If you’re suffering from knee pain, you are certainly not alone. One of the most common ailments to plague active people is knee pain, specifically pain beneath the knee cap. Officially known as anterior knee pain or patellofemoral pain, the condition hits 2.5 million runners each year.¹ The condition doesn’t limit itself to only the athletic types, either, as individuals of any background or lifestyle can be prone to the condition.

While an obvious solution may seem to be some type of treatment for the knee joint, the knee joint is not the root of the problem.¹ The underlying cause may actually point back to your hip muscles, and a regular Pilates and Foundation Training practice may help.

Why the Hip Muscles?

Patellofemoral Pain Syndrome (PFPS) may cause pain in the knee, but the knee joint is not to blame for the cause of the pain. We can trace the pain back to its origin by reviewing what’s going on with the body’s biomechanics. Let’s start with the hip muscles, which produce a steady, balanced gait when they are strong and able.

 weak hip abductor muscles

If your hip muscles are weak, however, you may suffer from a slightly abnormal stance or gait. This, in turn, can throw off the balance of your quadriceps and illiotibial tract, which is the band that runs from your hip to your shin on the outside of the thigh.² This instability can lead to what is known as patella maltracking, or abnormal movement of your kneecap.³

Instead of moving as it’s designed to move, your kneecap can instead spin, shift side to side, or tilt upward while walking, squatting or otherwise bending your knee joint when it’s under your weight.⁴ All that shifting, spinning and tilting of the kneecap with every step or move puts increased stress on your kneecap. That increased stress can eventually result in pain, suffering and PFPS.²

 anatomy of the knee

How Pilates and Foundation Training Can Help

While physical therapy and other exercise programs have shown some promise, they are unlikely to be wholly effective if they continue to focus solely on strengthening the knee joint.⁵ An extensive review of various exercise plan outcomes showed that knee exercise programs were not as consistently effective for reducing pain and improving function as programs that focus on proximal exercise, or exercise targeting the hip joint.⁵

Studies examining the effects of exercise on PFPS have shown positive outcomes with programs that include stretching, warm-up and cool-down sequences, core stability, hip strengthening and quadriceps strengthening.⁶ Here’s where Pilates and Foundation Training come in.

Pilates and Foundation Training can strengthen the hips and quadriceps while also targeting other muscle groups that can help offset the imbalances found in PFPS. Because both exercise types focus on the posterior chain of muscles, they both work to strengthen the posterolateral muscles that can play a role in the condition. These include the hamstrings, external rotators and gluteal muscles.

Another plus with Pilates and FT is the ability to tailor a program to focus on specific muscle groups to meet individual needs. While many people suffering from PFPS can benefit from strengthening of the hip abductors, hip external rotators and vasti muscles, exercises can be added or removed as needed to best address the individual. Some may require extra work on the hamstrings, for instance, while others may need to pay extra attention to the quadriceps.

Using Pilates and FT to address and correct the underlying causes of PFPS offers a long-term solution that can help restore your activity levels and well-being. Both can help fortify your balance, normalize your gait, alleviate pain and decrease conditions that contribute to this often agonizing condition.


1. Journal of Orthopaedic & Sports Physical Therapy (JOSPT). Anterior Knee Pain: A Holistic Approach to Treatment. J Orthop Sports Phys Ther. 2012;42(6):573.

2. Petersen W, Ellermann W, Gösele-Koppenburg, Best R, Rembitzki I, Bruggemann G, Liebau C. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2013.

3. Draper CE, Besier TF, Santos JM, Jennings F, Fredericson M, Gold GE, et al. Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res. 2009;27(5):571–577

4. Wilson NA, Press JM, Koh JL, Hendrix RW, Zhang LQ (2009) In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 2009;91(3):558–566

5. Peters J, Tyson N. Proximal Exercises are Effective in Treating Patellofemoral Pain Syndrome: A Systematic Review. Int J Sports Phys Ther. 2013;8(5):689-700.

6. Al-Hakim W, Jaiswal P, Khan W, Johnstone D. The Non-Operative Treatment of Anterior Knee Pain. Open J Orthop. 2012; 6(2):320-326.