Patellofemoral Pain Syndromes: Weight Bearing vs. Non Weight Bearing Exercises

Patellofemoral Pain Syndromes:  Weight Bearing vs. Non Weight Bearing Exercises

Patellofemoral Pain Syndrome (PFPS) is the most common type of knee pain that is causing pain around and under the kneecap.  It can sometimes be caused by wearing down, roughening or softening of the cartilage under the kneecap.  The pain can get worse when you are active or when you sit for a long time.  It can affect runners, hikers, desk job workers and cyclists.

PFPS can be described in two ways:

PF pain without malalignment which includes a number of diagnosis such us patellar tendinitis, fat pad syndrome, PF osteoarthritis, trauma (eg. Quadriceps or patellar tendon rupture, patella fracture, contusion).  Most patients are treated conservatively with physical therapy including quadriceps strengthening, lower extremity stretching and treatment of potential contributing factors

PF pain with malalignment includes patients with increased Q angles, tight lateral retinaculum,  weakness of medial stabilizers, patella alta (high patella), patella baja (low patella).  Such patients often are treated with surgery after an exhaustive trial of rehabilitation.

Non-weight bearing strengthening exercises:


  • Maximum strengthening stimulation is provided for the quadriceps
  • ROM can be easily controlled
  • The amount of resistance can be controlled with non weight bearing quadriceps exercises


  • Non weight bearing strengthening is nonfunctional
  • Quadriceps muscles do not work in isolation during normal activities
  • Does not allow to train the lower extremity muscle groups to work together in simultaneous action
  • The quadriceps are working maximally at end range extension—the position at which the PF joint is most unstable.  If patient has PF instability and/or quadriceps imbalance that directs the patella laterally, the patella may easily track abnormally in complete extension



Weight bearing strengthening exercises:


  • It is the position of function of the knee joint
  • Allows the quadriceps to train in simultaneous action with other muscles groups to complete     the activity
  • Leads to greatest improvement in functional performance
  • Quadriceps activity is minimal as the knee approaches terminal extension, thus minimal quadriceps activity in the least stable position of the knee joint


  • Other muscle groups specifically the hip extensors and soleus muscle can contribute to knee extension force.  Therefore patients with weakness or quadriceps pain may rely on other muscles to perform the action.  The result is insufficient stimulus for the quadriceps and minimal strength gains.






















Here at Oahu Spine & Rehab in Kailua our physical therapists specialize in creating personalized treatment plans including at-home stretches just like these. If you are suffering from pain or an injury, give us a call today to schedule an appointment at 488-5555!



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