Simple Exercises Can Reduce the Incidence of Patellofemoral Pain by 75%

A recent study was conducted and published in the American Journal of Sports Medicine looking at the incidence of patellofemoral pain in over 1500 military recruits undergoing a standard 14-week initial training program.  This basic military training program consisted of 3-4 hours of training daily.  Past reports have identified that up to 15% of new military recruits will develop patellofemoral pain during the initiation of basic training.  This totally makes sense as their workload likely shoots up dramatically and can be used as a great model for the observation of overuse injuries.  Just another reason to be thankful for all our troops!

The recruits were divided into two groups, the exercise group and a control group.  The exercise group began a very simple exercise program of 4 stretches and 4 strengthening exercises designed to minimize the development patellofemoral pain.  These included:

Strengthening Exercise

  • Standing isometric hip abduction against a wall
  • Forward lunges
  • Single-leg step downs from a 20cm box
  • Single-leg squats to 45 degrees of knee flexion with isometric glute contraction

patellofemoral exercises

Stretching Exercises

  • Quadriceps
  • Hamstring
  • Iliotibial band
  • Gastrocnemius

patellofemoral stretches

The strengthening exercises used body weight and progressed from 3 sets of 10 repetitions to 3 sets of 14 repetitions over the course of the 14 week program.  The isometric hip abduction exercise began with 3 sets of 1 repetition of 10 seconds and progressed to 20 seconds over 14 week.s  Stretches were held for 3 repetitions of 20 seconds over the entire 14-week duration.  Strengthening exercises were performed prior to the basic training program, while stretching exercises were performed afterward.

If we break down the exercises, we basically have a few generic stretches, an isometric exercise, and three quad exercises, one emphasizing eccentric lowering and another emphasizing concomitant glute contraction.  Pretty simple and basic.


Simple Exercises Can Reduce Patellofemoral Pain

The study intentionally characterized patellofemoral pain vaguely, which was fine with me.  Basically any type of patellofemoral pain or anterior knee pain.   Results of the study showed that 4.8% of people in the control group (i.e. no exercises) developed patellofemoral pain versus only 1.3% of people in the exercise group, or a reduction of incidence of developing patellofemoral pain by 75%.  That is a pretty strong reduction in patellofemoral pain.


What is the Take Home Message?

My first thought after reading this article was, “wow, pretty good results with such simple exercises.”  So what is the take home here?  Should we all be integrating the above exercises into our programming?  No, probably not.  My take home from all of this is actually very simple:

By performing even simple exercises, you can have a dramatic reduction in the incidence of patellofemoral pain

That is it.  I wouldn’t try to read too much into this article.  In fact, I probably would have picked 8 different exercises if I were going to design a program to prevent patellofemoral pain, wouldn’t you have?  But the results were still great.  We can only imagine what a comprehensive program would do.  Perhaps one that integrates more advanced strengthening, more emphasis on the hip, and more emphasis on balance and neuromuscular control?

Regardless, I thought this would be interesting to share and discuss to show that any exercise, even simple, is better than no exercise.

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11 replies
  1. Eric Folmar
    Eric Folmar says:

    Great topics as always. I agree that simple exercise can have dramatic results, probably for many reasons. I would be like to see the same study repeated on teenage females with biomechanical issues. It would make for interesting comparison. Just a thought.


  2. Brent Van Gemert
    Brent Van Gemert says:

    I would have to agree with the results of the study and Mike’s assessment. However I would like to add in the importance of consistency. The study hits on this inadvertently by showing this was done over a consecutive period of 14 weeks. Simple and basic exercise is better than nothing, but unless you are doing it consistently, as some patients fail to do, it becomes very difficult to make any meaningful changes, especially with PFPS.

  3. Jake Ellingson, PT, SCS, ATC, CSCS
    Jake Ellingson, PT, SCS, ATC, CSCS says:

    I completely agree with Mike on the selection of exercises. Kind of surprised by the use of a couple of strengthening exercises that placed a lot of strain on the knee. With different exercises and the consistency they would be performed the results could be even more impressive. I haven’t read the article but I also wonder how much education was used in the teaching of the strengthening exercises such as with preventing genu valgus of the knee.

  4. Nate, PT
    Nate, PT says:

    The choice of exercises is interesting, and I agree I would have picked different ones. Out of curiosity, which would you all have picked? Lets set a 4 of each limit.

  5. Christopher Johnson
    Christopher Johnson says:

    Great post Mike. Is it me or does every article use a different stretching protocol. I still need to read the article from start to finish but where does 3 repetitions of 20 seconds come from? Stretching continues to be a bastardized topic and more specific stretching regimens need to be established based on the available literature as there is a good deal out there on stretching. Hope all else is well.

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