Development of a 12‑week preventive exercise protocol for patellofemoral pain syndrome for healthy Hilly Runners

Abstract

Methods: An extensive literature search was conducted in PubMed, Scopus, Web of Science, Cochrane Library and Google Scholar, supplemented by manual screening of guidelines and reference lists. Studies (2010–2025) on preventive physiotherapy, strengthening, flexibility, neuromuscular control and load management for PFPS were screened, yielding 42 articles for qualitative synthesis and 17 for quantitative integration into frequency–intensity–time–type (FITT) prescriptions. Three prospectively identified modifiable risk variables—patellar tilt, iliotibial band (ITB) tightness and hip‑flexor tightness—were used as primary targets.

Results: A 12‑week, three‑phase (foundation, integration, performance) preventive protocol was developed, combining patellar taping, hip and knee strengthening, flexibility training, neuromuscular control drills and terrain‑specific single‑leg functional tasks. FITT‑based tables were created for each variable, and 12 core exercises were standardised using a pragmatic "10 × 10" dosage (10 sets × 10 repetitions or 10 × 10‑s holds) to simplify recall while maintaining training volume. The protocol is designed for home‑ or field‑based delivery using bodyweight, elastic loop bands and low‑cost substitutes for foam rollers and weights.

Conclusion: The proposed protocol translates current PFPS evidence and consensus recommendations into a structured, context‑specific preventive strategy for healthy hill runners, emphasising dynamic stability, single‑leg control and feasible implementation in resource‑limited environments.