6 Best Exercises For Plica Syndrome

Synovial Plica Syndrome Exercises

“Do you experience knee cap pain?

Persistent knee cap pain, also known as anterior knee pain, despite the best efforts of your physiotherapist and chiropractor, may be indicative of Plica Syndrome.

But, what is Plica Syndrome?”

Plica Syndrome: The Mediopatellar Plica Is The Most Common Plica. (medial plica closer to your body midline)
Plica Syndrome: The Mediopatellar Plica Is The Most Common Plica. (medial plica closer to your body midline)

With Plica Syndrome, your knee cap may be painful, accompanied by clicking, clunking, and popping during activities like squatting. Additionally, you may experience decreased knee bending along with intermittent knee cap pain, sometimes accompanied by medial knee pain.

See MRI CAT or X-ray which is best

The image below illustrates the medial side of the knee, commonly associated with Plica Syndrome.

Plica is residual knee tissue that didn’t reabsorb into the body during fetal development, present in about 50% of individuals. Most often, it is found on the medial side of the knee cap.

What causes Plica syndrome?

Plica syndrome can result from injury or overuse, with the plica getting caught between the femur, knee cap, or the femur and quadriceps tendon during knee bending (70-90 degrees), causing pain and inflammation.[2] Activities like running, rowing, gymnastics, hockey, and basketball can exacerbate the condition.

Symptoms of Plica Syndrome

  • More common in female young adults and teenagers.
  • Dull aching during activities such as walking up or down stairs, squatting, kneeling, or prolonged knee bending.
  • Symptoms may worsen progressively for some individuals.

Diagnosis Of Plica Syndrome

Plica syndrome is considered by your chiropractor or physiotherapist if patellofemoral pain treatment proves ineffective. Diagnosis relies on history and examination, as there are no specific tests or imaging, though an MRI may help detect inflammation and fibrosis.[3]

Palpating Your Plica

Your chiropractor can often palpate the plica on the medial side of the patella (knee cap) right at the joint line .

Very helpful for the diagnosis of Plica Syndrome. Although your chiropractor has to think about the possible diagnosis first.

How long does it take to recover from Plica Syndrome

Recovery time depends on the severity, practitioner skill, and your ability to avoid aggravating Plica Syndrome. Reduced training, cross-training with activities like swimming, and focusing on upper body training can expedite recovery, taking weeks to months.

Chiropractic Rehabilitation For Plica Syndrome

Treatment involves ice packs, ice massage, active release techniques, and later, quadriceps strengthening and hamstring flexibility exercises.

#1 Exercise: Foam Roll Knee Extension

This exercise is an effective method to stretch the back of your knee and hamstrings:

  1. Sit up with your hands supporting you.
  2. Place a foam roll under your lower leg.
  3. Straighten out your knee and let it relax.
  4. Hold the position for 2-5 minutes to stretch the back of your knee and hamstring.

For increased pressure and intensity, consider placing one leg on top of the other.

#2 Exercise: Straight Leg Raise ITB stretch

An ITB stretch stands for the iliotibial band, a band of fascia on the side of your thigh. The goal of this stretch is to alleviate pressure on the medial side of the knee by targeting and stretching the iliotibial band

  • Lie face up.
  • Place a Theraband or towel around your foot.
  • Keep your knee straight and lift your leg.
  • For those with Plica on the right knee: Cross your straight leg over your left shin or as far as comfortable.
  • Perform 2 sets of 8 repetitions.

#3 Exercise: Heel Slide For Plica Syndrome


Your hamstrings will strengthen with this exercise, simultaneously promoting joint mobility. Perform this exercise on a hardwood or laminate floor with socks on for smooth heel sliding. Alternatively, you can use a slider on the carpet or the floor, which is the most convenient method for this exercise. Avoid using a yoga mat for this particular exercise.

Level 1

  • Lie down on the floor with your socks on.
  • Ensure both of your legs are straight.
  • Point your toes upward towards the ceiling.
  • Bend your painful knee while applying slight pressure to your heel, bringing your knee to approximately 90 degrees.
  • If both knees are painful, perform the exercise on both sides.
  • Complete 3 sets of 15 repetitions, starting with sets of 10. Hold each repetition for 3 seconds.

Level 2

  • Lie down on the floor with your socks on, utilizing a slider as shown in the picture above.
  • Keep one leg straight while the other is bent, following the positioning in Picture A.
  • Ensure your toes are bent upward towards the ceiling.
  • “Bridge up” by lifting your hips and buttocks so they align with your chest, replicating the position shown in the picture.
  • Bend your painful knee until it reaches approximately 90 degrees, as demonstrated in Picture B.
  • Complete 3 sets of 15 repetitions, beginning with sets of 10. Hold each repetition for 3 seconds.

#4 Exercise: Straight Leg Raise For Plica Syndrome.

Straight Leg Raises starts strengthening the quadriceps muscle that.

  • Lie on your back with one knee straight and the other bent to help protect your lower back.
  • Bring your toes towards you to lock out your knee and keep your knees straight.
  • Slowly raise your leg straight with your leg locked to about 60 -70 degrees. Hold for 1 sec.
  • Slowly lower your leg back down.
  • Do 3 sets of 10 repetitions.

Advanced Straight leg Raise

  • Don’t let your feet rest on the floor.
  • Come down to about 30 cm or 1 foot off the floor then come back up again.
  • Do 3 sets of 15-20.

#5 Exercise Hip Adduction For Plica Syndrome.

You want to strengthen your adductors to help the muscles in that area of your plica.

  • Lie on your side resting on your elbow.
  • Your back leg is bent and your front leg is straight.
  • Bring your back leg to the front if you feel more comfortable.
  • Bring your toes up to lock out your knee.
  • Raise up your straight leg as much as you can. It won’t be very high for most of you.
  • Do 3 sets of 10 repetitions.

#6 Exercise Hip Abduction For Plica Syndrome.

Strengthen the abductors to help balance the muscles out. This exercise is very similar to the above. The main difference is you are raising the top leg this time.

  • Lie on your side resting on your arm.
  • Your bottom leg is bent.
  • Your top leg is straight.
  • Bring your toes up toward your body to lock out your knee.
  • Raise your straight leg slightly behind your body.
  • Lead with your heel when raising your leg. Meaning the heel should be the highest part of the leg raise.
  • Keep your body in a straight line.
  • Do 3 sets of 10 repetitions.

Picture Reference

  1. Photo by Jon Tyson on Unsplash
  2. https://www.researchgate.net/publication/316099763_Plica_Syndrome_and_its_Embryological_Origins
  3. Photo by Ramesh Iyer on Unsplash
  4. Photo by Marlon Lara on Unsplash
  5. http://www.stretching-exercises-guide.com/calf-stretches.html
  6. https://rollerderbyathletics.com/how-to-tfl-stretch/
  7. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=abj6473
  8. https://www.womenshealthmag.com/health/a20700636/single-leg-valslide-curl/
  9. https://www.performancehealthacademy.com/thera-band-cuff-weight-straight-leg-raise.html

Research

  1. Roofeh. (2008, Juli). The medical plica syndrome can mimic recurring acute haemarthroses. HAEMOPHILIA , pp. 862-862.
  2. Lee, Nixion, Chadratreya, Murray, Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain, The Journal Surgery, 2017 Jan, 3(11); e9-e16.
  3. Chevestick A, Huie G, Kissin Y D, Kelly M A. Anterior knee pain: the pitfalls of plica and chondromalacia patellae. Adv NPs PAs. 2011;2(06):37–39. [PubMed] [Google Scholar]

Leave a Reply

  • Hello Dr Nakamura,
    Thank you for the article! I got diagnosed with plica syndrome (suprapatellar and medial) on both knees 4 years ago. The reason was too much mountain biking 🙁 I was doing rehab for almsot 5 months, and had also PRP treatment on both knees and all was good until this July when I overloaded the knees again (my fault not listening to the first symptoms). I do the same rehab program as 4 years ago (all exercises and stretching as in your article here) but maybe due to me being older, the healing seems to go slower… Anyway, I live in Sweden and ice therapy is not that “known” however I do ice pack/compression frequently. I guess this is OK? Also, the exercises that you suggest in your article – would you recommend to do them every day? I do mine every 2nd day… Thank you in advance for your recommendations! Kind regards, Karolina

  • Hi my daughter has the plica condition in her elbow. Is there anything we can do besides surgery. She’s in gymnastics and handstands are painful.

  • Hi there, I think I may have this. I was learning guitar for about a month, often in seiza, and one day just felt the stress get to my knees while coming out of that position. It is one more than the other, but both remain inflamed and stiff 5 months later. I only had one morning pain free in all that time, and that was a week ago. Very concerned the plica may have hardened as some describe. How could I tell? Is my only choice an expensive scan? Trying to do “tailgates” often and some massage. It gives some temporary relief, but my knees still look swollen. What are my steps forward, excuse the pun.

  • Hi Dr.

    I had surgery to remove my Plica 4 years ago. Now it feels like it is back. Popping, dull pain, etc…

    I don’t understand how it could come back. I don’t want to have to get surgery every 4 years.

    Any suggestions?

  • Dr. Nakamura,
    While rushing one day I jumped out over the side of my pickup truck onto my feet onto asphalt but not absorbing the shock by bending my knees. My knee cap has been sensitive to the touch for several years prior but now it pops & crackles when bending. Does this sound like my plica has been affected? I’m in my mid 50’s

    • Post
      Author

      Thanks for your comment Jeff. Sounds like your knee is affected by chondromalcia patella which is a condition where the underside of the knee cap which is covered in cartilage as worn unevenly thus causing the pop and crackles when bending the knee. Off course only a physical exam will be able to determine for sure. A CT would be able to definitively tell the difference show if there is a plica problem or knee cap problem. If it is a knee cap problem tracking of the knee cap is the likely problem and often related to flat feet or subtalor pronation.

      Hope that helps.

  • Hi doctor, I’ve been suffering from knee pain since 6 years ago, until my MRI result showed that I have mediopatellar pilca, I’ve tried physiotherapy twice but it didn’t work,i took some pills but they couldn’t help me either,I don’t know what to do☹

  • Hi. I have a lateral plica on the left knee. I have done all the exercises that the physio has prescribed to me which are similiar to yours. The snapping is still present. Im trying to avoid surgery but i feel im delaying the inevitable.

    • Post
      Author

      Thanks for your question or statement Parvez. Also you might want to see a physiatrist or orthopaedic surgeon for a second opinion as it may not be Plica syndrome as many things can cause snapping especially at the joint. Depending on the diagnosis you may try various types of injections like steroid, PRP, etc.. which you should discuss with the above specialists. Surgery might not be inevitable.

      Hope that helps. The above is an opinion and not a recommendation.

      I will try my best to give you a good answer.

  • Hello, thank you for this article. Do you have any images of the last two exercises? I found them a bit confusing and want to make sure I am doing them correctly.

    • Post
      Author

      Thanks for your comment Eleya. This article for plica syndrome has now been updated with two videos to show you the last two exercises. Hope that helps. Remember these are opinions and not recommendations. Always consult a health care practitioner that can take a history and proper exam and don’t rely on the internet. I strive to give you the best I can give as a chiropractor.

  • Thank you very much for sharing this article, I just had plica syndrome confirmed with MRI. It got activated after skiing accident 9 months ago. I will practise those exercises and hope to get it healed. Also I found that cryotherapy may be helpful in the treatment.

  • Hello Dr. Nakamura,

    I learned a lot from your exercise information. I believe I have a mild case of Plica Band Syndrome in my left knee. I suspect it was caused by overuse running. However, the exercises you recommended are going to help me get better sooner than later. I am going to do the exercises. Once again, thank you for sharing that wealth of information to the world:)

    • Post
      Author

      You are welcome Omowale. Keep in mind you are self-diagnosing. This means if the diagnosis is wrong or if you do the exercises wrong then you will not likely get better. It isn’t likely you get worse but it’s still a possibility.

      Hope that helps. The above is an opinion and not a recommendation. I will do my absolute best to give you a good opinion.

img 9195 4 depositphotos bgremover
img 9195 4 depositphotos bgremover
Dr. Ken is an award-winning chiropractor in downtown Toronto, serving a diverse clientele. He is an avid athlete, representing Ontario in the Canadian Judo Championships, and has completed the Toronto Marathon twice. Dr. Ken specializes in in treating his patients using the C3 Program.