Patella-femoral pain syndrome, otherwise known as PFPS, is characterized by recurring pain and irritation in the front of the knee, typically directly below the patella. PFPS is one of the more amusing clinical diagnoses because it’s basically a complex and scientific way of saying, “I honestly have no idea why your knee hurts.”
Current Knowledge on the Causes of PFPS
Don’t believe me? A quick trip to the Wikipedia page for PFPS tells us this:
The causes of PFPS are unclear, but there are several theories. Which tissues give rise to the pain is debated. Similarly, there is no consensus as to what is the best way of treating PFPS, and there is not enough evidence to support any particular management approach.
So what does this mean for us? In a general sense, most movement-based joint pain that isn’t the result of an anatomical or structural abnormality is stress related. My experience has been that PFPS is caused by muscular imbalances that lead to an undue amount of pressure being placed on the front of the knee. Our bodies are incredible machines capable of impressive compensatory strategies. Unfortunately, in almost all cases those compensations lead to problems down the line.
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So, without further ado, here are five of the simplest interventions that will give you the most bang for your buck and can likely be accomplished with existing equipment in your gym.
1. Fire Up the Glutes
I don’t know exactly why our culture has reached an epidemic level of IGS (imaginary glute syndrome), but most patients I see, even high-level athletes, tend to have weak or inactive glutes. This causes all sorts of problems at the knee.
The primary movers of your legs are the muscles of your hips and thighs. When the muscles of your hips aren’t working properly, that means the muscles of your thighs (usually your quadriceps) have to pick up the slack.
Here is a simple and effective glute activation warm up:
- Glute Bridges – 10x
- Single-Leg Glute Bridges – 5-10x each side
- Quadruped Hip Extension – 10x each side
- Fire Hydrants – 10x each side
- Quadruped Hip Circles – 10x each side
Here are video examples of each of these exericises:
Do two to three rounds, depending on how you feel. You may also benefit from performing a hip flexor stretch prior to these warm ups, as it will release some of the tissue on the front of your hip and should allow you to take advantage of improved hip extension.
“Really focus on squeezing your glutes at the top like you’re trying to hold a pencil between them.”
Another great way to warm up the glutes, particularly for a squat workout, is to simply do some lightweight squats. Use just the bar or a single plate, depending on your 1RM. Really focus on squeezing your glutes at the top like you’re trying to hold a pencil between them. I realize it’s a silly cue, but try it. It’s effective.
2. Hammer Your Posterior Chain
Riding on the coattails of the previous suggestion, now that your glutes are turned on, it would be a good idea to take advantage of this newfound activation and strengthen them. The three best options for specific glute activation that simultaneously reduce stress on the front of the knee are weighted glute bridges, box squats, and deadlifts.
- Weighted Glute Bridges– In physical therapy, following the glute set, a glute bridge is the go-to exercise for gluteal activation. So load that bad boy up and start bridging. But remember this is rehab, so the focus is on perfect form and technical mastery, not on PR-ing your glute bridge.
- Box Squats– These are great because they teach you to sit backwards and load up the hip. There’s a reason they’ve been a favorite of powerlifters for years. They also significantly diminish the impact of the eccentric phase of the lift. Eccentrics are a useful tool to be sure, but until you’ve got the requisite mobility and strength to move pain-free, those baselines should be your primary goal.
- Deadlifts– These work basically the same muscles as a squat, but they place a higher emphasis on lockout (gluteal recruitment) and not nearly as much stress is placed on the knee. Unless you’re really tall (over six foot), in which case deadlifts might not be a great option for you.
On all of these movements, it is important to focus on proper alignment of the knees. If your knees are constantly caving, even on a bridge, you’re missing out on activating the glute med, which is one of the most important muscles for stabilizing the knee during movement.
3. Learn to Land Like a Ninja
Landing mechanics are a problem for a lot of people, particularly in untrained individuals who have recently started an intense exercise program. You could probably go on and on about landing mechanics, but the two most significant variables I’ve seen are knee valgus and loud landings.
“If I can hear you land, I guarantee your knee can feel it.”
I think at this point we all know knee cave is bad. Don’t do it and don’t let your clients do it. But landing quietly is equally important because when you land with an audible crash, it’s physics letting everyone in the room know you just did a terrible job of absorbing the shock of that landing. If I can hear you land, I guarantee your knee can feel it. It might not be painful now, but it probably will be soon.
4. Turn Your Feet Out
The vastus medialis oblique (VMO) is one of the muscles of your quadriceps that is directly responsible for proper patellar motion. If your VMO is weak, your patella may get stuck or click as you move, which will cause pain.
A simple method of VMO strengthening is to turn your foot out. You can do this on leg raises, leg extensions, squats, or pretty much any movement that involves the quads. This will increase activation of the VMO.
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For the record, I’m not recommending you simply turn your feet out on everything and call it a day. This shouldn’t become your go-to technique on anything. This is a rehabilitative form tweak and should be used as such.
It’s also important to note that turn-out is relative. We all have slightly different anatomical degrees of turn-out, so what is turned out for one person may only be neutral or slightly past neutral for another.
5. Mobilize Your Adductors
Frequently, when you have weak glutes and weak hip abductors, you will also have tight adductors. Without getting too much into it, this is basically just another compensation strategy our bodies develop to mediate knee instability.
Tight adductors can cause all sorts of problems and may also prevent you from being able to perform some of the exercises outlined above. It’s hard to move your knees out when your muscles are constantly pulling them inward.
So, get on those adductors with either a foam roller or a barbell for a few minutes. You can also perform a deep squat stretch and actively push your knees apart with your hands. Hold this position for two to three minutes a few times a day. It should do wonders to unwind your wound-up adductors.
The Free Squat Stretch – Stretch instruction starts around 1:07.
Runner’s knee, jumper’s knee, call it what you want, but PFPS is no fun. Hopefully some of these simple interventions can get you out of pain and back to setting some personal records.
Photos courtesy of Shutterstock.