Knee > Patellofemoral Pain Syndrome > Treatments

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It is important to refrain from the activities that are causing your patellofemoral pain. In general, any activity that puts a heavy load or strain on your knees with the knee bent beyond 90 degrees should be avoided. This includes heavy running, bicycling with the seat too low, climbing, yoga, and stretches, like the classic hurdler's stretch, where the heel is brought up to the buttocks. Your general goal for the first few months is to be gentle with your knee. Be smart about the activities you do and be consistent with your conditioning and physical therapy to keep your muscles pulling evenly on your kneecap.


Physicians usually prefer that you do not use painkillers, but anti-inflammatories like aspirin or ibuprofen may be used in some cases. A small amount of pain is normal during physical activity, but if you feel so much pain in your knee to warrant taking a painkiller before an activity, you should consider cutting back or stopping. Too much pain could be a sign that you need more aggressive treatment of your patellofemoral pain.


For simple kneecap tracking problems that cause minor discomfort, such as might be related to patellofemoral pain syndrome, a soft knee sleeve brace worn during activities may provide some relief. A neoprene brace with a hole or pad around the kneecap may help relieve stress and ensure normal tracking. The knee sleeve should be snug but not tight. Some sleeves may have straps that wrap underneath the kneecap, around the patellar tendon. At your physician's discretion, physical therapists can also teach you to tape your knee if braces are not effective in alleviating your pain. Even with the neoprene sleeve, you should take it easy on your knee for about a week. Physicians generally tell patients to avoid strenuous or high-impact activities for up to six weeks. In general, avoid movements that put strain on your knees, like bending down, climbing stairs, or lifting heavy objects.


Your physician may prescribe visits to a physical therapist to begin supervised strengthening exercises as soon as possible after patellofemoral pain syndrome is diagnosed. Physical therapy can help train the muscles around the kneecap to pull evenly in all directions, keeping your kneecap in normal alignment. You usually need to stay off your feet for only a short time, but the real key is relative rest. This means staying away from activities that put excessive pressure on the knee while being aggressive in strengthening the knee so the kneecap will track properly. Patients should do stretching and strengthening exercises for a minimum of four days a week. The workouts should focus on the knee for at least 30 minutes and be combined with a knee friendly cardiovascular workout. Despite your dedicated to the rehab program and wearing a knee sleeve, you may not feel any improvement for six weeks or longer, and your kneecap pain may recur. Though everyone's rehab program is slightly different, physical therapy after kneecap pain follows a general pattern. Most people can begin stretching the muscles and tendons around the kneecap within a week. Although your knee may be weak, it is generally strong enough to handle mild stretching and slow movements. Working to restore early range of motion may help reduce swelling and stiffness, and increase your healing time. Rehab progresses into strengthening exercises that focus on the quadriceps and hamstrings – the main stabilizing muscles for your knee. Physicians suggest you gradually increase the amount of weight as your leg muscles get stronger. Strengthening exercises require dedication because results often take weeks and pain may recur. Once the muscles of your injured leg are about as strong as the uninjured leg, the focus of rehab turns to increasing your coordination. After about six weeks of rehab, physical therapy can become activity-oriented as you regain the ability to perform complicated movements, using stationary bikes, elliptical machines, and cross-country skiing machines. Physicians usually suggest that you continue strength training even after your kneecap has been rehabilitated. Have your physician periodically check your kneecap for strength and proper tracking.


   Knee strengthening exercises: Kneecap (patella) injuries

Prevention [top]

Physicians may suggest that you wear a neoprene knee sleeve with a hole around the kneecap during any activities that may stress your knee. The knee sleeve by itself may improve the tracking of your kneecap; however, to prevent patellofemoral pain, your rehab exercises are ultimately more important than bracing. Physicians generally recommend that you make the stretching and strengthening exercises you learned in rehab part of your everyday routine as soon as your doctor diagnoses you with patellofemoral pain. Many of the exercises and activities that are popular for fitness put stress on your knees. To prevent further kneecap pain it is important to learn knee-sparing exercise techniques by dividing your activities into three components:

   Daily living – the average person takes between 12,000 and 15,000 steps a day, with each step exerting a force between two and five times your body weight on your knees. After a knee injury, take it easy on your knees during the day whenever possible to save them for activities and exercise. Avoid stairs when there is an elevator, take the shortest path when walking, and consider wearing athletic shoes designed to absorb shock rather than hard-soled shoes.

   Muscle strengthening and conditioning – activities themselves are not a substitute for conditioning. Your need for special conditioning to prepare for activities increases with age. The best strengthening programs are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, so that the knees do not have to absorb shock.

   Recreation – sports that require twisting and quick direction changes put great strain on your knee. Any climbing or jumping activity where the knee is bent beyond 90 degrees puts undue pressure on the cartilage surfaces under the kneecap. To prevent injury, stick to light, non-impact activities for your recreation after suffering patellofemoral pain. If you decide to return to sports like football and basketball, a physician should carefully examine your kneecap and test it for proper alignment.

If you plan on participating in sports, remember to take it easy during daily activities and to keep your kneecap tracking properly with stretching and strengthening exercises.

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