New to shockwave or in pain for more than 3 months? Book a Telehealth to see if we can help you!
If you’re battling persistent knee pain from patellofemoral syndrome (also known as patellofemoral pain syndrome or “runner’s knee”), you’re not alone. This condition – marked by aching or sharp pain around the kneecap – can be frustrating and limiting. Everyday activities like climbing stairs, squatting, or even sitting for a long movie can flare up your knee pain. We understand how disheartening this can be, especially when the pain drags on despite rest and basic remedies.
On the bright side, there are practical tools and treatments that can help relieve patellofemoral syndrome. In this post, we’ll explore what science and real clinical experience say about the best braces, knee sleeves, orthotics, and rehab strategies for patellofemoral pain. Our goal is to give you a clear, compassionate guide – grounded in evidence – to managing your knee pain. We’ll also share how our team at Unpain Clinic approaches patellofemoral syndrome, combining cutting-edge therapies with a holistic, patient-centered touch.
Let’s dive into understanding why this knee pain happens, and then examine which supports and therapies actually help (and why). Remember, every individual is different – so an approach that works wonders for one person may offer only modest relief for another. Always consult a qualified health professional for personalized advice. With that said, there are proven strategies that tilt the odds in your favor.
By the end of this article, you’ll know the latest evidence on patellofemoral syndrome relief – from braces and orthotics to exercises and advanced therapies – and how to apply it to your own recovery. Let’s start by understanding the problem itself.
Patellofemoral syndrome refers to pain at the front of the knee, around or behind the patella (kneecap). It often starts gradually and is characterized by diffuse anterior knee pain, especially during activities that load the kneecap. This is why it’s commonly called “runner’s knee” – running is a frequent trigger – but it affects more than just runners. In fact, patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain in teens and adults.
The exact cause of patellofemoral syndrome is usually multifactorial and individualized. In many cases, it’s not a single injury but an overuse syndrome or movement dysfunction. Key factors that can contribute include:
Muscle Imbalances or Weakness: Weak quadriceps (especially the inner quad, the vastus medialis) or weak hip stabilizers (like the gluteal muscles) can fail to keep the patella tracking properly. Research shows PFPS is often linked to quadriceps weakness and hip muscle deficits. If the glutes aren’t keeping the thigh aligned, or the quads aren’t controlling the kneecap, extra stress can hit the patellofemoral joint.
Biomechanical Imbalances: Poor alignment from the hip down to the foot can alter knee mechanics. For example, excessive foot pronation (flat feet) or inward knee collapse (knock-knee position) during activity may increase pressure on the kneecap. Even a tight iliotibial band or calf can tug the kneecap out of its ideal groove. Essentially, any imbalance in the legs’ alignment can cause the patella to “maltrack,” irritating the joint surfaces.
Overuse and Repetitive Strain: Patellofemoral pain often emerges in people who suddenly increase running mileage, squatting, stair climbing, or similar repetitive knee-bending activities. The cartilage under the kneecap and surrounding tissues get irritated from chronic stress. Typically, PFPS develops progressively with overuse rather than from one traumatic event.
Age and Gender: It can affect anyone, but young adults (teens to early 30s) seem especially prone. Adolescent and young adult women report patellofemoral pain at higher rates, possibly due to anatomical and hormonal factors. That said, men and older adults can certainly get “runner’s knee” too.
Psychosocial Factors: Interestingly, our minds and pain sensitivity play a role. Chronic knee pain can be worsened by anxiety, pain fear-avoidance, or other psychological factors. There’s evidence that psychological aspects can influence patellofemoral syndrome development and persistence– for instance, if pain causes you to move differently or avoid activity, it can create a cycle that perpetuates the problem.
In summary, patellofemoral syndrome often results from a combination of physical factors (like muscle weakness or foot mechanics) and sometimes even nervous system factors (sensitized pain pathways). Because there are many potential contributors, it’s important to have a thorough assessment. Our clinicians often find that knee pain is the “victim” of problems elsewhere – for example, stiff ankles or weak hips can overload the kneecap. Identifying these root causes is key to relief.
Patellofemoral pain typically presents as an achy or sharp pain in the front of the knee, around or under the kneecap. You might feel or hear grinding/crackling (crepitus) in the knee. Symptoms often worsen with activities that put pressure on the patellofemoral joint, such as:
Squatting or Kneeling: Bending the knee deeply can compress the kneecap and provoke pain.
Stairs or Hills: Going down stairs or downhill usually hurts more (due to higher patellofemoral loads), though uphill can also aggravate it.
Running and Jumping: High-impact activities can flare the pain, especially running (hence the nickname “runner’s knee”).
Prolonged Sitting: Many PFPS sufferers report the “movie theater sign” – the knee aches after sitting for a long time with bent legs, and may feel stiff or painful when standing up from the seat.
Getting Up From Chairs or Low Seats: The first few steps after sitting can be painful until the knee “warms up.”
Kneecap Tenderness: Pressing on the edges of the patella might feel sore, and some swelling may occur around the kneecap after activity.
The pain is usually diffuse – hard to pinpoint – and typically not accompanied by significant swelling or locking of the knee (those signs suggest other injuries). It’s more of a dull ache that comes and goes with activity. Many people with patellofemoral syndrome find that the pain improves with rest, but comes back when they resume the aggravating activity. Without proper rehab, it can become a nagging chronic issue.
Diagnosis: There is no single definitive test for patellofemoral syndrome. Doctors and physiotherapists diagnose it based on history and exam. They may perform a patellofemoral grind test (Clarke’s test) – where the examiner presses the top of your kneecap as you tighten your quad – to see if it reproduces pain or grinding. A positive test (pain with this maneuver) can support the diagnosis, though no test is perfect. Imaging like X-rays or MRI is usually normal in patellofemoral pain (or may show very mild cartilage wear). Often, imaging is done to rule out other conditions (like patellar tendon tears or osteoarthritis) rather than to “prove” PFPS. So if you have the classic symptoms and no red flags, a clinical exam is usually enough to identify patellofemoral pain syndrome.
The bottom line: Patellofemoral syndrome is a common, frustrating knee problem caused by a mix of overload and alignment issues. Fortunately, it’s treatable. Next, we’ll discuss what research says about relieving this pain – specifically, whether using knee braces, sleeves, foot orthotics, and rehab exercises actually make a difference.
When your knee is hurting, it’s tempting to reach for a brace or think a new insole might fix it. Or maybe you’ve heard certain exercises are the “magic bullet” for knee pain. In this section, we take an evidence-based look at common supports and treatments for patellofemoral syndrome. What does scientific research (randomized trials, reviews, etc.) say about their effectiveness? Let’s break down the main ones:
Knee braces – especially those designed for patellar support – are often recommended to patients with patellofemoral pain. These can range from simple neoprene knee sleeves (compression sleeves) to more specific patellar stabilization braces (with straps or buttresses that press the kneecap inward). The idea is to improve alignment of the patella and provide stability or proprioceptive feedback to the joint.
So, do they work? According to multiple studies, knee bracing can indeed provide short-term pain relief and improved function in many patellofemoral pain sufferers:
A clinical trial on an “elastomeric” patellofemoral brace (the DonJoy Reaction Web brace) found that adding this brace to rehab significantly reduced pain compared to rehab alone. Over 6 months, the brace group had on average 5 points greater reduction in pain (on a 10-point scale) than those doing rehab exercises without a brace. By 12 months, 24 of 30 patients who wore the brace were able to return to sport, versus 14 of 30 in the no-brace group. Both groups improved over time, but the braced patients reported less pain and faster return to activity. Notably, 75% of patients were satisfied with their knee brace use.
Biomechanical studies using MRI and motion analysis have shown braces can correct patellar tracking to some degree. For example, a patella-stabilizing brace can reduce lateral patella displacement and tilt during movement. Braces and even simple sleeves likely work by improving kneecap alignment, increasing proprioception (your body’s awareness of joint position), and providing gentle pressure that “reminds” the patella to stay in its groove.
Systematic reviews suggest a mixed but generally positive effect of bracing. A meta-analysis noted that patients who used knee orthoses (braces) reported reduced pain and improved function in the short term. However, some older studies were low-quality, so results vary and we interpret them cautiously. Overall, bracing is considered a helpful adjunct to therapy, rather than a standalone cure.
Knee sleeves (compression sleeves), while simpler than hinged braces, may also help by keeping the joint warm and providing mild support. There’s less specific research on soft sleeves, but they likely have a proprioceptive benefit – meaning they help your body sense the knee better, which can improve how your muscles control the joint. Many people report that a sleeve “feels good” or gives confidence during activity.
Patellar taping (like McConnell taping or Kinesio taping) is another related strategy. Taping the kneecap can mechanically pull it into a better position and reduce pain. Studies show short-term pain relief from taping in PFPS, especially when combined with exercise. The effect can be significant over weeks, but tends to be temporary (helpful as a therapeutic window to enable exercise). Braces essentially serve as a reusable, less fiddly tape – so it’s no surprise their effects are similar.
Important: While a brace or tape can reduce pain and improve function, it’s usually addressing the symptoms more than the root cause. A brace doesn’t strengthen your muscles or fix biomechanical issues long-term. Our own clinic’s experience aligns with research: braces are best used to assist rehab. They allow you to do pain-free exercises by stabilizing the knee and boosting confidence. But if you rely on a brace alone without addressing underlying weakness or alignment, the pain often returns once the brace is off. As one of our podcasts explains, braces (and even cortisone shots) “only mask symptoms… they don’t fix the underlying issue”. So, yes – use that knee brace or sleeve to get relief, but combine it with corrective exercise (see below) for lasting results.
In summary, knee braces and sleeves can be a beneficial part of patellofemoral pain management, giving short-term relief and stability. Scientific evidence and patient feedback confirm they can help you hurt less during activity. Just remember that for long-term relief, they should be paired with active rehabilitation.
Your feet are literally the foundation for your knees. If you have flat feet or other foot alignment issues, that can contribute to patellofemoral pain by causing the knee to rotate inward with each step. This is why foot orthotics (arch supports or shoe inserts) are often recommended for patellofemoral syndrome, especially in patients who overpronate.
Evidence for orthotics: There is solid research showing that orthotic insoles can improve patellofemoral pain in the right patients. A well-known randomized trial found that using custom foot orthoses significantly reduced knee pain in PFPS sufferers compared to flat shoe inserts, particularly in the short term (6 weeks to 3 months). Based on multiple studies, an international consensus panel actually recommended foot orthoses to reduce pain in the short term for patellofemoral pain.
How do orthotics help? By supporting the arch, orthotics can reduce excessive pronation (inward foot roll), which in turn may prevent the knee from collapsing inward. This aligns the patellofemoral joint more optimally, reducing strain on the kneecap. Orthotics also absorb shock, which might lessen impact on the knee.
Interestingly, a 2018 study went a step further: it compared a program of foot strengthening exercises plus orthotics vs. knee strengthening exercises in people with PFPS. The result: patients who worked on their feet (using orthotics and doing foot exercises) had better outcomes than those who only did knee exercises. In other words, sometimes the foot and ankle strategy outperforms a knee-focused approach. This makes sense if poor foot mechanics were a root cause of the knee pain.
Practical takeaways: If you have flat or very high arches, or notice your shoes wear down unevenly, consider an orthotic. A custom orthotic (from a podiatrist or physio) can be tailored to you, but even over-the-counter arch support insoles help some people. Proper supportive footwear is important too – a stable shoe with good arch support and cushioning can complement the orthotic. Think of it as giving your knee a better foundation so it isn’t subjected to abnormal forces from the ground up.
One caution: orthotics, like braces, treat a contributing factor. They work best when combined with exercise. In fact, research suggests orthotics plus exercise education is a powerful combo – one study noted education + orthoses + exercise yielded higher odds of improvement at 3 months. Over longer term (12+ months), exercise may play a bigger role, but orthotics can jump-start pain relief. Also, not everyone with PFPS needs orthotics – if your foot mechanics are fine, an insole won’t magically fix your knee. A skilled clinician can assess whether you pronate or have alignment issues that orthotics could address.
Exercise is the cornerstone of patellofemoral pain rehabilitation. While braces and orthotics can reduce stress on the knee, only exercise can strengthen your muscles and correct dysfunctional movement patterns. Nearly every clinical guideline and systematic review identifies exercise therapy – particularly strengthening of the quadriceps and hips – as the most effective long-term strategy for patellofemoral pain.
Here’s what the research tells us about exercises for PFPS:
Strengthening the Quads and Hips: Building up the quadriceps (especially the vastus medialis oblique, or VMO) helps the kneecap track properly. Strengthening the hip abductors and external rotators (gluteus medius, deep hip muscles) prevents the knee from caving inward. A global consensus in 2016 stated that combining hip and knee strengthening is strongly recommended to reduce patellofemoral pain and improve function in the short, medium, and long term. In fact, hip+knee exercise was favored over knee exercises alone for better outcomes. So don’t just do knee extensions – incorporate lateral leg raises, clamshells, or band walks to target the glutes as well.
Stretching and Flexibility: Tight muscles can alter knee mechanics. Many people with patellofemoral pain have tight calves, hamstrings, or iliotibial bands. Gentle stretching of the calf (to improve ankle dorsiflexion), hamstrings, and quads may reduce abnormal pulling on the knee. While stretching alone won’t resolve PFPS, it’s a helpful supportive measure to restore normal mobility.
Balance and Control Exercises: Because patellofemoral pain often involves poor knee control, exercises that improve balance and proprioception can be useful. This could be single-leg balance drills, step-down exercises (learning to control knee alignment), or using a wobble board. Improved neuromuscular control ensures the knee doesn’t wobble or track poorly during daily activities.
Low-Impact Cardio & Endurance: Keeping the knee joint moving with low-impact activities (cycling, swimming, using an elliptical) can help maintain fitness and get blood flow to the knee without excessive stress. Cycling with low resistance is often tolerated well and strengthens the legs. Avoid high-impact pounding (like running on hard surfaces) in the early rehab stage if it aggravates pain.
Education to Stay Active: Not exactly an “exercise,” but patient education is key. A network meta-analysis found that simply educating patients about their condition and activity modifications, when combined with exercise, led to better 3-month outcomes. Knowing how to modify painful activities rather than stopping all activity can keep you conditioned while rehabbing. (For example, you might temporarily cut back running mileage and do more cycling, rather than quitting exercise entirely.)
The efficacy of exercise is backed by strong evidence. One review of 22 RCTs concluded that exercise therapy reduces pain in the short, medium, and long term for patellofemoral pain, and improves function in the medium/long term. People who stick to a structured exercise program are more likely to get better and be pain-free down the road. In contrast, doing nothing (“wait and see”) has the worst outcomes – all active treatments outperform doing nothing at 3 months. So, avoiding activity completely is not a good strategy; controlled, targeted exercise is the way to go.
Note: It’s normal for some exercises to cause a mild increase in pain at first. A common guideline is the “traffic light” system: mild discomfort (rated <3/10) during exercise is acceptable, as long as it settles shortly after. Severe pain is a sign to modify the exercise (e.g., decrease the range or intensity). A physiotherapist can help tailor the program so you’re challenging the knee safely. Consistency is key – doing your rehab exercises a few times weekly (or as prescribed) for at least 6-12 weeks is usually needed to see significant improvement. Many patients start feeling relief in the first 4-6 weeks, but continuing beyond that consolidates the gains and prevents recurrence.
Beyond braces and orthotics, several other tools can assist in patellofemoral pain rehab:
Patellar Taping: As mentioned, taping the kneecap (usually with rigid sports tape) can provide immediate pain relief for some people by guiding the patella medially (inward). It’s a well-established short-term intervention and often used in physical therapy sessions to enable pain-free exercise. The effect tends to last a few hours to a couple of days. It’s something you can learn to do yourself with guidance.
Foam Rollers and Massage Balls: Foam rolling the quads, IT band, and glutes can help release tight soft tissues that might be pulling on the kneecap. Some PFPS patients find that regular foam rolling or using a massage ball on hip muscles reduces discomfort and improves mobility. This is likely due to improving blood flow and reducing myofascial tightness.
Cold Packs and Anti-inflammatories: After exercise or activity, icing the knee for 10-15 minutes can reduce pain and swelling. Over-the-counter anti-inflammatory medications (NSAIDs) may help in short courses, though they’re not a long-term solution. They can be used to calm a flare-up so you can keep moving.
Neuromuscular Electrical Stimulation (NMES): In cases of significant muscle inhibition (for example, if your VMO just isn’t activating), some physios use electrical stimulation to get the muscle contracting. This can be a useful adjunct to wake up a “lazy” quad muscle, but it’s usually combined with active exercise (e.g., NMES while doing a quad set or leg raise).
Biofeedback: Similarly, visual or auditory biofeedback can help ensure you’re recruiting the right muscles. For instance, placing an EMG biofeedback device or even a blood pressure cuff behind the knee while doing quad exercises can train you to activate and control the contraction better. This is more specialized, but can speed up muscle re-training.
Putting it all together: The best results typically come from a combination of methods. In fact, a comprehensive review (called a network meta-analysis) concluded that education combined with a physical treatment (such as exercise, orthotics, or taping) is the most effective approach at 3 months. No single modality is a guaranteed fix for everyone – but combining them addresses multiple facets of the problem. For example, you might use a brace and orthotics for support, do targeted exercises to fix muscle imbalances, and use taping or foam rolling for symptom relief as needed.
The silver lining is that patellofemoral syndrome is very treatable with conservative measures. Many patients see significant improvement within weeks to a few months by following an appropriate rehab program. Next, we’ll discuss some of the advanced treatment options we offer at Unpain Clinic that can accelerate this healing process, especially for stubborn cases.
At Unpain Clinic, our approach to patellofemoral syndrome (and knee pain in general) is holistic and evidence-informed. We don’t just toss you a brace and a sheet of exercises – we dig deeper to address the root causes of your knee pain. This often means combining advanced therapeutic technologies (like shockwave or EMTT) with hands-on treatment and tailored exercise. The goal is not only to relieve pain but to stimulate true healing of the tissues and correct the dysfunctional movement patterns that caused your pain in the first place.
Here are some of the specialized treatment options we utilize for patellofemoral pain:
Shockwave therapy is one of our centerpiece treatments for chronic musculoskeletal pain, including tough cases of patellofemoral syndrome. Shockwave involves delivering high-energy sound waves to the injured tissues. This might sound intense, but it’s a non-invasive therapy that can jump-start the body’s repair processes.
Research has shown shockwave can promote tissue regeneration and reduce pain in various conditions, from plantar fasciitis to patellar tendinopathy. For patellofemoral pain, shockwave is a promising newer intervention that may help with any soft-tissue contributors (like tendon or muscle dysfunction around the knee).
In practice at our clinic, we use focused shockwave or radial pressure wave devices depending on the case. Focused shockwaves penetrate deeper to target specific spots (like a thickened tendon or a sensitive spot under the kneecap), whereas radial waves treat broader areas more superficially (like tight muscle groups around the knee). Both types stimulate blood flow, break up microscopic scar tissue, and trigger an analgesic effect by desensitizing nerve endings and releasing growth factors.
A recent study in Journal of Clinical Medicine (2024) demonstrated how effective shockwave can be when combined with exercise for PFPS. In 64 patients, those who received shockwave therapy plus rehab exercises had significantly greater pain reduction and improved knee function compared to those who did standard physiotherapy modalities without shockwave. The authors concluded that radial shockwave combined with physiotherapy provided additional benefits for patellofemoral syndrome, including greater pain relief and joint mobility. In short, shockwave accelerated their recovery.
How it feels: Shockwave treatments are quick (usually 5-10 minutes to treat a knee) and don’t require anesthesia. You’ll feel rapid percussion or tapping on the treatment area. It can be a bit uncomfortable on very sore spots, but most patients tolerate it well – describing it like a strong deep tissue massage sensation. Importantly, shockwave is not just masking pain; it’s stimulating real healing at the cellular level. As we often explain to patients, “shockwave therapy uses sound waves to regenerate soft tissue, improve blood flow, and trigger the body’s natural healing response”. Unlike a cortisone injection (which may weaken tissues over time), shockwave’s effects actually strengthen the knee area by encouraging repair.
At Unpain Clinic, we’ve seen excellent outcomes using shockwave for anterior knee pain. Particularly when patellofemoral pain is accompanied by patellar tendinitis or quad tendon irritation, shockwave can calm down the tissue and allow you to rehab without constant pain. It’s a tool that aligns with our regenerative approach – helping the body fix itself.
To complement shockwave, we often employ EMTT, which stands for Extracorporeal Magnetotransduction Therapy. EMTT is a pulsed electromagnetic field therapy – essentially, a device generates high-frequency magnetic pulses that penetrate into the tissues. You lie comfortably while a loop or paddle emits these pulses over the injured area.
So what does EMTT do? It appears to reduce inflammation and modulate pain signals at the cellular level. The magnetic field can influence ion channels and cell membranes in a way that promotes an anti-inflammatory effect and tissue regeneration. In simpler terms, EMTT helps calm down overactive nerves and jump-start cellular repair, without any sensation of force or heat. Most patients don’t feel much during EMTT, aside from maybe gentle warmth.
EMTT is quite new, but early clinical use has been positive for conditions like osteoarthritis and tendinopathies. It’s especially useful for chronic pain or wear-and-tear conditions that don’t respond to conventional treatments. In patellofemoral syndrome, we use EMTT to settle stubborn knee pain that has a lot of inflammatory or neural sensitivity component. For example, if a patient’s knee is extremely touchy and painful even with light pressure, EMTT can help desensitize it so that manual therapy and exercise are better tolerated.
We often pair shockwave + EMTT in the same session, because they complement each other. Shockwave provides a mechanical stimulus and triggers local healing, while EMTT provides an electromagnetic stimulus that can penetrate a broader area (like the entire knee joint). This one-two punch is great for chronic cases. As one summary puts it, combining shockwave and EMTT allows us to treat the root causes of pain, not just mask the symptoms, by addressing both tissue healing and pain modulation. Our clinical observations show faster pain relief and improved function when both modalities are used together, versus either alone.
(A quick note: EMTT is safe – it’s FDA/Health Canada approved for musculoskeletal pain – but we avoid it in patients with implanted electronic devices like pacemakers, due to the magnetic field.)
Chronic patellofemoral pain can lead to something called “central sensitization,” where the nervous system becomes hyper-reactive. In such cases, neuromodulation techniques can be very helpful to “reset” the way your nerves are processing pain. Neuromodulation, broadly speaking, refers to therapies that alter nerve activity.
At Unpain Clinic, our neuromodulation approaches may include electrical nerve stimulation, low-level laser, or even specialized acupuncture/needling techniques aimed at calming nerve signals. For example, we might use a gentle frequency-specific microcurrent or Scrambler therapy (a form of electronic nerve stimulation) around the knee. This isn’t the shocking TENS units of the past – modern neuromodulation is often painless and induces a soothing sensation.
The aim is to desensitize overactive pain fibers so that normal movement doesn’t trigger a pain alarm. As we’ve described on our site, it’s like telling the nerves to stop over-reacting to stimuli. In practice, patients often report that neuromodulation treatments feel relaxing – perhaps a mild warmth or tingling – and that afterward the knee feels “lighter” or less painful for hours or days. Over several sessions, this can reduce the overall pain baseline, buying you a window to progress your exercises.
Neuromodulation can also include nerve-focused exercises. We might teach “nerve flossing” exercises if we suspect neural tension (for instance, a sliding nerve technique for the saphenous nerve in the knee). Additionally, graded exposure – slowly and safely exposing you to previously painful movements – is a form of neuromodulation from a rehab perspective (retraining the brain that movement is safe).
In summary, while neuromodulation is a broad category, our use of it is tailored to calm the nervous system component of knee pain. It’s especially useful if you have long-standing pain that outlasts the tissue injury (the kind of pain that seems disproportionate or is accompanied by a lot of sensitivity). By reducing that “alarm system” volume, we can help restore normal pain-free movement.
Despite our love for technology, we haven’t forgotten the basics: hands-on manual therapy and individualized movement retraining are core parts of our patellofemoral pain treatment. Warm, empathetic, and skillful manual therapy can achieve things machines can’t – like relieving a specific joint restriction or easing a muscle spasm contributing to your pain.
Some manual techniques we use for PFPS include:
Patellar Mobilizations: Gently gliding and stretching the kneecap’s connective tissues can improve its mobility. If the lateral retinaculum (tissue on the outer knee) is tight, we may do lateral-to-medial glides of the patella to help it track better.
Soft Tissue Release: Tight quads, IT band, or hamstrings? We’ll apply targeted massage, myofascial release, or trigger point therapy to those areas. Often, by releasing tight thigh muscles, we reduce the pressure on the patella during movement.
Joint Mobilization/Manipulation: Sometimes the knee pain is exacerbated by issues above or below – like a stiff hip or ankle. Our physiotherapists and chiropractors can mobilize the ankle (improve dorsiflexion) or adjust the hip/pelvis if needed. We look at the whole kinetic chain. For example, if your sacroiliac joint or lower back is misaligned, it could be affecting how your leg moves, so we address that.
Manual Stretching: We might perform therapist-assisted stretches for the quads, hip flexors, or calves. Getting a good stretch with the right stabilization can be more effective than what you achieve alone.
Education and Movement Correction: We coach you through functional movements – squatting, stepping, etc. – to ensure you’re using proper form. Sometimes a little cue like “knees out” during a squat or improving your single-leg landing technique can offload the kneecap significantly. We provide those cues and practice with you.
Our philosophy is to treat the person, not just the knee. Patellofemoral pain often has contributors all along the chain. As one patient noted in a testimonial, our therapist “treated secondary problem areas (i.e. a sore foot can affect your knees, etc.), because they look at the whole chain”. This whole-body approach sets us apart. We use manual therapy not just on the knee, but anywhere from the foot to the spine if it will help the knee pain.
Furthermore, we integrate manual therapy with our modalities and exercise. A typical session might involve some soft tissue release and joint adjustments, followed by shockwave on the knee, then finishing with exercise practice. By combining these therapies – shockwave plus EMTT/neuromodulation plus manual therapy and exercise – we treat the root causes of pain, not just mask the symptoms. This comprehensive care is why even chronic cases find relief with us when standard cookie-cutter physio hasn’t worked.
You might wonder, do I really need all these different treatments? The answer is, not always – it depends on your specific case. But having multiple tools allows us to tailor a program that addresses all aspects of your patellofemoral syndrome:
Persistent pain not easing with exercise alone? Shockwave and EMTT can catalyze healing and pain reduction.
Underlying hip weakness? We’ll zero in on that with targeted strengthening and perhaps neuromuscular stimulation.
Foot issues contributing? We add orthotics, foot exercises, and even treat the foot with shockwave if plantar fasciitis is also present (it often coexists).
Significant muscular tightness? Manual therapy and stretching to restore flexibility.
Neurological sensitivity? Neuromodulation to tone down the pain receptors.
This integrative approach means we’re not leaving any stone unturned. It’s common at our clinic to hear patients say, “Wow, no one ever looked at my [hips/back/feet] before for my knee pain.” By looking at the whole picture, we often find the true driving factor of the patellofemoral pain and can correct it. Our team of physiotherapists, chiropractors, and massage therapists all collaborate, so you get a well-rounded plan.
And crucially, we educate you along the way – you’ll learn the why and how of each exercise and treatment. We empower you with knowledge about your condition and how to manage it.
Lastly, all these advanced treatments we offer are evidence-based and safe. For example, shockwave has been validated in clinical studies for knee-related pains, and consensus guidelines support combining therapies like we do. We also closely follow new research (and even contribute to it) to ensure we’re providing state-of-the-art care.
Now, let’s move from the clinic to real life: what kind of progress can someone with stubborn patellofemoral syndrome expect? We’ll share a brief patient story to illustrate how these treatments come together, and then cover some self-care guidance you can try at home.
To protect privacy, names have been changed.
Meet Jane: a 29-year-old avid hiker and office worker who came to us with a 2-year history of patellofemoral pain in her right knee. Jane’s pain began after a summer of ramping up her hiking mileage. Initially it was just soreness after long hikes, but soon she felt a constant ache around her kneecap even during daily activities. She tried rest, ice, and a patellar strap brace she bought online. These gave some relief, but her knee pain kept flaring every time she attempted to get back into running or hiking. By the time she visited Unpain Clinic, she was frustrated and worried that she’d never be able to enjoy the outdoors pain-free again.
Assessment findings: Our evaluation found that Jane had significant weakness in her right hip abductors and quads. When she did a single-leg squat, her knee drifted inward (dynamic valgus). We also noticed she had overpronation in her right foot (flat arch) and her right hip was slightly rotated. Palpation revealed tight IT band and quadricep tissues, and a very tender spot at the outer patellofemoral joint. The patellar grind test was positive on the right (reproduced her pain). We also assessed her movement patterns and discovered that after an old ankle sprain years ago, she never fully regained her ankle mobility – which likely contributed to her compensating at the knee.
Treatment plan: We created a multimodal plan for Jane:
Orthotic & Shoe Advice: We fitted her with a semi-custom arch support to correct her pronation, and recommended more supportive hiking shoes.
Exercise Therapy: Our physiotherapist taught Jane hip-strengthening exercises (side-lying leg lifts, clamshells with a resistance band) and quadriceps exercises (wall sits and step-downs within pain-free range). We emphasized form – avoiding that inward knee collapse. We also gave her calf stretches and ankle mobility drills to address the stiff ankle.
Shockwave & EMTT: Once a week, we applied focused shockwave to her lateral patellar border and quad tendon (to stimulate healing in those irritated tissues), and radial shockwave to her tight IT band and quad muscle. We followed this with 10 minutes of EMTT around the knee to reduce inflammation and pain.
Manual Therapy: The chiropractor on our team worked on Jane’s hip alignment with some gentle adjustments, and mobilized her patella and knee joint. The massage therapist focused on myofascial release for her IT band and quads. After sessions, Jane noted her knee felt “looser”.
Neuromodulation: Because Jane’s pain was long-standing, we also did a couple of sessions of a gentle electrical stimulation around her knee (a form of neurofeedback therapy) to help “reset” her pain perception. She described these sessions as very relaxing.
Progress: After 3 weeks (about 3 sessions) Jane reported that her daily pain was considerably lower – she no longer ached at her desk job, and could do bodyweight squats with only mild discomfort. After 6 weeks, she was hiking easy trails again, wearing her brace and orthotics, without a pain flare. By 8 weeks, her single-leg squat looked much improved (no more knee collapse) and she was essentially pain-free in routine activities. Stairs in her house were no longer a nemesis. We gradually weaned her off the brace as her muscles got stronger. At the 3-month mark, Jane was back to weekend hiking and even light jogging on soft surfaces, with only occasional twinges in the knee. She continued doing her hip and quad exercises twice weekly as maintenance.
Case takeaways: Jane’s story illustrates a common scenario – long-standing patellofemoral pain can indeed turn around with a comprehensive approach. For her, the key was addressing the hip and foot issues that were overloading her knee. The brace and orthotic gave her immediate support, but the real progress came as the shockwave therapy and exercise rehab strengthened her knee and corrected her mechanics. She went from thinking “I just have bad knees” to realizing her knee pain was a fixable problem with the right plan.
We’ve helped many “Janes” (and “Johns”) with patellofemoral syndrome get back to the activities they love. Each patient is unique, but the consistent theme is combining therapies to tackle the pain from all angles. And just as importantly, teaching the patient how to take care of their knees long-term.
Speaking of taking care of your knees – let’s finish with some at-home guidance. These are things you can start on your own to support your knees, whether or not you’re undergoing formal treatment.
While professional treatment is often needed to fully resolve patellofemoral syndrome, there’s a lot you can do on your own to speed up recovery and prevent flare-ups. Here are some at-home exercises and self-care strategies we recommend to our patients with PFPS:
Doing targeted exercises consistently is the most important thing you can do at home. As covered earlier, strengthening and stretching are key. Ensure you have your healthcare provider’s approval, then consider adding these to your routine a few times per week:
Clamshells (Hip External Rotation): Great for gluteus medius. Lie on your side with knees bent ~90°. Keeping feet together, lift the top knee (open like a clamshell) without rolling your pelvis back. Do 2–3 sets of 12–15 reps per side. You should feel your upper buttock working. This helps control knee alignment by strengthening hip rotators.
Side-Lying Leg Raises (Hip Abduction): Lie on your side, bottom leg bent for balance, top leg straight. Lead with your heel and lift the top leg ~30° keeping it straight and slightly back (not coming forward). 2–3 sets of 10–15 slow reps. This targets the lateral hip muscles.
Straight Leg Raises (Quad Activation): Lie on your back, one knee bent, the other leg straight. Tighten the thigh of the straight leg and lift it to the height of the opposite knee. Lower slowly. Do 2 sets of 10 on each side. If too easy, add an ankle weight. This is good for VMO activation if full squats hurt initially.
Wall Slides or Mini-Squats: Stand with your back against a wall and a ball (or pillow) between your knees. Gently squeeze the ball and slide down into a mini-squat (about 30–45° knee bend), keeping knees in line with toes. Hold 5 seconds, then rise. Repeat 10–15 reps. This helps practice controlled knee movement and strengthens quads without deep flexion.
Step-Downs (Eccentric Control): Stand on a step or sturdy box (~6 inches high). Slowly lower the unaffected leg toward the floor, bending the affected knee. Tap the heel and come back up. Do 2 sets of 8–10. Focus on not letting the affected knee cave inward – keep it aligned over middle toes. This exercise is slightly advanced; it’s excellent for building control but don’t do it if it causes sharp pain.
Calf and Hamstring Stretches: Stretching the muscles in the back of your leg can improve knee mechanics. For calves: lean into a wall with one leg back (heel down) as described earlier, hold 30 seconds, 3x per side. For hamstrings: prop your leg on a low stool or step and lean forward at the hips (keeping back straight) until you feel a gentle pull in the back of thigh; hold 30 sec, 3x each.
Foam Rolling Quads/IT Band: Roll the front and outer thigh on a foam roller for a few minutes daily. When you hit a tender spot, pause and breathe for 20 seconds to let the tension release. This can be uncomfortable (a “good hurt”), so adjust pressure with your arms as needed.
Remember, exercise should be mostly pain-free or only mildly uncomfortable. If something hurts, modify the range or skip it for now. The goal is to gradually build strength and not aggravate the joint.
Also, consistency trumps intensity. Doing 15 minutes of these exercises every other day beats a one-time hardcore workout that leaves you sore. Over about 6–8 weeks, these exercises can markedly improve your knee stability and pain, as supported by research.
If your knee gets painful during certain activities (running, hiking, etc.), consider wearing a knee sleeve or patellar tendon strap. A simple neoprene sleeve can provide compression, warmth, and a sense of support. It might reduce pain during the activity by improving proprioception. A patellar strap (a band just below the kneecap) can sometimes ease pain by changing the forces through the patellar tendon.
These aids are inexpensive and worth trying – just remember they’re temporary helpers. They don’t fix the root issue, but they can allow you to stay active with less pain. Many people with patellofemoral syndrome find they can exercise longer or pain-free with a sleeve on. If that’s the case, use it! The more you can stay active (within reason) the better your muscles will support the knee.
One of the trickiest parts of recovering is knowing how to balance rest and activity. Completely stopping all knee-loading activity isn’t ideal (as we saw, avoiding activity can lead to deconditioning without necessarily speeding healing). Instead, use relative rest:
Cut Back (Temporarily) on High-Impact or Deep Knee Bending: For instance, if you’re a runner with PFPS, reduce your mileage or switch to low-impact cardio for a few weeks. If squatting heavy at the gym hurts, do partial squats or leg presses with less weight for now.
Don’t Kneel or Deep Squat on Hard Surfaces: Avoid scrubbing floors on your knees or doing full-depth lunges if those provoke pain. Use a cushion if you must kneel.
Break Up Prolonged Sitting: If you have to sit at work for hours, try to stand up and stretch your legs every 30 minutes. This avoids that movie-theater stiffness.
Use Downhill Aids: When hiking or walking downhill, use trekking poles or go zig-zag to reduce patella stress. Walk down stairs slowly, focusing on control (or take an elevator if available on bad days).
Cross-Train: Keep up your general fitness by cross-training with activities that don’t aggravate the knee (swimming, cycling, yoga with modifications). Movement is medicine – you just want to avoid movements that are specifically irritating your patellofemoral joint until it’s stronger.
The idea is not to stop moving, but to adjust how you move until your rehab kicks in. Listen to your pain as a guide: a mild increase during activity that settles after is okay, but pain that’s sharp or lasts hours after is a sign you overdid it.
On days your knee is throbbing or after a heavy workout, use simple pain relief strategies:
Ice: Wrap an ice pack or bag of frozen peas in a thin cloth and place over the kneecap area for 10-15 minutes. This can reduce inflammation and numb pain. It’s especially helpful after exercise or if you notice swelling.
Elevation: If your knee is puffy, lie down and prop the leg up on pillows above heart level for 20 minutes. Gravity helps drain excess fluid.
Topical Gels: Anti-inflammatory or cooling gels (like diclofenac gel or menthol-based sports creams) can provide temporary relief when rubbed around the knee. They’re not a cure but can soothe a flare-up.
NSAIDs: Over-the-counter ibuprofen or naproxen can reduce pain and inflammation on bad days. Use them sparingly and with food (and ask your doctor if you have any contraindications). They may be useful before a physical therapy session so you can participate more comfortably.
A few quick tips to round out your home program:
DO focus on form in all exercises – quality over quantity. Keep knees aligned with toes; avoid inward collapse.
DO strengthen your hips and core in addition to the knee. A strong core and glutes take load off the knees with every step.
DO wear supportive shoes especially during exercise. Replace worn-out shoes. Consider orthotic insoles if recommended.
DON’T push through sharp pain. Discomfort or muscle burn is okay, but sharp knee pain is your body’s stop sign.
DON’T rush back into high-impact sports. Wait until you can do lower-level activities (like climbing stairs, jogging lightly) with no pain before resuming intense sports. Gradually reintroduce running or jumping – e.g., start with a mix of walking and running intervals.
DO be patient and consistent. Healing takes time. Muscles strengthen over weeks, not days. Stick with your routine and celebrate small improvements (e.g., “Hey, I walked 2 km today and my pain was only 2/10!”).
DON’T hesitate to seek professional guidance if you’re unsure about exercises or if pain persists. A physio can tailor a program to you and ensure you’re activating the right muscles.
By implementing these at-home strategies, you’ll create a strong foundation for recovery. Think of it as giving your knees the best possible environment to heal: aligned joints, strong muscles, and reduced aggravating forces. In combination with any clinical treatments, these self-care measures can significantly accelerate your progress.
Before we close, let’s address some frequently asked questions about patellofemoral syndrome and its rehab. These are queries we often hear from patients – hopefully, they clear up any remaining curiosities you might have.
Patellofemoral syndrome is a condition causing pain at the front of the knee, around the kneecap (patella). It’s often called “runner’s knee” because it’s common in runners, but it can affect anyone. Essentially, it means the kneecap isn’t tracking smoothly in its groove, leading to irritation of the joint surfaces or surrounding tissues. Common features include diffuse anterior knee pain that comes on gradually, and pain that’s worse with squatting, stairs, or sitting for long periods. Unlike an acute injury, there’s usually no single incident that caused it – it’s an overuse or alignment-related problem. If you hear or feel crackling in the knee (crepitus) and have pain with kneecap pressure, that points toward patellofemoral pain. The good news is, it’s a soft-tissue issue (no fracture or tear), so it’s very treatable with conservative measures.
The hallmark symptom is an ache or pain around the kneecap. It might feel like it’s behind or beneath the kneecap. Symptoms often include:
Pain during knee-bending activities like going up or down stairs, squatting, or running.
Pain after sitting with bent knees for a while (you might need to straighten your leg for relief – known as the “theater sign”).
A sensation of grinding or crackling when you move the knee.
Tenderness along the edges of the patella. Sometimes you can find a specific spot that hurts, usually on the inner (medial) or outer (lateral) patella border.
Usually minimal swelling (maybe a slight puffiness but not dramatic).
The pain can range from dull and annoying to sharp and severe with certain movements. Many describe it as a “nagging ache” that flares with activity.
Symptoms can affect one or both knees. Often, it starts in one knee and if the underlying issues (like muscle imbalance) are on both sides, the other knee might eventually get symptoms too. If you’re experiencing these signs, it’s a good idea to get assessed – patellofemoral pain is easier to treat in earlier stages than after years of compensation.
Patellofemoral syndrome is primarily a clinical diagnosis, meaning a doctor or physical therapist identifies it based on your history and physical exam. They’ll ask about your pain pattern (e.g., “Does it hurt more with stairs or sitting?”). On exam, a classic test is Clarke’s test (patellar grind test): the examiner presses down on the top of your kneecap while you gently contract your quad. If this reproduces your pain or you can’t hold the contraction due to pain, it’s considered a positive sign for patellofemoral pain. They may also do an eccentric step test – asking you to step down from a step and checking if that causes knee pain. Additionally, they’ll check your kneecap mobility by pushing it side to side, and examine your hip strength, foot alignment, etc.
There’s no single definitive lab or imaging test for PFPS. X-rays are usually normal or may show a slight tilt of the patella. MRI can show cartilage wear or inflammation behind the kneecap in some cases, but it’s not routinely needed. The diagnosis really comes from excluding other causes (like ligament injury, meniscus tear, tendonitis) and noting the typical signs of patellofemoral pain. Many patients self-diagnose runner’s knee based on symptoms, but it’s wise to have a professional confirm it, to make sure nothing else is going on (such as patellar tendinopathy or arthritis).
The best exercises for PFPS focus on strengthening the quadriceps (especially the vastus medialis oblique, or VMO) and the hip abductors/external rotators (gluteus medius, etc.), as well as improving flexibility where needed. Research-backed exercises include:
Quadriceps strengthening: e.g., straight leg raises, mini-squats, wall sits, or leg presses (within a pain-free range). Strengthening the quads helps the kneecap track better and reduces stress on the joint.
Hip strengthening: e.g., clamshells, side-lying leg lifts, hip bridges, monster walks with a resistance band. Strong hip muscles keep the thigh bone aligned properly under the patella. Combining hip & knee exercises is proven more effective than knee exercises alone.
Hamstring and calf stretching: Tight hamstrings or calves can alter knee mechanics; keeping them flexible can relieve some pressure.
Core and glute strengthening: A stable core/pelvis sets the stage for proper knee alignment during activities. Don’t neglect things like planks or glute bridges.
Balance/proprioception exercises: Simple balance drills or single-leg exercises can improve knee control. For example, practicing a controlled single-leg squat or step-down (as tolerated) can train your body to avoid the inward knee collapse.
It’s important to do exercises with good form. If possible, work with a physical therapist to learn them correctly. They might also tailor exercises to your specific needs (for instance, adding foot strengthening if you have flat feet).
Consistency is key – aim for at least 3 days a week of targeted rehab exercises. In general, a well-rounded program following these principles is recommended by experts globally. Always warm up before exercising (a few minutes of easy cycling or brisk walking) and progress gradually. If an exercise causes sharp pain, modify it (shorter range, lighter resistance) or hold off until you have less pain.
A knee brace or sleeve can help manage patellofemoral pain, especially in the short term. Patellofemoral braces (those with a buttress or strap to support the kneecap) have been shown to reduce pain in many patients. They work by improving patella alignment and providing gentle compression, which can enhance proprioception and stability. Many people feel they can do more activity with less pain while wearing a brace. For example, wearing a patellar-tracking brace during a run might allow you to run farther without pain. One study found that using a knee brace alongside rehab exercises resulted in greater pain reduction and faster return to sport than rehab alone.
Simple neoprene sleeves (without any patella buttress) can also be beneficial. They keep the knee warm and give a sense of support. Sometimes that psychological and slight physical support is enough to alleviate mild pain and improve confidence during movement.
However, it’s crucial to note: braces and sleeves are not a cure. They are a helpful tool to manage symptoms. Think of them as a supplement to your rehab. If you rely on a brace but don’t do your exercises, the underlying muscle imbalance or biomechanical issue isn’t being fixed – meaning you might need that brace indefinitely. Ideally, you use the brace to allow you to stay active and do rehab pain-free, while the exercise therapy works on the root cause. Over time, many patients can wean off the brace as their knee stabilizes.
In summary, yes – try a brace or sleeve and see if your pain decreases. Many patellofemoral pain sufferers find it worthwhile. Just make sure you’re also addressing the fundamentals (strength and flexibility). Also, ensure the brace fits well; an improperly placed strap or brace can cause discomfort. If unsure which type to get, consult a physiotherapist – they can recommend a specific patella-tracking brace if needed.
Patellofemoral pain can resolve on its own in some cases, but often it lingers or recurs unless the underlying issues are addressed. If someone rests completely, the pain might diminish over several weeks, but as soon as they return to the aggravating activity, it comes back because the root cause (like weak hips or poor tracking) wasn’t fixed. That’s why PFPS can become chronic – people feel a bit better with rest, resume activity, pain returns, and the cycle continues.
With proper treatment and rehab, most patellofemoral syndrome cases improve significantly within about 6 to 12 weeks. In mild cases, you might see major improvement in 4-6 weeks. In more severe or long-standing cases, it could take 3-6 months to fully rehabilitate. The timeline depends on factors like how long you’ve had it, your activity level, and how diligent you are with exercises. Studies that follow patellofemoral pain patients show that at 3 months, interventions like exercise, orthotics, and taping lead to notable pain reduction and better function. By 12 months, a large percentage of patients have minimal to no pain, especially if they kept up with the rehab.
However, some people do have recurrent flare-ups over the years – typically when they lapse on their exercises or suddenly overload the knee (e.g., go from sedentary winter to running a half-marathon in spring without prep). The key to a lasting resolution is correcting the causative factors and maintaining good knee health habits. The consensus is that patellofemoral syndrome is not permanent or inevitably progressive (it doesn’t necessarily turn into arthritis, for example). Most individuals can get to a point of being pain-free or only having occasional,
manageable pain. Think of it like a warning sign that your kneecap mechanism needs maintenance – once you tune it up, the pain goes away.
So, PFPS can “go away,” but pro-active management greatly accelerates that. If you’re doing the right things and still in pain after 3-4 months, it’s time to re-evaluate with a healthcare provider. There might be another issue masquerading as PFPS or an aspect of your rehab that was missed.
Living with patellofemoral syndrome can be challenging – it’s a condition that often causes persistent knee pain and frustration. But as we’ve explored in this post, relief is very much within reach. The key is a comprehensive approach: combining the right supports (like braces or orthotics) with targeted exercises and, when needed, advanced therapies.
To recap, patellofemoral syndrome relief often involves: improving muscle strength (especially quads and hips), optimizing alignment with braces or orthotics, and using tools like knee sleeves, taping, or shockwave therapy to manage pain and promote healing. Scientific evidence supports these strategies – for example, braces and orthotics can reduce pain in the short term, and exercise therapy remains the gold standard for long-term improvement. Newer modalities such as shockwave and EMTT are showing promise for speeding up recovery when traditional rehab alone plateaus.
At Unpain Clinic, we take all of this evidence and integrate it into a warm, patient-centered treatment plan. We’ve seen firsthand that even stubborn “runner’s knee” cases can get better – often dramatically – when we address the root causes and use a multimodal approach. Whether it’s through shockwave stimulating true healing, neuromodulation calming an irritable nervous system, or simply coaching someone through proper squat form, our aim is to get you back to moving pain-free and confidently.
If you’re struggling with patellofemoral pain that isn’t improving, don’t lose hope. There’s a lot that can be done. Every knee is a bit different, so what works for someone else might need tweaking for you – but with persistence and the right guidance, your knee can get better.
You don’t have to live with daily knee pain or give up the activities you love. Our team at Unpain Clinic is here to help you pinpoint what’s causing your patellofemoral syndrome and to craft a personalized rehab plan that actually works. From cutting-edge shockwave therapy to tailored exercise programs, we provide the full spectrum of care to finally relieve that kneecap pain.
Ready to Live Pain-Free? If you’re tired of knee pain limiting your life, the Unpain Clinic team is here to help. Our experts provide a personalized plan using shockwave, EMTT, neuromodulation, and targeted rehab to tackle patellofemoral syndrome at its root. Book your appointment today and take the first step towards lasting relief!
Remember, overcoming patellofemoral syndrome is a journey – but you’re not alone on it. With the right tools, support, and a bit of patience, you can conquer “runner’s knee” and come out stronger. Here’s to moving pain-free and getting back to the activities that make you feel alive!
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Winters, M. et al. (2021). Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med, 55(7), 369-377. DOI: 10.1136/bjsports-2020-102819researchgate.netresearchgate.net
2. Uboldi, F.M. et al. (2018). Use of an Elastomeric Knee Brace in Patellofemoral Pain Syndrome: Short-Term Results. Joints, 6(4), 203-208 (PMC6059862)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
3. Mølgaard, C.M. et al. (2018). Foot exercises and foot orthoses are more effective than knee focused exercises in individuals with patellofemoral pain. J Sci Med Sport, 21(1), 10-15. DOI: 10.1016/j.jsams.2017.05.010pubmed.ncbi.nlm.nih.gov
4. Crossley, K.M. et al. (2016). Patellofemoral pain consensus statement from the 4th International Patellofemoral Research Retreat, Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med, 50(14), 844-852. DOI: 10.1136/bjsports-2016-096268physioaustria.atphysioaustria.at
5. Neculăeș, M. et al. (2024). Contribution of Shockwave Therapy in the Functional Rehabilitation Program of Patients with Patellofemoral Pain Syndrome. J Clin Med, 13(23): 7260. DOI: 10.3390/jcm13237260researchgate.netresearchgate.net
6. Unpain Clinic – Physiotherapy for Knee Pain Relief in Edmonton. (n.d.). [Internal clinic webpage describing knee pain causes and treatments]unpainclinic.com
7. Unpain Clinic Podcast Episode #5 – “Eliminate the cause of your knee pain with True Shockwave therapy” (Transcript). (2023). Hosted by Uran Berishaunpainclinic.comunpainclinic.com
8. Unpain Clinic – Shockwave therapy for Heel Spurs & Plantar Fasciitis in Edmonton. (2025). [Clinic article illustrating combined shockwave, EMTT, neuromodulation approach]unpainclinic.comunpainclinic.com
