Patellar Pain Exercise Program

 

Strengthening program for patellar injury recovery

By

Ian McMahan, Lisa Giannone

Published

October 10, 2012

The program is adapted from a comprehensive knee rehabilitation program that has been used successfully with Olympic and elite runners at the San Francisco-based rehabilitation center, Active Care Physical Therapy.  Several of these runners competed at the 2012 London Olympics.

Level 1 Exercises

This initial level of exercise is focused on improving quad muscle tone and strength without aggravating the kneecap. Cycling or swimming should be used for cardiovascular training. At this point, running should be stopped so that the inflammation associated with the kneecap pain can be reduced.

Straight Leg Raise (quadriceps, hip flexors)
3 sets of 15 reps

In seated position, tighten quad and fully straighten knee
Keeping knee straight lift leg off of 2-3 inches off of floor
Hold for 3 sec, lower in a controlled fashion

Leg Press (quadriceps)
3-4 sets

Using 20-30 lbs, position foot and lower leg so that knee and foot are at the same height as pictured above
Keeping weight on heel of foot, press out and hold position
Hold for 30 seconds, then try 15 small repetitions
Continue holds and repetitions until quad is fatigued and is burning.

Side-lying Hip (hip abductors)
3-4 sets

10-15 repetitions in each of the above positions without stopping in between
Fatigue/burn should be felt in outside of hip

Foam Roll IT Band Massage
5-10 minutes

Use foam roll to massage IT Band (outside of thigh).  Expect it to be uncomfortable.

Level 2 Exercises
This second level of exercise should be started when the kneecap becomes less sore and when the previous level of exercises can be performed without any discomfort.  Cardiovascular training on the elliptical can be started.

Hamstring Bridge (Hamstring muscles)
3-4 sets

Tighten abs, lift hips off of floor and tighten hamstring muscles by trying to pull heels toward hips.
Hold position, taking care not to lift too high and arch lower back
Hold for 30 seconds, then try 15 repetitions, lifting hips up and down as above
Continue holds and repetitions until at hamstring muscles are fully fatigued and are burning

Squat (quads, glutes, hamstring)
3-4 sets

Squat down while reaching hips back
Weight should be on heels of feet
Hold position slightly above 90° for 20-30 seconds, then move up and down for 10 repetitions.  Continue series until fatigue

Level 3 Exercises
This final phase of exercise adds more dynamic exercise in preparation for the return to running.  A running progression can be started if the exercises in this phase do not result in knee soreness.

Single Leg Absorption Drill
3 sets of 20 repetitions

Exercise is best done in front of a mirror
Stand on involved leg with one hand holding onto nearby object for support
Bend knee slightly while keeping foot flat
In a motion similar to jumping off of one leg straighten knee and lift heel off of the ground.  Without pausing at the top, bend knee and lower heel back to the ground.  Do not leave the ground
If done correctly fatigue should be felt in quad and calf muscles.  Make sure knee does not collapse in when coming down

General Program Guidelines
-The exercise program is not intended to replace a thorough evaluation by a sports medicine physician and licensed physical therapist.  If knee discomfort is experienced or persists, the program should not be continued.
-Exercises should be performed 3-4 days a week, with at least one day of rest in between.
-After advancing to the next level of exercise, continue to do the previous levels
-The goal of each exercise is to reach muscular fatigue and burn.  After performing the exercises several times they should begin to get easier.  In order to keep them challenging, add time and repetitions to each set as necessary.
-Each exercise should be done to at least a moderate level of fatigue/burn and should be felt in the indicated muscle.  It is common for an injured leg to fatigue/burn less than the uninjured leg, despite the fact that it is usually much weaker.  After each exercise, fatigue should be felt at very least equally in both legs.  Care should be taken to focus on using both legs evenly to ensure that the injured leg’s muscles can be strengthened.
-For those with the goal of establishing a program for injury prevention, perform Level 1 and 2 exercises for 1-2 weeks apiece before starting Level 3 exercises.

Lisa Giannone is the founder of Active Care Physical Therapy in San Francisco and has worked with Olympic, professional and elite athletes from a variety of different sports.  Lisa trained in Physiology and Biomechanics at UCLA and received a Master’s Degree in Physical Therapy from UCSF.  She routinely treats athletes and dancers from all over the world and is responsible for developing the exercise theory and technique of the exercises in the knee rehabilitation program.

Ian McMahan is head athletic trainer at Active Care Physical Therapy in San Francisco and has worked with runners and endurance athletes of all ages and ability levels.  He has a Master’s Degree in Exercise Physiology from the University of Maryland.  In addition to his clinical work he writes articles for fitness and health publications and has had articles published in running and cycling magazines on a variety of sports medicine/injury topics. Since having to walk half of his first 5k in college he has completed five marathons, including two Boston Marathons.