Massage techniques
Because a significant part of the problem with PFPS appears to be pain originating from the soft tissues around the knee, massage is helpful. Changes may not be immediate as you are trying to alter biomechanical patterns that have been established for some time; however, the client should feel some improvement in symptoms within about three to four sessions.

Excess tension in the quadriceps is an important factor in PFPS, so massage methods aimed at reduction of tension in these muscles are helpful, such as compressive effleurage and deep longitudinal stripping (see Figure 1). The latter is particularly beneficial if the stripping is emphasized along the vastus lateralis to decrease its contribution to lateral patellar tracking.

Specific multi-directional friction techniques around the retinaculum will also be very helpful (see Figure 2). Special attention should be paid to any area that the client reports greater pain, especially if that pain is consistent with the pain the client has been feeling when doing activity.

Various fascial elongation methods applied to the quadriceps, and especially to the vastus lateralis are also helpful. Pin-and-stretch techniques are particularly effective here (see Figure 3). In later stages, adding resistance to the eccentric action of the quadriceps during their elongation can enhance the active techniques further.

Additional eccentric load can be added with resistance bands, weights, or with the practitioner's hand (see Figures 4 and 5). Stretching the quadriceps group is also very important during the rehabilitation process.

Due to its pathology, PFPS will respond very well to massage. However, in order to derive the best therapeutic benefit from massage applications, the practitioner needs to understand patellofemoral mechanics and the role played by soft tissues. When the anatomy, biomechanics and massage options are understood, it is much easier to construct a beneficial approach to addressing PFPS.

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