Patellofemoral Pain Syndrome Rehabilitation Protocol

Acute Phase

- Pain control
- Modalities
- Ice
- Electrical stimulation
- NSAIDS
- Activity modification (things to avoid)1
- Prolonged sitting
- Legs crossed while sitting
- Kneeling
- Stairs
- Squatting
- Warm up 3
- 5 minute walking at comfortable pace
- Stretching
- Hip flexion stretch with a strap1
- Supine figure 4 stretch
- Sitting toe touch
- Sitting gastroc stretch with strap
- Standing quadricep stretch
- Strengthening
- Short arc quad with 2 sec hold (no weight) 1
- 3x10
- Straight leg raises 1
- 3x10
- Hip external rotation with Theraband 123
- 3x10 red
- Hip abduction with Theraband 123
- 3x10 red
- Include core strengthening and cardio exercises
- Cool down 3
- 5 minute walking with verbal cueing to normal gait 4

Subacute phase

- Should have pain free ROM

- Warm up 3
- 5 minute walking at comfortable pace
- Stretching
- Continue from phase 1
- Strengthening
 - Short arc quad with 2 sec hold 1
- 3x10 with light ankle weight
- Straight leg raises with Theraband 1
- 3x10 red
- Hip external rotation with Theraband 123
- 3x10 green
- Hip abduction with Theraband 123
- 3x10 green
- Side step against Theraband 2
- 3x1 min green
- Seated knee extension from 90 to 45 with Theraband 12
- 3x10 green
- Hamstring curls from 0-45 with Theraband
- 3x10 green
-
- Include core strengthening and cardio exercises
- Include proprioceptive exercises
- Cool down 3
- 3 minute jogging with verbal cueing to correct gait 4

Return to Play Phase

- Should be pain free during all exercises and at all ranges of motion
- Strength and stability should be high at this stage
- Warm up 3
- 5 minute walking at comfortable pace
- Stretching
- Continue from phase 1&2
- Strengthening
- Hip external rotation with Theraband 123
- 3x10 blue
- Hip abduction with Theraband 123
- 3x10 blue
- Side step against Theraband 2
- 3x1 min blue
- Seated knee extension from 90 to 0 with Theraband 12
- 3x10 blue
- Hamstring curls from 0-90 with Theraband
- 3x10 blue
- Standing squat from 0 to 90 12
- 3x5
- Leg press from 0 to 90 (moderate weight) 2
- 3x10
- Include core strengthening and cardio exercises
 - Include proprioceptive exercises

- Cool down 3
- 5 minute running
- Should have no pain
- No cueing should be needed but monitoring to ensure normal gait 4

Citations

1. Şahin M, Ayhan F, Borman P, Atasoy H. The effect of hip and knee exercises on pain,
function, and strength in patients with patellofemoral pain syndrome: A randomized
controlled trial. Turk J Med Sci. March 2016;46(2):265.
2. Thiago Yukio F, Flavio Marcondes R, Eduardo M, Flavio Fernandes B, Paulo Roberto
Garcia L, Nilza Aparecida D. Short-term effects of hip abductors and lateral rotators
strengthening in females with patellofemoral pain syndrome: A randomized controlled
clinical trial. J Orthop Sports Phys. 2010;(11):736.
3. Khalil K, Zeynab M, Kourosh G, Mark A. L, Christopher M. P. The effects of isolated
hip abductor and external rotator muscle strengthening on pain, health status, and hip
strength in females with patellofemoral pain: A randomized controlled trial. J Orthop
Sports Phys. 2012;(1):22.
4. Willy R, Scholz J, Davis I. Mirror gait retraining for the treatment of patellofemoral pain
in female runners. Clin Biomech. December 1, 2012;27:1045-1051.1