red Flags to Watch Out For – Preventing Shin Splints – Getting rid of Posterior Tibial Tendonitis