Exercise guidelines for knee pain

2 mins to read

A common cause of knee pain is a condition called patellofemoral pain syndrome. Andrew Cate explains exactly what this is and how you can manage it.

Arthritis, joint, bone & muscle

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome (sometimes referred to as runner’s knee) can be defined as pain around the patella, or knee cap that occurs during or after flexion and extension of the knee.

The three main contributing factors of patellofemoral pain syndrome are thought to include overuse and overload, biomechanical problems or a muscular imbalance (or a combination of factors). Pain usually starts during adolescence when participation in sporting activities is high.

Does exercise help patellofemoral pain syndrome?

Recent research has looked at the benefits of exercise therapy for patellofemoral pain syndrome. A study that was conducted in the Netherlands and published in the British Medical Journal in 2009 compared a group who received an exercise program with a control group who were advised to rest during periods of pain and refrain from pain provoking activities.

After 3 months, the exercise group showed better outcomes than the control group with regard to pain at rest, pain on activity and function. At 12 months, the exercise group continued to show better outcomes than the control group with regard to pain at rest and pain on activity.
The researchers said their study provides evidence that exercise is effective for improving pain and function in patients with patellofemoral pain syndrome.

Exercise guidelines to help manage and prevent patellofemoral pain syndrome

Knee pain can be a challenge when it comes to physical activity. Exercise can help to strengthen the muscles around the joint, yet physical activity can trigger pain. However, as mentioned above, research suggests exercise therapy is beneficial. To be most effective, specific exercises and stretches should be individually prescribed and supervised. However, the following tips may offer some useful guidelines for exercise with patellofemoral pain syndrome:

Muscle strengthening – Exercising the muscles surrounding the knee joint will make it stronger and less susceptible to injury. It will also provide support that makes movement easier and reduces pain. The muscles that should be targeted for strength training include:

the quadriceps - muscles at the front of your thigh
the hamstrings - muscles at the back of your thigh
the abductors – muscles on the outside of your thigh
the adductors – muscles on the inside of your thigh
the hip flexors – stronger hip muscles may improve knee mobility

Muscle stretching – Stretching prepares your muscles for activity and can help to correct muscular imbalances. Choose stretches that target the same muscles listed above for strengthening.

Correct footwear – Make sure that the shoes you wear are suitable for your chosen activity and provide adequate cushioning. Shoes can lose their cushioning over time.

Include cross training – Adjust your exercise routine to incorporate activities that help maintain your fitness while taking some stress off the knee joint. Try swimming, paddling or boxing training. You could also include more walking and cycling if you are a runner.

Adjust your surface – Take the stress off your knee by exercising on softer surfaces such as grass or sand. It is also best to avoid training on hills and stairs.

Stop if there’s pain – If you develop knee pain during your strengthening and stretching exercises, or during any other physical activity, stop immediately. Exercise should help, not hurt. While some discomfort is OK, pain is a warning sign that something isn’t right, and an indicator that you should see a doctor

References available on request