T Nation

Help! Patello-Femoral Syndrome


Fellow T-Men & Women,

Today is a sad day in my life. After a very crappy attempt at squating earlier today I've decided that I can no longer squat!

My physical therapist advised me not to even attempt them again, but I knew I would at least try them again! I waited an entire 6 months. The knee felt good. The leg press weight had gradually climbed up, it was time to squat again. It was pitiful my knee was killing me w/only 95lbs!

So I turn to my T-brethren, I need help. I need some suggestions as to how I can effectively train my quads w/o my beloved squats. :((




Take the time and look up a physical therapist with a sports medicine specialty or a certified athletic trainer (ATC).

Any number of quad exercises is going to require your patella to move.

I started to get this issue and just began icing the knees everyday for 20 minutes every 2 hours. I still do this whether they hurt or not. The only off time is sleeping.

Also take 1 glucosamine w/ MSM w/ every meal.

2 advil before bed.

But I think your best bet is to go with a sports medicine specialist.


What did you do besides Leg Press in the 6 months of no-squatting? I went to a physical therapist (who, incidentally, after I told him I was doing deadlifts instead of squats, said "What's a deadlift?") and despite the above comment he was pretty helpful with ideas. Some of the things that have helped me out are:

  1. Concentrating on not locking out my knees. Apparently the way I walked, I locked them out completely with every step and put huge amounts of pressure on the joints because of this. I did this even when doing high impact activities like basketball, and basketball has been THE biggest aggravator of my PFS.

  2. Strengthening the hip abductors. I was baffled when he tested my hip strength and I failed miserably, despite all my deadlifting and squatting.

  3. Orthotic insoles for my shoes, especially for walking and high impact stuff. I overpronate massively because of my flat feet and just the cheapo inserts have helped.

  4. Lying straight leg lifts to do low impact VMO recruitment.

  5. Stretching. You've probably already been through this.

  6. Foam rolling. I hadn't read the foam rolling articles here on T-Nation but the therapist suggested this, especially the (painful) ITB rolling. I've been doing this every morning.

  7. When squatting, it seems to help me when I use a x1x tempo rather than a x0x tempo. Rocketing back up immediately once I hit bottom seems to hurt more than giving a little pause in the hole.

My recent squatting sessions have resulted in very little pain during the squat and only mild pain for about 5 minutes after I'm done.


This is a very complicated issue here my friend. I can agree with some of the comments that some therapists might not know all that much regarding many of the things here at T-nation, but I can tell you that a GOOD therapist can get around that relatively easily.

For a PT to just say no more squatting, there has to be more involved here. A LOT more. I know personally since I am about to enter my second year of grad school for physical therapy (and a long time T-nation reader I might add....oh yeah...)

Anyway, the more indepth information you can give regarding your injury, the better advice people can give.

Not to be mean, but if you think about it, your post was basically like going to the doctor and saying my ear hurts, and almost expecting diagnosis and medication without a physical exam. or even an eval.

Bottom line, tell us ALL about what's up, and the T Forumites will work hard to help out our fellow brethren.


P.S. PFS diagnosed by a Dr. generally means "You have knee pain and I don't know what exactly it is". Especially when they are about to send you to a PT.


Have a lateral release done.


One of Tate's tool box articles recently showed band "knee backs" (I think they were called). They work.

BTW I can not imagine that the leg press would be better on the knees than the squat if you squat wide and sit back.


Do you squat oly style or more like powerlifters? I was sqatting oly style before and front too, I ended up with pain in the knees when squatting. So I switched to a more "powerlifting" squat before fucking my knees for good. I havent experienced pain in the knee since I squat that way.



need more info but ....

depending on what is the issue with your knee i would look at following things :
1.stretch and strech....and then ice
2. strenghten your VMO(one of the most common patella tracking problems comes from that alone)
3.weak hamstrings
4.weak Glut Med and Min
5.excessive pelvic tilt due to tightness in quads/adductors/psoas
6.overpronation in the feet (due to increased pelvic tilt or not)

my sincere recommendation- find an ART provider near you.....get him/her to release all the structures directly and indirectly involved.
i personally have seen many athletes and weekend warriors with knee pain and most of the time it's fairly easy to treat the condition like yours(provided that you stil have cartilage)

.....oh yeah....and another thing....you can help curb your inflammation by taking mega doses of EPA/DHA

just my 2p. :))


OK, since the T-Nation requires more information, here it is. My knee problems are a result of 3 things (1) Compromised joint stability (2) Muscle Imbalance & (3) Poor exercise form. I'll cover each of these contributing factors in order.

My right knee track excessively to the right in-part because I had some actually a lot of cartilage shaved from that part of my knee joint.

I made a potentially bad situation worse by continuing to squat with an excessively wide stance. This led to an overdeveloped Rectus Femoris & Vastus Lateralis. Not to mention a severely underdeveloped Vastus Medialis.

It was so obvious that when the therapist saw my quads she was really amazed (at how unbalanced they were. I always wondered why I never had a good "tear drop" visible in my quad. Well this imbalance was the answer ? the Medialis is what gives your front quads that "tear drop" appearance. My Lateralis was so much larger and tight that it was just a matter of time before my knee cap tracking was compromised.

I also had very tight hips, and hamstrings. Therefore I've spent the last 9 months increasing my lower body flexibility & strengthening my inner quads. Due to my knee situation I was advised not to attempt to squat but that if I must I should do "bodybuilder" squats & be very careful of my foot placement. I was also told that the combination of tendonitis, due to my earlier surgery, and in-line squats would be a potentially painful combination - which it was!

All of this information led me to my original post. I requested effective substitutes for squats not a diagnosis of my knee problems. But for those of you w/medical training or similar experiences feel free to conjecture away.




suggestions around squatting style and exercises will only work temporarily..... you will run out of options soon.....
i am a therapist and see these things over and over ...... you need to address flexibility/strength imbalances across the joint and in the chain.....

find a good ART provider ...or anyone good with hads-on..... get them to release your Vast.Lat, Rec Fem.... TFL, ITB..... then get to work in strenghtening VMO..... that's the way forward...... single leg VMO stuff will work great..... it will require time... but you will get there.....

hope this helps

if you need anymore help ..PM me

stay safe