Until acute symptoms subside, the patient is advised to avoid or modify activities which bring on or exacerbate their symptoms. This means reduced bicycling for a period of time, avoiding frequent usage of steps, and avoiding activities which require squatting or kneeling. It is also recommended that the patient reduce or eliminate running for a period of days to weeks. Recently, there has been increased interest in closed kinetic chain activities, including partial squats, which place the knee joint through active weight-bearing flexion and extension in terminal range only. There are several studies to support this approach, as there is less shear force through the knee and the proprioceptive feedback is more physiological. The rule of specificity of training would imply that this would be the best way to training optimal tracking of the patella. This requires additional study for confirmation, however.

In addition, taping of the patella to reduce tracking abnormalities has found favor over the last five or so years. Again, this technique, which makes excellent biomechanical sense, requires additional randomized studies for confirmation. Electrical stimulation or biofeedback may supply and enhance the exercise program. Biofeedback involves application of electrodes with both auditory and visual feedback signals which assist the patient in enhancing and completing the contraction. This also allows improvement of balance between the vastus medialis obliquus and other branches of the quadriceps muscle, with theoretical optimal improvement in tracking ability. One should always avoid exercise through a painful arc of the range of motion. This is usually in that part of the arc where the patellofemoral pressure is highest, through mid-flexion. Even this concept has been controversial due to several recent studies.

Whereas, ten years ago, isokinetic strengthening was the rage, because of the increased shear force and many anecdotal stories about exacerbation of symptoms, this has fallen into relative disfavor. Isokinetic strengthening still serves a purpose when speed of contraction is of the essence. This is probably appropriate for higher-level athletes who have not been able to make functional gains despite a closed kinetic chain program and biofeedback. In theory, developing torque (rate of force development) in the muscle, should enhance the tracking mechanism. However, in the case of most isokinetic machines, this is at the expense of stability and control during the training phase.

Supplementing the exercise program, nonsteroidal anti-inflammatory drugs taken in full dosage can often reduce the initial inflammation of the patellofemoral joint. These medications reduce the inflammation process by inhibiting prostaglandin synthesis. Prostoglandins are responsible for much of the pain, swelling, and destruction of cartilage. These medications are often quite effective. However, there is a risk of gastrointestinal side effects, fluid retention, and other less common side effects on the kidney. Therefore, these should not be taken without the advice of a physician.

In addition to the exercise program, modalities such as ultrasound and electricity can reduce adhesionss behind the patella in the acute phase. In addition, patellar mobilization techniques, involving the therapist manually freeing up and gaining normal motion in the patella, can be of great benefit. A detailed evaluation to assess the nature of malalignment or tracking abnormalities is crucial. Orthotics are appliances which support, unload, or redistribute forces to the patella. It is often effective to use a knee sleeve with a patella cut-out (with a horseshoe pad). This can supplement a taping program. This knee support results in better distribution of pressure at the patella and in better patellar tracking. This is often a temporary measure until quadriceps strength is sufficient and control adequate to reduce symptoms.

In addition, there is a role for orthotics in the shoe, especially in people with malalignment. For example, for people with pes planus, the consequent increased Q angle can be reduced by proper measurement and prescription of orthotics. Again, this is only a supplement to taping techniques, other manual therapy techniques, and a good exercise program.

In summary, 80 to 85 percent of patients with patellofemoral syndrome are successfully treated with the above measures. Careful evaluation of predisposing factors and a diligent rehabilitation program can result in better statistical success. When the patient does not improve in a fairly brief period with the above measures, other diagnostic entities must be looked for by means of more extensive testing.