Other causes for patella femoral syndrome include weak quadriceps muscles, injury to the knee, obesity and overuse. Initial treatment involves reducing inflammation and re-establishing the proper alignment between the knee cap and its groove. Rest is used for the painful swollen knee until symptoms improve. Stair climbing and squatting are avoided. Ice and anti-inflammatory medications are also used to decrease inflammation. Treatment is directed at strengthening the thigh muscles of the inside of the knee and stretching of the tight muscles and connective tissues of the outside of the knee. Malalignments of the flat feet are corrected with shoes with good medial arch support or through the use of orthotics. Hip rotation is improved through stretching exercises.