Conditions / Musculoskeletal

Patellofemoral pain

Pain around or behind the kneecap, typically with squatting, stairs and prolonged sitting. Exercise therapy is the strongest recommendation, and the hip matters as much as the knee.

Prescribe

Combined hip and knee exercise therapy, which outperforms knee work alone
Weight the early phase toward hip abductor and external rotator work
Keep loading within a pain level the client can hold steady
Expect a 6-12 week block before judging the response

Avoid, and why

Knee-only programs, which are less effective than adding hip work
Deep loaded knee flexion early, which spikes patellofemoral joint stress
Prolonged sitting between sessions, which reproduces symptoms
Adding running volume while symptoms are still climbing session to session

How the generator handles this

Max exercise complexity	2
Patterns excluded	None
Balance work added	No
Clearance required first	No

Exercises automatically excluded: Walking lunge Bulgarian split squat Front squat Barbell back squat

Sources

Arthritis Society Canada (2024). Physical Activity Guide. Source
Source of the two-hour pain rule: if joints hurt more than usual and take more than two hours to settle after activity, modify the activity. Modify, not stop.
Willy et al., JOSPT (2019). Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health. Source
Exercise therapy is the Grade A treatment, and combined hip and knee work beats knee work alone for pain and function. Hip-focused work should come first in the early phase.