3 Steps to Get Out of Knee Pain

If you have ever dealt with pain in the front of your knee or in close proximity to the knee cap (patella) you may have been told that you have patellofemoral pain. Given this diagnosis by itself doesn’t explain what exactly is causing the pain. As it turns out, there are several mechanisms that can lead to patellofemoral pain. Finding which one is the culprit helps to determine our approach.

Patellofemoral pain can be broken down into two categories:

Global Compression Syndrome and Excessive Lateral Pressure Syndrome (ELPS).

Global compression syndrome occurs when the entire knee cap is compressed due to tight tissue on both sides of the patella. This can be a side effect of prolonged immobilization following a surgery or fracture.

Excessive lateral pressure syndrome occurs when tissues on one side of the patella become stiff, causing uneven friction as it slides over the femur. If ignored, the imbalance can lead to degradation of the underside of the knee cap (chondromalacia). There will likely be pain adjacent to the knee cap when navigating stairs, squatting, or extending the knee from a bent position. 

ELPS tends to be the case for people who develop patellofemoral pain in the absence of surgery or trauma. For this reason, this will be the topic of focus. 


Anatomy 101

Knowing some basic anatomy of the knee helps to understand the issue a bit more in depth. Your patella sits within a small notch, called the patella groove. You can think of it as a train sitting on a track and the surrounding quad muscles acting as the engine that pulls the train along. As you bend and straighten your knee, the patella glides within its groove while muscle, ligaments and fascia provide stability. In the case of ELPS, the patella is excessively tacked down to one side of its groove and is pulled off line as the knee bends and extends. It’s like if everyone on the train were sitting on the same side, weighing it down as it grinds against the rails.

Something else to consider is that the patella is not in direct contact with the femur all of the time. In fact, the amount of contact between your knee cap and your knee increases as you bend your knee. You can test this out by straightening your leg and relaxing the quad, you should be able to move the knee cap side to side about one centimeter each way. Once you start to contract your quad or bend your knee, the patella becomes significantly more flush to the femur. In the case of ELPS, the tight tissues on the outside of the knee cap limit its ability to move medially towards the inside of your leg, even in a relaxed position. 

Now What?

We can break up our approach to addressing this type of pain within 3 main components:

  1. Reduce swelling/inflammation 
  2. Decrease soft tissue restrictions 
  3. Address any weakness or imbalances 

Reduce Swelling/ Inflammation

Small amounts of swelling may be common and must be addressed. The swelling may not seem severe, but even small amounts of fluid can inhibit the quad muscles and cause atrophy and weakness. 

Some of our go to’s for this type of issue are the MarcPro for recovery. This machine uses e-stim to turn the surrounding muscles into a natural pump, clearing out any remaining fluid within the joint. However, if you don’t have one laying around, another option is a Voodoo Band.

Decrease Soft Tissue Restrictions

The goal is to decrease stiffness of the lateral (outside of the leg) structures that are restricting the patella. You can perform some self mobility exercises with a Rumble Roller Gator or a lacrosse ball. 

Start by scanning for points of stiff/tenderness along the outside of your quad, down to the side of your knee cap. After finding a spot that feels particularly tight, take a few breaths as you settle onto the ball/roller. Continue scanning and pausing for a total of 2-3 minutes. 

Addressing Weakness and Imbalances 

Weakness of the quad must be addressed in order to regain proper pull of the patella. In order to do this effectively, we have to strengthen the quads while avoiding excessive compression of the knee cap.

As you lower into a squat, the amount of contact increases with the back side of the patella and the femur. However, when performing a squat, the contact is spread over the entire surface of the patella. There is still a considerable amount of pressure within the joint when we get into deeper squats, starting out with a pain free range is key. 

Open chain movements like straightening your knee from a flexed position (knee extension), increases the contact over a smaller surface area. An analogy to compare the two would be the difference of walking over a bed of nails to stepping onto a single tack. The pressure is much more dispersed in the former than the latter. 

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A good starting point is the wall sit. We can fire up the quads without going into a range where excess compression is an issue. Start out by holding 30 seconds for 3 repetitions, and work your way up to a minute. If you can get to a minute with ease, progress to a single leg wall sit. 

Wall Sit Video – Explanation

In addition to the wall sit, the single leg step down is another great way to regain back strength and stability that may be lost. The key to this exercise is learning to hinge from the hips while keeping the shin and knee stable. Start with a small plate or thin textbook (3-4 inches high), drive the hips back and lower the heel to the floor, tap and return to start. You should feel this in the glutes/hip as they work to keep you in a stable position. 

Start to progress the height only if you are able to maintain rock solid form (hip hinge, vertical shin). 

Step Down – Explained 


Working out of patellofemoral pain due to lateral compression consists of three basic components. Reduce any swelling, reduce any mobility restrictions, improve strength without excessive compression (knee extension, deep squats, running and jumping). 

Want to talk more about your knee? We offer free 15-minute consults (817) 438-6583 or you can email me directly at [email protected] 


Links Used 

Marc Pro – Recovery


Voodoo Band


Rumble Roller Gator


Wall Sit Video Link


Step Down Video Link