Knee Pain

ANTERIOR KNEE PAIN

Anterior knee pain, or patellofemoral pain is a common complaint in the general population, with higher incidence in females and adolescents, and with potential progression to patellofemoral osteoarthritis in later years. It may be felt with explosive activities like jumping or landing movements, everyday activities of ascending or descending stairs, or sitting with the knee bent for prolonged periods of time -‘movie goers knee’.

There are many other structures in the knee which can cause pain for example the patella tendon, fat pad, menisci and ligaments, but for the moment we will just consider the patellofemoral joint. The kneecap or ‘patella’ sits at the front of the knee and enables the muscles at the front of the thigh to act like a pulley system and support heavy weights (bodyweight +) more easily when the knee bends (e.g. In squatting, running, jumping). It runs in a groove in the femur (thigh bone).

Pain arising from this joint can be caused by many factors, including tightness of the muscles around the knee, weakness of quadriceps muscles but also of their synergistic (helping) muscles, e.g.of hip or foot/ ankle which help optimise alignment and efficiency. Additionally tightness or laxity of the passive restraints of the kneecap may alter its ability to track normally in its groove. Bony shape of the joint can also play a role where the groove in the femur is shallow or the patella is small or sits higher than normal. These conditions can cause the patella to move slightly out of position (sublux) or escape out of the groove completely (dislocate) – think of a sliding door coming out of its runner.

In most cases it is a combination of the above factors together with a change in the loading of the knee. This often will happen around the changes of sport seasons with change in emphasis from swimming to running, or from the overlapping of summer and winter sports and a subsequent doubling up of training sessions. It may come from times of growth spurts, where the lever arm and subsequent forces change. The amount of work going through the knee is its load. If there is too much load – too great, too often, for too long, it is termed overload. There may not be any real physical impairment, but too much has been asked of the joint and pain is the result. In this case rest is the most appropriate initial treatment followed by a graduated return to activity.

At PEP we can screen you for alignment, muscle tightness, weakness, identify those factors you can change and those you can’t and work with you to set out a program to get you back to your chosen activity and minimise risk of recurrence.