Patellofemoral pain syndrome, also known as runner’s knee, is a common injury among those who play sports that involve running and jumping, and among those who have tight hip flexors and restricted calf mobility.

Some of the telltale symptoms include: clicking, popping, swelling, and general pain and discomfort at the front of the knee and around the kneecap when running, sitting, taking the stairs or squatting.

Patellofemoral pain syndrome can be caused by overuse, injury, misalignment, muscle imbalances or non-optimal posture.

When working with a client who presents with or has been diagnosed with patellofemoral pain syndrome, it’s important to look at their unique situation and do a full-body assessment so you can load their joints appropriately during their Pilates session.

“When we address the causes of patellofemoral pain syndrome, we need to look at any imbalance or malalignment throughout the whole body. We have to address all of the improper compression issues that can happen because of shifts, rotations and imbalances, and then we have to make sure that we restore proper landing mechanics so our clients can climb up and down stairs, walk and run without pain,” explains Melanie Byford-Young, a Merrithew Master Instructor Trainer, physiotherapist and co-owner of Licensed Training Center Pacific Northwest Pilates in Portland, Oregon.

In this video, Melanie demonstrates some Pilates-based physical therapy exercises on the V2 Max Plus Reformer that are suitable for clients who have patellofemoral pain syndrome.

Key areas to address when dealing with patellofemoral pain syndrome

Thoracic spine

Frequently there is a shift or rotation in the thoracic spine. It may be large or small but it often leads clients to offload one knee, or load their knee inappropriately. It’s a very sneaky issue that frequently doesn’t get unwound and ends up perpetuating the pain or limiting the client when they go back to running, often causing the pain to return.


It’s common to see lateral dominance over the medial structure, so that might be a dominance of tensor fasciae latae, gluteus minimus, anterior glute medius or the lateral hamstrings over the medial hamstrings and the adductor group.

When we look at insufficiency, frequently the short adductors are tight and grippy and the long adductors are insufficient, either in terms of their timing, strength or length. When it comes to the hip abductors, we often see the insufficiency or weakness in the landing mechanics, so maybe they’re slow or not strong enough to manage that force. Too much adduction can compress the hip and lateral knee.


With patellofemoral pain syndrome, we’re dealing with femoral and tibial rotations. There is often a mismatch, whether it’s a rotation or a valgus or varus dysfunction that we need to address if we can.

Address the medial hamstrings and the lateral hamstrings with a keen eye on the vastus medialis oblique (VMO), making sure that the VMO in particular is able to pre-contract and guide the patella properly. We have to be careful of our clients who have interpreted “not hyperextending” as having soft knees all the time. If clients always maintain soft knees and never straighten them, they’re highly predisposed to patellofemoral pain syndrome.


We frequently see clients with a high rigid arch or plantar flexed first ray. Those two scenarios will prevent the body from coming forward over the foot when walking and will cause altered rotations of the knees, hips or pelvis, or could even be the driver for what’s happening in the thoracic spine. We also have to address balance, length and control of the gastrocnemius.

Any proper rehab program will address the whole body system and will include open and closed kinetic chain exercises.

4 reasons why the V2 Max Plus Reformer is ideal for rehab clients

  1. The V2 Max Plus is versatile and efficient to use. It’s very easy to adjust the load, angle of pull, and the client’s position. It’s a sturdy, reliable and space-efficient piece of equipment.
  2. The V2 Max Plus enables therapists to:
    • Choose open and closed chain variations of movement patterns, uniplanar or multiplanar movements
    • Challenge clients with compression and distraction at multiple angles
    • Re-introduce and restore plyometric and cardiovascular capacity
  3. The V2 Max Plus can be used throughout each stage of rehabilitation from acute to return to sports and daily activities, and with clients of all sizes and abilities. Therapists can adapt the settings to facilitate a movement and make it more accessible, or challenge the client to build strength and endurance capacity by adding load.
  4. Clients can work in all positions and postures— supine, prone, side-lying, sitting and standing. Exercises can be very controlled or can be adapted to challenge balance and perturbation.

Props and equipment used in this video:

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