Many different terms are used to describe Anterior Knee Pain or pain around the patella.
When the knee bends or straightens, the knee cap glides in a special groove on the thigh bone called the femoral trochlea controlled by the thigh (quadriceps) muscles. Pain occurs when the knee cap strays from this path (maltracking), causing patellofemoral pain.
One or both knees may be affected, and it is more common in girls, particularly adolescents.
Signs & Symptoms
Sudden onset of anterior knee pain (sometimes after injury or surgery)
Generalised vague knee pain
Aggravated by activities that load the knee such as running, stairs, hills, squats or after prolonged sitting
Pain which worsens with activity (running in particular)
Possible wasting of the muscles around the knee
Possible giving way of the knee
Pain over the front of the knee is a frequent presentation to a physiotherapy clinic.
What Causes It?
Altered lower limb biomechanics (inward rotation of the hips; ‘knock knee’ or valgus knees; over-pronated feet)
Tight lateral knee structures which create an imbalance and restrict patellar glide
Increased load on the PFJ (increased training load, introduction of hill or stair running)
Weakness and/or dysfunction of the VMO muscle which stabilizes the patell
Anatomic variations such as a shallow patellofemoral groove
Poor lower limb muscle flexibility
Sporting activities which can lead to the development of patello-femoral pain include running, walking, jumping and cycling.
How to Self Manage
Follow R.I.C.E. protocol
Obtain pain medication and or anti-inflammatories to reduce pain and inflammation
Review recent training program (activities, intensity, surface, footwear)
Rehabilitation of this problem can be lengthy so following the correct stretching and strengthening program until the knee is fully stable is recommended to prevent reoccurrences.
How Physio Helps
Exclude other pathology to determine if PFJ pain is your problem
Assess your lower limb biomechanics for possible contributing factors
Test the length and strength of your muscles to assess for any imbalance
Review your training history to identify contributing factors
Provide manual therapy including massage, stretches, dry needling, VMO retraining, joint mobilisation to release tight lateral structures, and McConnell taping education
Prescribe an appropriate self management program which aims to stretch tight structures, strengthen weak muscles (importantly the patellar stabilizers), and education RE training and management using McConnell taping.
If poor foot biomechanics are indicated you may be recommended for podiatric assessment as over-pronation can cause a ‘turning in’ (internal rotation) of the lower leg leading to altered forces through the knee.