Patello-Femoral Syndrome Jumper’s Knee Rehabilitation Protocol


Patello-Femoral Syndrome/Jumper’s Knee Rehabilitation Protocol

This rehabilitation protocol has been developed for the patient with general pain and tenderness around the knee cap which may increase in intensity with daily and sporting activities. The symptoms will often decrease with rest and are frequently bilateral. Sporting activities, especially running and jumping, stairs, sitting with knees flexed for a long period of time, and deep squatting activities may intensify the pain. Early intervention of strengthening and stretching is recommended to decrease pain and assist in returning to activity. The protocol is divided into phases. Each phase is adaptable based on the individual patient and special circumstances. Progress through the phases as pain, range of motion, swelling and strength allow.

The overall goals of the rehabilitation protocol are to:

  • Control pain and swelling
  • Regain normal knee range of motion
  • Establish appropriate stretching and strengthening exercises
  • Regain normal proprioception, balance, and coordination for daily activities
  • Achieve the level of function based on the orthopedic and patient goals

Physical therapy is an important intervention to assist the patient in early rehabilitation in attaining a level of fitness to return to functional activity without pain. It is extremely important for the supervised rehabilitation to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility. Physical therapy for PF syndrome/jumper’s knee varies in length on factors such as:

  • Structure(s) involved: infrapatellar tendon, patellar cartilage plica, or patellar tracking
  • Acute versus chronic condition
  • Lower extremity flexibility
  • Lower extremity biomechanics: pronated foot, leg lengths
  • Performance or activity demands
  • Muscular strength and endurance

Return to activity requires both time and clinical evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Return to intense activities may increase the possibility of repeat injury or the potential of compounding the original injury. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.

Rehabilitation Protocols

Phase 1: Patello-Femoral Syndrome/Jumper’s Knee


  • Full range of motion
  • Hamstring/ITB/Gastroc/Soleus/Quad/Hip flexor stretches
  • Patella mobilizations


  • Quad sets with biofeedback
  • SLR in 4 planes
  • Heel raise/Toe raise
  • SAQ (30-0°)
  • Leg press (0-45°)
  • Hamstring curls
  • TKE with theraband
  • Bicycle with resistance with seat high


  • Single leg balance with plyotoss
  • Sportscord balance/agility work
  • Wobble board balance work
  • ½ Foam roller balance work
  • Minitramp balance work


  • E-stim/biofeedback as needed
  • Ice 15-20 minutes


  • Control pain and inflammation
  • Independent in HEP
  • Initiate muscular strength and endurance training without pain
  • Educate patient on diagnosis
  • Adequate quad/VMO contraction

Phase 2: Patello-Femoral Syndrome/Jumper’s Knee


  • Continue with all stretching exercises from phase one, concentrating on muscle group with greatest deficiency


  • SLR with ankle wt/tubing
  • SAQ with ankle wt
  • Knee extension (90-45°,90-30°)-range of motion depending on pain
  • Leg press-single leg eccentric
  • Hamstring curl
  • Reverse lunge-not to migrate knee over toe
  • Mini-squat (0-30°)
  • Stool crawl
  • Straight leg dead lift
  • Multi-hip in 4 directions
  • Bicycle for endurance
  • EFX for strength and endurance


  • Continue with all balance activities from phase one
  • Advance balance/neuromuscular by variance of surface


  • Ice 15-20 minutes


  • Minimize pain with all exercise
  • Enhance lower extremity strength and endurance
  • Normalize dynamic balance, proprioception, and coordination
  • Preparation for return to functional activities

Phase 3: Patello-Femoral Syndrome/Jumper’s Knee


  • Continue with all stretching activity from previous phases


  • Continue with all strengthening activity from previous phases increasing weight and repetition
  • Progressively increase resisted knee range of motion within a pain free arc
  • Continue with all eccentric quad/hamstring work
  • Bicycle for strength and endurance
  • EFX for strength and endurance
  • Advance all single leg activity within pain free range


  • Continue with advanced balance, proprioception, and coordination training


  • Initiate running on a minitramp, progressing to treadmill as tolerated
  • Initiate jump rope for impact/endurance activity
  • Backward running


  • Initiate agility drills-carioca, high knee drills, short sprints, figure 8’s


  • Initiate sports specific drills
  • Initiate functional drills


  • Ice 15-20 minutes as needed for pain and/or swelling


  • Maximize lower extremity strength and endurance
  • Maximize balance, proprioception, and coordination
  • Minimize pain and swelling
  • Return to functional activities
  • Return to sports specific activities

Patello-femoral pain/syndrome is a common problem. With recognition of the problem and early intervention, this problem can be treated and allow for return to maximum performance and participation in sporting activities for a lifetime.

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