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I'm working with a physical therapist to rehab my knee. I've been told I have patellofemoral pain. The therapist keeps telling me to avoid thinking "no pain, no gain." That's been my motto as an athlete since first grade. How can this be wrong thinking?

It's true that the "no pain, no gain" thinking helps many athletes improve in many areas but it's the enemy of anyone with patellofemoral pain (PFP). The goal is to reduce pain and improve function. The way to get there is with activities that don't increase pain.

Research shows that putting load on a joint without overloading it is the way to go. Keeping the patient's level of activity below what would trigger pain prevents tissue damage. Slow but steady progression of strength and flexibility are the keys to success in treating PFP.

First the therapist will help PFP patients find exercises that don't cause pain. Icing and the use of pain relievers can help. Some patients need to start in a pool therapy program before attempting dry land training. More repetitions and more load can be added slowly so long as they don't cause pain.

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