Patellofemoral Pain Syndrome (PFPS) nicknamed “runners’ knee” is the one of the most common cause of knee pain in sport, especially in runners, hence the nickname (Thomeé, 1999). It can be caused by imbalances in the forces controlling patellar tracking during knee flexion and extension and particularly when the joint is being overloaded (Dixit, 2007). It is also widely accepted that it is caused by an increased patellofemoral joint stress and the wearing down of articular cartilage (Collado, 2010). It is commonly found that patients with PFPS have a distinct lack in knee extensor strength (Thomeé, 1999). There is also belief of a pattern of weaknesses in eccentric muscle strength within the quadriceps muscles (Thomeé, 1999). One study found that correct sport specific biomechanics may decrease the risks of injury (Weiss & Chris Whatman, 2015). By learning to move properly makes it more efficient for the body which in theory should reduce the chances of injury. My aim with this information is to create an exercise program which will in theory, decrease the chances of athletes developing patellofemoral pain syndrome. Although it is near impossible to completely prevent an injury, I as a practitioner can prescribe prehabillitation program’s in attempt to reduce the risk of these injuries occurring (Heidt, 2000). Physical rehabilitation programs to treat anterior knee pain have proven to be a highly effective non-operative option (Waryasz, 2008).
Patellofemoral pain syndrome gets the nickname runners knee because it is a common injury to receive in runners. Out of all the injuries runners get, it is said that at least 25% of those injuries are PFPS (Dixit, 2007). Although it is a common running injury, people who partake in all sports are at risk of developing it. Basketball players, gymnasts, any sport that contains lots of running and jumping along with every day people are at risk of developing PFPS.

When creating a prehabilitation (prehab) program, all risk factors should be accounted for. PFPS specific risk factors that will be encountered when creating this program will predominantly include the risk of overloading the joint, anatomic anomalies (hypoplasia of the medial patellar facet), altered biomechanics, muscle dysfunction and taking into consideration for any possible previous injuries/surgeries. Overloading the knee joint will cause unnecessary stress on the quadriceps, patella, ligaments, and other surrounding anatomical structures. The prehabilitation program is designed to strengthen these areas and prevent injury, not weaken and cause further injury. Previous injuries from the hip downwards will influence the program design for these athletes due to some structures already being weakened. For example, if the athlete has had previous knee pain, the practitioner needs to find and understand the cause of this pain before pursuing the program. Another common risk factor that should not be forgotten about is the risk of developing patellofemoral osteoarthritis. This disease occurs due to the loss of cartilage within the patella (Kim, 2012). Kim et al, reported that valgus knee alignment has been proven to increase the risk of developing patellofemoral osteoarthritis and the direction or force of the quadriceps femoris can also be of influence to the progression of the disease (Kim, 2012). Knowledge of these risk factors will allow me to create a program around these concerns in aim of providing exercises with the most beneficial, low risk outcome.

The knee joint is a complex configuration of muscles, joints, ligaments, tendons, and cartilage. The main knee extensors are a group of muscles called the quadriceps. This group is made up from the vastus medialis (medial side), Vastus lateralis (Lateral side), Vastus intermedius (middle portion) and the rectus femoris (largest quadriceps muscle). On the posterior side of the thigh, you have the hamstrings which are the primary flexors for the knee joint. The hamstrings consist of 3 muscles, the semitendinosus (medial side), the semimembranosus (medial side) and the bicep femoris (largest and most lateral). With this information and the findings of Thomee et al, the program can begin to look at focusing on stabilising the muscles and tendons that surround the patella and knee joint. Thomee et al found a common trend that people with PFPS were likely to be lacking strength from their quadriceps muscles. By progressively building strength in this area, especially in the eccentric phase of the quadriceps muscle, we should be able to begin to reduce the risk of developing PFPS.
Isotonic eccentric training of quadriceps muscles have been found to be effective in decreasing pain and increasing functional performance of patients with patellofemoral pain syndrome and is a suggested method of treatment (Eapen, 2011). The program must also work behind the law of progressive overload to create muscular hypertrophy safely without causing unnecessary loading on the joint which could have a detrimental effect (Kim, 2012). Alongside strengthening the quadriceps (knee extensors) we need to strengthen the hamstrings (knee flexors). Research suggests that there is a common trend that patents with PFPS have tight hamstrings (Kwon, 2014). With this information, the program can include stretches and strengthening exercises for the hamstrings. Having properly functioning muscle groups around the knee joint will influence correct biomechanics of the knee and as we already discussed, this is helping to reduce the risk of developing PFPS.
So, to develop a good injury prevention/ prehabilitation exercise program, the therapist needs to analyse the patient’s performance goals and work around their lifestyle. Whether this be an add on to their current exercise routine or for this to be the main focus. The prehab exercise program needs to be focusing on growing and strengthening the muscles and structures surrounding the knee in order to reduce the risk of developing Patellofemoral pain syndrome.