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Rationale:  The number of patellofemoral problems is increasing.  No single cure exists for the treatment of this problem. This suggested exercise program is divided into three goal-oriented phases.  Paying attention to the precautions and good education is paramount to success.

Phase 1-Acute phase

Goals:

• Education
• Decrease pain, swelling, palpable tenderness
• Improve gait deviations
• Restore normal mechanics

Suggested treatment:

• Modalities to include ice, phonophoresis, moist heat, and electrical stimulation
• Taping
• Stretching for hamstrings, triceps surae, quadriceps, and iliotibial band
• Start with isometric strengthening
• Immobilizer and cane/crutches if acute

Precautions

• Program should not increase symptoms
• Phase 2 begins when resting pain is resolved, swelling decreased, and palpable tenderness is moderate to minimal

Phase 2-Subacute phase

Goals:

• Balance length and strength of lower extremity musculature
• Increase quadriceps strength (VMO control)
• Good patellar mechanics

Suggested treatment

• Exercises include quad sets, straight leg raises, wall squats, mini-squats, closed chain strengthening (eg. Slow motion walking, leg press, step ups, resistive bends in weight-bearing, be innovative with weight-bearing activities)
• Continue stretching tight muscles
• Patellar mobilizations (medial glides and lateral tilts)
• Electrical stimulation to VMO
• Orthotics to balance the foot
• Pain free biking (high seat with low resistance)
• Overall conditioning program (avoid open chain knee extension exercises)

Precautions

• Do not work through pain
• Program should not increase symptoms

Phase 3-Functional phase

Goals

• Pain free functional closed chain activities (steps, jogging, running, and sport specific activities)
• Return to unrestricted pain free activities

Suggested treatment

• Functional activities in closed chain position
• Slow motion walking
• Squats, leg press, biking, stairmaster, jogging, running
• Speed and agility drills progressing to curve cuts and sharp cuts and one-legged hops

Precautions

• Avoid full range open chain knee extension exercises
• No stretching of the adductor muscles
• No pain during or after exercises