Address safety, settle excessive irritability and maintain useful movement.
What to do
Explain load-capacity relationship and adjust painful running/jumping temporarily
Continue tolerable activity
Begin knee and/or hip strengthening at manageable range
Exercise dosage
Isometric quadriceps or shallow squat: 4–5 x 20–30 seconds
Temporarily reduce provoking volume, not all activity
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Progress quadriceps and hip strengthening
Add step-down, squat and single-leg control
Use running retraining only when relevant to individual deficits
Exercise dosage
Squat/leg press: 3 x 8–12
Hip abductor/external rotator strengthening: 2–3 x 10–15, 2–3 days/week
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Graded return to running, jumping and stairs
Progress volume, speed and hills separately
Maintain strengthening to reduce recurrence
Exercise dosage
Hops/jumps: 2–4 sets of 5–10 quality reps
Run-walk progression with rest/recovery days
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Patellar taping or mobilisation may provide short-term adjunctive relief in selected patients.
Manual therapy should not replace hip and knee exercise.
Modalities — Use / Avoid
Foot orthoses may help selected patients short term when matched to response.
Routine passive electrotherapy is not a core intervention.
Return / Discharge Criteria
Stairs and single-leg squat tolerated
Running/jumping progressed without meaningful flare
Quadriceps and hip capacity appropriate for goals
Common Clinical Mistakes
Focusing on static knee valgus as the diagnosis
Only strengthening VMO
Stopping all running indefinitely
Ignoring training load
Clinical Pearls
Combined hip- and knee-targeted exercise is supported by the PFP guideline.
Use the patient's pain response and functional goals to select exercise range.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
