Rehabilitation Science

Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Etiology and Exercise Treatment of Patellofemoral Pain Syndrome

Objective: As a result of peripatellar pain or anatomical or biomechanical anomalies in the anterior knee, patellofemoral pain syndrome (PFPS) is a knee injury that can be made worse by weight-bearing activities like climbing and descending stairs. According to long-term follow-up studies, patellofemoral arthritis may eventually develop in 45% of PFPS patients who do not receive prompt and efficient treatment in the early stages, causing irreparable harm that may significantly impair the patient's quality of life. In order to prevent injuries, enhance daily life activities and athletes' sporting performance, it is important that we understand the mechanism and exercise treatment of PFPS. Methods: We reviewed the China Knowledge Network (CNKI) and PubMed life science database, searched for the terms "patellofemoral pain syndrome," "patellar tenderness," "running knee," and "anterior knee pain," and summarized the pertinent research. Results: Its cause is still unknown, and its etiology is complicated, with the main contributing factors being poor lower extremity function, decreased muscle strength, lack of flexibility, and impaired neuromuscular control. The majority of exercise therapy currently performed includes training the hip, knee, core, retraining the gait, and blood flow restriction training. The impact of the condition may depend on quick and efficient interventions. Conclusion: Exercise therapy had the strongest evidence base, particularly for the positive effects of either single hip or knee muscle strength training or a combination of the two, according to systematic evaluations that came to conclusions about the effectiveness of interventions. However, there was insufficient evidence to determine the ideal form of training and long-term effects. Contrarily, there is still scant evidence to support interventions such as gait retraining, blood flow restriction training, and core stability training. When it comes to selecting a course of treatment, a combination of treatments is typically advised and chosen in accordance with the precise evaluation of the patient's condition.

Patellofemoral Pain Syndrome, Exercise Therapy, Quadriceps

APA Style

Qiu Nie, Huili Hu, Furong Xiang, Yinxu Wang. (2023). Etiology and Exercise Treatment of Patellofemoral Pain Syndrome. Rehabilitation Science, 8(2), 23-29.

ACS Style

Qiu Nie; Huili Hu; Furong Xiang; Yinxu Wang. Etiology and Exercise Treatment of Patellofemoral Pain Syndrome. Rehabil. Sci. 2023, 8(2), 23-29. doi: 10.11648/

AMA Style

Qiu Nie, Huili Hu, Furong Xiang, Yinxu Wang. Etiology and Exercise Treatment of Patellofemoral Pain Syndrome. Rehabil Sci. 2023;8(2):23-29. doi: 10.11648/

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Kayll SA, Hinman RS, Bryant AL, et al. Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis. Br J Sports Med. 2023.
2. Loudon JK. Biomechanics and pathomechanics of the patellofemoral joint. lnt J Sports Phys Ther, 2016, 11 (6): 820-830.
3. Smith, B. E, Selfe, J, Thacker, D, et al. Incidence and Prevalence of Patellofemoral Pain: A Systematic Review and Meta-Analysis. PLoS ONE, 2018, 13, e0190892.
4. Baquie, P Brukner P. Injuries Presenting to an Australian Sports Medicine Centre. Clinical Journal of Sport Medicine, 1997, 7 (1): 28-31.
5. Stathopulu E Baildam E. Anterior knee pain: a long-term follow-up. Rheumatology, 2003, 42 (2): 380-382.
6. Witvrouw E, Crossley K, Davis I, et al. The 3rd International Patellofemoral Research Retreat: an international expert consensus meeting to improve the scientific understanding and clinical management of patellofemoral pain. Br J Sports Med. 2014, 48 (6): 408.
7. American Physical Therapy Association, Orthopaedic Section, translated by Wang Xiangbin, translated by Liu Yanping, et al. Clinical Practice Guidelines for the International Classification of Functioning, Disability and Health - Patellofemoral Pain (I). Journal of Rehabilitation, 2021, 31 (2): 23.
8. Glaviano N R, Bazett-Jones D M, Norte G. Gluteal muscle inhibition: Consequences of patellofemoral pain. Med Hypotheses, 2019, 126: 9-14.
9. Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017, 51 (24): 1713-1723.
10. Ho Kai-Yu, Hu, Houchun H, et al. Comparison of patella bone strain between females with and without patellofemoral pain: A finite element analysis study. Magnetic Resonance Imaging, 2014, 32 (7): 965-968.
11. Erkocak OF, Altan E, Altintas M, et al. Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 2016, 24 (9): 3011-3020.
12. Lotfi H, Moghadam A N, Shati M, et al. Comparing Electromyographic Activity of Quadriceps Muscle During Straight Leg Raise in Individuals With and Without Patellofemoral Pain Syndrome. Physical Treatments: Specific Physical Therapy Journal, 2018: 197-204.
13. Dong C, Li M, Hao K, et al. Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome. Journal of Orthopaedic Surgery and Research, 2021, 16: 1-6.
14. Gallina A, Hunt M A, Hodges P W, et al. Vastus Lateralis Motor Unit Firing Rate Is Higher in Women With Patellofemoral Pain. Archives of physical medicine and rehabilitation, 2018, 99 (5): 907-913.
15. Glaviano NR, Saliba S. Differences in Gluteal and Quadriceps Muscle Activation During Weight-Bearing Exercises Between Female Subjects With and Without Patellofemoral Pain. J Strength Cond Res. 2022, 1; 36 (1): 55-62.
16. Park J, Denning W M, Pitt J D, et al. Effects of Experimental Anterior Knee Pain on Muscle Activation During Landing and Jumping Performed at Various Intensities. Journal of sport rehabilitation, 2017, 26 (1): 78-93.
17. Xie P, István B, Liang M. The Relationship between Patellofemoral Pain Syndrome and Hip Biomechanics: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022, 11 (1): 99.
18. Souza R B, Powers C M. Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. Journal of O& Sports Physical Therapy, 2009, 39 (1): 12-19.
19. Barbosa A C, Vieira E R, Barbosa M A, et al. Gluteal activation and increased frontal plane projection angle during a step-down test in young women. Human Movement, 2018, (1): 64-70.
20. Holden S, Boreham C, Doherty C, et al. Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females. Scandinavian Journal of Medicine & Science in Sports, 2017, 27 (2): 188-194.
21. Citaker S, Kaya D, Yuksel I, et al. Static balance in patients with patellofemoral pain syndrome. Sports Health, 2011, 3 (6): 524-527.
22. Apibantaweesakul S. Comparison of knee muscle balance at different knee flexion angles between patients with patellofemoral pain syndrome with healthy subjects. Walailak Journal of Science and Technology (WJST), 2017, 14 (8): 637-643.
23. Motealleh A, Kordi Yoosefinejad A, Ghoddosi M, et al. Trunk postural control during unstable sitting differs between patients with patellofemoral pain syndrome and healthy people: A cross-sectional study. Knee, 2019, 26 (1): 26-32.
24. Motealleh A, Maroufi N, Sarrafzadeh J, et al. Comparative evaluation of core and knee extensor mechanism muscles activation patterns in stair stepping task in healthy control and patellofemoral pain patients. Journal of Rehabilitation Sciences & Research, 2014, 1 (4): 84-91.
25. Shirazi Z R, Moghaddam M B, Motealleh A. Comparative evaluation of core muscle recruitment pattern in response to sudden external perturbations in patients with patellofemoral pain syndrome and healthy subjects. Archives of Physical Medicine and Rehabilitation, 2014, 95 (7): 1383-1389.
26. Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015, 49 (14): 923-34.
27. Flôr J S, Barbosa R I, Marcolino A M, et al. Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study. Motriz: Revista de Educação Física, 2020, 26 (1): 1-9.
28. Şahin M, Ayhan F F, Borman P, et al. The effect of hip and knee exercises on pain, function, and strength in patients with patellofemoral pain syndrome: a randomized controlled trial. Turkish journal of medical sciences, 2016, 46 (2): 265-277.
29. Hott A, Brox J I, Pripp A H. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. American Journal of Sports Medicine, 2019, 47 (6): 1312-1322.
30. Miao P, Wang Chuhui, Pan Cuihuan, et al. Surface electromyographic study of the action of closed-chain and open-chain exercises on quadriceps muscle in patellofemoral pain syndrome [J]. Chinese Journal of Rehabilitation Medicine, 2015, 30 (12): 1238-1242.
31. Irish S E, Millward A J, Wride J, et al. The Effect of Closed-Kinetic Chain Exercises and Open-Kinetic Chain Exercise on the Muscle Activity of Vastus Medialis Oblique and Vastus Lateralis. The Journal of Strength & Conditioning Research, 2010, 24 (5): 1256-1262.
32. Chiu J K W, Wong Y, Yung P S H, et al. The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain. American Journal of Physical Medicine & Rehabilitation, 2012, 91 (2): 98-106.
33. Alrshood A, El Alwani A, Amein N, et al. A systematic review of the effect of open and closed kinetic chain exercises on the vastus medialis oblique and vastus lateralis muscles of patients with patellofemoral pain syndrome. International Journal of Orthopaedics, 2017, 3 (1): 152-161.
34. Zazulak B T, Hewett T E, Reeves N P, et al. the Effects of Core Proprioception on Knee Injury: A Prospective Biomechanical-Epidemiological Study. The American Journal of Sports Medicine, 2008, 35 (3): 368-373.
35. Motealleh A, Mohamadi M, Moghadam M B, et al. Effects of core neuromuscular training on pain, balance, and functional performance in women with patellofemoral pain syndrome: a clinical trial. Journal of Chiropractic Medicine, 2019, 18 (1): 9-18.
36. Luo P. Effect of neuromuscular control training and strength training on patients with Patellofemoral Pain Syndrome [D]. Beijing: Beijing Sport University, 2018.
37. Davis, I S, Tenforde, A S, Neal, BS, et al. Gait Retraining as an Intervention for Patellofemoral Pain. Curr Rev Musculoskelet Med. 2020, 13, 103–114.
38. Giles L, Webster K E, McClelland J, et al. Quadriceps Strengthening with and without Blood Flow Restriction in the Treatment of Patellofemoral Pain: A Double-Blind Randomised Trial. British Journal of Sports Medicine, 2017, 51, 1688-1694.
39. Collins N J, Barton C J, Van Middelkoop M, et al. Consensus Statement on Exercise Therapy and Physical Interventions (Orthoses, Taping and Manual Therapy) to Treat Patellofemoral Pain: Recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coastl, Australia, British Journal of Sports Medicine, 2017, 52, 1170-1178.