When I say I often utilize a “walking program for Patellofemoral Pain Syndrome”, I am not trying to trick you into thinking there is some fancy walking exercise for Patellofemoral Pain Syndrome.
Nor am I trying to come off acting like I know of a secret program that promises to “get you back to walking pain free.”
Please don’t go searching for “walking program for Patellofemoral Pain Syndrome” on Dr. Google.
Besides this blog post, I don’t think you will find anything.
That is because a “walking program for Patellofemoral Pain Syndrome” is not an official thing.
I made the term up.
It is what I personally refer to it as, and often utilize, when seeing an individual with Patellofemoral Pain Syndrome.
When I mention a “walking program for Patellofemoral Pain Syndrome”, it is meant to describe exactly what it sounds like:
A strategy to get those suffering from Patellofemoral Pain Syndrome walking on a regular basis.
Now that I know you won’t come to me saying, “Dr. Google doesn’t know about a walking program for Patellofemoral Pain Syndrome”, let’s dive in!
This article will cover the following on using a walking program for Patellofemoral Pain Syndrome:
Why I think a walking program for Patellofemoral Pain Syndrome is important
To put it simply, I think a walking program for Patellofemoral Pain Syndrome is important because it has been found that those suffering from this condition WALK LESS!
In a 2017 study, it was found that adults with Patellofemoral Pain Syndrome walk almost 3,400 less steps each day when compared to healthy adults [1].
Now, pull out your calculator. It is time to do some math.
(3,400 steps/day) x (365 days/year) = 1.24 million steps less each year.
That is, those suffering from Patellofemoral Pain Syndrome are walking 1.24 MILLION STEPS LESS YEAR.
Keep the calculator handy.
Now, let’s figure out how many less miles a person with Patellofemoral Pain Syndrome would walk.
I will assume there are about 2,000 steps per mile. So, by following the calculations below, this would equate to a person with Patellofemoral Pain Syndrome walking 1.7 miles LESS each day and 620 miles LESS each year!
(3,400 steps) / (2,000 steps/mile) = 1.7 miles less each day
1.7 miles x 365 days = 620 miles less each year
Do you understand why I utilize a walking program for Patellofemoral Pain Syndrome, yet?
If not, I am determined to convince you.
Now, let’s figure out how many more minutes would need to be walked in order to walk 1.7 additional miles each day.
In order to do so, I need to make some assumptions first.
To do this, I will use a fake woman named Sandy as an example. I will assume the following about Sandy:
- Walking speed: 3.0 mph
- Minutes walked each day: X more minutes than someone with Patellofemoral Pain Syndrome
By following the calculations below, you can see that Sandy will need to walk 34 more minutes each day in order to walk an additional 1.7 miles each day.
Walking speed x Time walked = Number of additional miles walked each day
(3 miles/hours) x (X minutes/60 minutes) = 1.7 additional miles walked each day
X minutes = ((1.7 additional miles) / (3 miles/hours)) x 60 minutes
X minutes = 34 additional minutes of walking each day
In other words, the description of Sandy above, resembles how much MORE a healthy person walks each day compared to someone with Patellofemoral Pain Syndrome.
Next, let’s see how many more calories Sandy will burn by walking an additional 34 minutes each day.
Forget the calculator. I will use a common walking calorie calculator.
In order to use the walking calorie calculator, I need to make some more assumptions about Sandy:
- Gender: Female
- Age: 25 years old
- Height: 5 ft 5 inches
- Weight: 140 lbs
- Walking speed: 3.0 mph
- Minutes walked each day: 34 more minutes than someone with Patellofemoral Pain Syndrome
By plugging Sandy’s information into the walking calorie calculator, you will learn that Sandy burns an additional 119 calories each day by walking 34 more minutes each day.
To put it another way, Sandy would burn 43,435 more calories in a year than someone with Patellofemoral Pain Syndrome.
Lastly, let me show you how many more pounds Sandy would burn each year.
Assuming there are 3,500 calories per 1 pound of fat, Sandy would burn an additional 12 pounds of fat each year!
(43,435 calories burned/year) / (3,500 calories/1 pound of fat) = 12 additional pounds burned each year
At first glance, 12 pounds may not seem significant. However, Sandy is only 25 years old. By continuing to walk an additional 34 minutes each day, Sandy would have burned an additional:
- 120 pounds of fat by age 35
- 180 pounds of fat by age 40
- 240 pounds of fat by age 45
- 300 pounds of fat by age 50
- 540 pounds of fat by age 70
As I made several assumptions about Sandy, this is obviously just an estimate. Nevertheless, it hopefully helped illustrate the point I am trying to make:
A WALKING PROGRAM FOR PATELLOFEMORAL PAIN SYNDROME IS IMPORTANT!
Besides the fact that a walking program for Patellofemoral Pain Syndrome aims at increasing the number of steps walked each day, there are numerous other benefits as well.
Some other benefits of a walking program for Patellofemoral Pain Syndrome include:
- Provides stress relief
- Builds self-efficacy
- Can be completed with friends or family
- Requires zero equipment
- Requires minimal time
When to begin a walking program for Patellofemoral Pain Syndrome
Yes, this blog write up is about why I think a walking program for Patellofemoral Pain Syndrome is beneficial.
However, if you do have Patellofemoral Pain Syndrome, I do not advise you to begin a walking program without first consulting with a qualified healthcare professional.
I advise consulting with a qualified healthcare professional for one reason:
You are putting yourself at risk of exacerbating your symptoms.
To understand this concept, you must understand that the most common cause of Patellofemoral Pain Syndrome is OVERUSE [1] [2].
If you want to be precise, this condition is thought to be caused by multiple factors. That being said, overuse is by far the most common cause associated with developing Patellofemoral Pain Syndrome.
With any overuse injury, activity modification is necessary. This holds true for Patellofemoral Pain Syndrome as well.
The purpose of modifying your activity is to allow time for bones, muscles, tendons, and other tissues to calm down to ultimately decrease pain levels.
Don’t just take this from me though. Listen to the experts!
In a 2015 study, 17 Patellofemoral Pain Syndrome experts shared their thoughts on rehabbing this condition. When asked about the importance of on activity modification, they said [3]:
“I basically advise everyone to reduce their primary aggravating activities.”
“There’s a certain amount of activity modification that needs to be done. And that might be a small amount or quite a big amount.”
“Activity modification. Very important, initially, that’s very important.”
“That’s incredibly significant, if we can offload the tissues (through activity modification), they don’t hurt.”
So, based on what the experts say, by beginning a walking program too early, you are putting yourself at risk of exacerbating your symptoms!
A simple rule to follow when contemplating beginning a walking program for Patellofemoral Pain Syndrome is:
If walking increases your pain, it is too early to begin a walking program
Who will benefit the most from a walking program for Patellofemoral Pain Syndrome?
In my opinion, the best Physical Therapists provide “patient-centered care.”
That is, I think the best Physical Therapists construct every decision, treatment, etc based on the patient’s interests and goals.
As such, if walking is something my patient is not interested in, I will not spend time trying to convince them. There are many ways to increase someone’s activity rather than walking!
Furthermore, if walking is an activity that increases a patient’s pain levels, I am not going to begin a walking program for Patellofemoral Pain Syndrome. I would consider it evil to advise someone to suffer through walking!
Another demographic where a walking program may not be beneficial are certain athletes.
I would argue that 100% of athletes want to get back to moving like an athlete. Basketball, soccer, and volleyball require athletes to run, jump, and accelerate.
Thus, for athletes participating in these sports, it would likely be of better interest to focus on getting them back to performing those movements.
Unless this generation of athletes are different, a walking program for Patellofemoral Pain Syndrome sounds boring if you ask me!
So who would benefit from a walking program for Patellofemoral Pain Syndrome?
Those who enjoy walking
For starters, it would benefit those who enjoy walking!
This doesn’t only refer to those who enjoy walking in their neighborhood, but also those who enjoy hiking, golfing, or going on vacations with family and friends!
Those looking to become more active
As Patellofemoral Pain Syndrome can occur in sedentary individuals, a walking program would also benefit those looking to become more active.
A 5 minute walk each day can make a world of difference in those unfamiliar with living an active lifestyle!
Those that fear walking will increase their pain
Lastly, a walking program for Patellofemoral Pain Syndrome can benefit those that are nervous about making their symptoms worse.
I realize I sound contradicting, as symptoms can worsen without proper implementation of a walking program.
However, if this pertains to your situation, hear me out.
To begin, it is COMPLETELY NORMAL to develop a sense of fear about moving in ways that currently cause pain, or have in the past.
For instance, I have rolled my ankles playing basketball probably close to 30 times on each ankle.
Each time I roll my ankle, it ranges from weeks to months of pain and walking with a limp.
Eventually it got to the point where I started to roll my ankle while hiking or going for a jog. Recently, it has even gotten to the point that I will roll my ankle while walking to get the mail.
The first time I rolled my ankle was 10 years ago.
To this day, every time I play basketball, go hiking, or anything that requires walking or running I have a fear that I am going to roll my ankle again.
I know this is MUCH easier said than done, however, I do not let my fear of rolling my ankles prevent me from participating in things that I enjoy in life.
This didn’t happen overnight for me.
It took time to self reflect on what I enjoy in life.
I love playing basketball with friends.
I love hiking with my wife and our dogs.
I love walking around new cities to find fun activities to do.
It eventually got to the point where the risk of rolling my ankle was NOT NEARLY AS BAD as the reward of enjoying life with family and friends.
I’ll get off my soapbox now!
So, what am I trying to say is this…
If walking is an activity that you associate your Patellofemoral Pain Syndrome with, it is COMPLETELY NORMAL to avoid walking.
Furthermore, a walking program is most likely not the best thing for you initially. Rather, your rehab should dedicate the initial rehab phases to decreasing your pain, increasing strength, and building confidence.
That being said, with guidance from a qualified healthcare professional, I HIGHLY ADVISE a walking program for Patellofemoral Pain Syndrome at some point for the reasons mentioned at the start of this blog.
Before you keep scrolling, if I am describing your situation, try this thinking exercise.
Take a moment and think of what you want your life to be like a year from now.
Picture who you enjoy being around.
Picture what your perfect day would entail.
When you are finished, now, I want you to think about how often walking was required in your future that you just envisioned.
More than likely, some walking will be required to do the things you enjoy in life!
Matter of fact, this is the biggest reason why I advise a walking program for Patellofemoral Pain Syndrome.
Yes, walking more each day is good exercise, etc, but more so, it is likely a necessity to fulfill your future dreams and aspirations.
If you do have a fear of walking because of past or current painful experiences, in no way am I saying it will be easy to overcome that fear.
It may not occur tomorrow, next week, or even next month.
However, I firmly believe with dedication, perseverance, and guidance that you can overcome that fear in order to make your dream a reality.
How I implement a walking program for Patellofemoral Pain Syndrome
The implementation of a walking program for Patellofemoral Pain Syndrome can be broken down into 6 steps:
Step 1: Ensure the patient is interested a walking program for Patellofemoral Pain Syndrome
The first step in implementing a walking program for Patellofemoral Pain Syndrome involves making sure the patient is interested in it in the first place.
Even though a walking program for Patellofemoral Pain Syndrome may not begin right away, I often know whether a patient would be interested or not after their first couple visits.
Step 2: Ensure the patient is ready to begin a walking program for Patellofemoral Pain Syndrome
Making sure a patient is ready is arguably the most important step.
This step involves two parts that are completed in this order:
- Pain assessment
- Education
Pain assessment
As I already mentioned, beginning a walking program for Patellofemoral Pain Syndrome too early may exacerbate one’s symptoms.
For that reason, I find value in assessing a patient’s pain levels.
Passing a pain assessment involves achieving two criteria:
- The patient’s pain levels have become stable
- The patient reports they are confident in beginning a walking program
Education
Once the pain assessment is passed, I will then begin educating the patient on the initial stages of the walking program.
Some examples of education I provide to patients at the start include:
- The purpose of the initial phases of a walking program is to build habits. A 2 minute walk is better than a 0 minute walk!
- The walking program will begin by walking a short distance.
- The walking program will begin by walking on flat surfaces only.
- Some pain while walking is okay, but if your pain increases to >4/10, it is best to take a break.
- Listening to music, an audiobook, or walking with a friend can make the walking program more enjoyable.
Step 3: Gather a baseline measure
This step of the implementation process can be exciting, yet humbling.
I often use a standardized test called the 6 minute walk test, or 6 MWT, to gather a baseline measurement.
The 6 MWT is exactly how it sounds: a test consisting of walking for 6 minutes. Then, the distance walked is measured to gather a baseline measure.
I prefer to use the 6 MWT because there are normative values essentially for all genders and ages. These normative values make it easy to show the patient how they compare to someone else that is their age and gender.
Furthermore, it is a well known test amongst healthcare professionals. If a patient’s Medical Doctor, Psychologist, or any healthcare professional inquires about their status with Physical Therapy, the 6 MWT distance is a quick way to demonstrate one’s current status.
Once the 6 MWT is completed, I will inform the patient on their results.
This is where I am not known for being fair to the patient.
I don’t care if the patient did the same or better than their age norms on the 6 minute walk test. No matter what, I will advise the patient to strive to do better the next time we complete the test.
Since when is being average acceptable in today’s world?
I am all about building habits. I believe the more active you are right now, the more likely you will continue that lifestyle.
On the other hand, if the patient performed worse compared to their age norms, that is okay too!
This is a great opportunity to build small goals with the patient to become more active. Then, when it comes time to complete the 6 minute walk test again, it is an opportunity to improve the patient’s self efficacy.
Step 4: Initiate testing phases
The purpose of this step is to introduce the patient to the walking program, while continually assessing their symptoms.
The decision making that occurs in this step varies from person to person.
Here are some examples of how the testing phase can differ amongst individuals:
- The walking distance used in this phase is based on a patient’s baseline score.
- Some patients may be able to complete daily walking, as others may only tolerate a couple days a week.
- Some patients may require short rest breaks while walking, while others will not require any.
- Once the testing phase is completed, the walking distance may be increased for some patients, whereas it may not change, or slightly decrease in others.
The patient has completed the testing phase when:
- They can complete ANY amount of walking without exacerbation of symptoms.
- They are still interested in completing a walking program at the end of the testing phase.
At this point, the implementation of a walking program for Patellofemoral Pain Syndrome is officially complete.
Step 5: Progress as tolerated
This phase of the walking program for Patellofemoral Pain Syndrome is fairly straightforward. All that is left to do is monitor a patient’s status and progress the walking program as tolerated.
Some ways that I progress the walking program are:
- Increasing the distance walked in a single bout
- Decrease the number or length of breaks used while walking
- Introduce speed walking
- Introduce different terrains
Step 6: Repeat steps 3 and 5
The last and final step is the simplest of them all!
At this point, all that is required is:
- Complete the 6 MWT each month of the walking program and compare to previous score.
- Continue to progress the walking program as tolerated.
Closing Thoughts
By now, I hope you understand why I am so passionate about the importance of staying active when dealing with Patellofemoral Pain Syndrome.
Although this blog was about a walking program for Patellofemoral Pain Syndrome, the list of different ways to live an active lifestyle is endless.
If you already forgot nearly everything you just read, I hope you at least walk away knowing this:
Living an active lifestyle is important when dealing with Patellofemoral Pain Syndrome.
Resources
- [1] Glaviano NR, Baellow A, Saliba S. Physical activity levels in individuals with and without patellofemoral pain. Phys Ther Sport. 2017 Sep;27:12-16. doi: 10.1016/j.ptsp.2017.07.002. Epub 2017 Jul 18. PMID: 28780340.
- [2] Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302
- [3] Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015;49(14):923-934. doi:10.1136/bjsports-2014-093637
- [4] Cacau LA, de Santana-Filho VJ, Maynard LG, Gomes M Neto, Fernandes M, Carvalho VO. Reference Values for the Six-Minute Walk Test in Healthy Children and Adolescents: a Systematic Review. Braz J Cardiovasc Surg. 2016;31(5):381-388. doi:10.5935/1678-9741.20160081
- [5] Casanova C, Celli BR, Barria P, et al. The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J. 2011;37(1):150-156. doi:10.1183/09031936.00194909
- [6] Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2):128-137. doi:10.1093/ptj/82.2.128
- [7] Halliday SJ, Wang L, Yu C, et al. Six-minute walk distance in healthy young adults. Respir Med. 2020;165:105933. doi:10.1016/j.rmed.2020.105933
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