Anterior Knee Pain
A common condition that we will see most days at Altrincham Physiotherapy Clinic is anterior knee pain. We see it in the sporty teenager, as a sequel to an acute knee injury or following knee surgery and in later years as patellofemoral arthritis.
Anterior knee pain or patellofemoral pain usually presents as pain at the front of the knee. It is aggravated by activities that load the kneecap or patella femoral joint during weightbearing on a flex knee, for example running, squatting and jumping, descending a mountain or even just a flight of stairs. It can also cause pain when sitting. Anterior knee pain can affect both active and inactive people. It can reduce a sufferers ability to participate in sporting activities as well as affecting their activities of daily living.
Symptoms of patellofemoral pain can include
- A grinding sensation from the kneecap during knee flexion
- Tenderness on palpation around, under or behind the kneecap
- Swelling below the knee cap
- Pain on sitting or activities involving bending the knee
What causes Anterior Knee Pain
Anterior knee pain or patella femoral pain in the younger or sporty person may be caused by a rapid increase in activity, e.g. starting running, starting a new weight bearing class, or stepping up too quickly in running training or an increase in hill work.
It is poor biomechanics that contributes to this problem. When there is an uneven pull across the knee cap or patella as a result of a muscle imbalance between the medial and lateral sides of the quadriceps muscles. This is often as a result of tightness in the vastus lateralis and the ilio-tibial band on the outside of the knee and a relatively weaker vastus medialis on the inside of the knee. This scenario results in a lateral maltracking of the patella over the knee joint. Causing irritation of the facets on the underside of the patella.
There are 4 causes of this muscle imbalance in the quadriceps and one or all four of these may need to be address to successfully rehabilitate this problem:
- The pelvis drops on the opposite side to the problem knee placing tension on the outside of the leg and tightening up the lateral structures
- The hip collapses inwards and rolls under the knee cap due to poor function and weakness in the hip muscles
- There are weak or poorly functioning quadriceps, resulting in inadequate support for the knee and the patella
- The foot pronates too much causing the tibia and knee to collapse inward under the knee cap causing extra loading on the medial side of the knee
Factors that need to be addressed in the treatment of patellofemoral pain
- Strengthen the core muscles around the pelvis especially the abdominals
- Strengthen the hip muscles especially the gluteal muscles
- Strengthen the weak medial quadriceps muscles and stretch and lengthen the tight lateral quadriceps muscles
- Correct unhelpful biomechanics of the foot, especially over pronation
Physiotherapy Treatment Options For Anterior Knee Pain
- Exercises to improve core stability and strength in the abdominals
- Exercises to improve strength in the hip and gluteal muscles
- Taping of the knee cap to reduce pain in the short term
- Foot orthotics if there is too much foot roll or pronation of the foot