Anterior Knee Pain

Simon Hall. Physiotherapist

Patellofemoral pain is pain around or behind the kneecap especially with activities like squatting, lunging, stairs, running and prolonged sitting.

Patellofemoral pain is extremely common, approximately ¼ of the population will experience it in any one year. It is a musculoskeletal condition that can affect people of any age, gender, physical activity profile, size etc. although it is slightly more common in women. It is important to seek early diagnosis and management of patellofemoral pain as prolonged symptoms often make recovery more challenging

What is causing the pain?

The patellofemoral joint is the joint between the patella (kneecap) and femur (thigh bone).

Patellofemoral pain is caused by an irritation to the joint which may occur due to overload (a sudden change in the amount, type, and/or level of physical activity) and/or altered movement patterns (patella maltracking).

Should I get a scan?

There is not one specific structure within the patellofemoral joint that can be blamed so imaging, such as MRI or X-Ray, is rarely necessary.

As patellofemoral pain is caused by joint irritation rather than significant tissue damage, complete rest is rarely the answer and exercise, together with education, is the cornerstone of management.

What can I do about it?

Patellofemoral pain is “multifactorial”, meaning there are often a number of individual factors contributing to it. Therefore, there is no “one size fits all” approach to managing patellofemoral pain.

The Zone34 physiotherapy team utilise a thorough examination to determine which factors are most relevant to you and tailor a rehabilitation program to address them. Elements of your rehabilitation may include:

GLOBAL FACTORS

Activity and Lifestyle Factors

Education regarding the specifics of your condition.

– Load management and activity modification.

– Weight management strategies.

– Pain management strategies.

LOCAL FACTORS

Around the Knee

– Exercises to target strength and control of the quadriceps and/or hamstrings.

– Exercises to target flexibility of the quadriceps and/or hamstrings.

– Manual therapy of the structures around the knee for symptom modification.

– Taping or bracing the knee for symptom modification. Check out our How To video here

PROXIMAL FACTORS

Above the Knee

– Exercises to target strength and control of the hips and/or trunk.

– Exercises +/- manual therapy to target flexibility and mobility of the hips.

DISTAL FACTORS

Below the Knee

– Exercises to target strength and control of the foot and ankle complex.

– Exercises +/- manual therapy to target flexibility and mobility of the calves, ankles and/or feet.

– Foot orthoses.

Your individualised treatment plan will be designed to help you control your knee pain, avoid recurrence of pain and help you reach your goals!

References:

Barton, C. J., Lack, S., Hemmings, S., Tufail, S., & Morrissey, D. (2015). The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med, 49(14), 923-934. doi:10.1136/bjsports-2014-093637

Bolgla, L. A., Boling, M. C., Mace, K. L., DiStefano, M. J., Fithian, D. C., & Powers, C. M. (2018). National Athletic Trainers’ Association Position Statement: Management of Individuals With Patellofemoral Pain. Journal of athletic training, 53(9), 820–836. https://doi.org/10.4085/1062-6050-231-15

Lack, S., Neal, B., De Oliveira Silva, D., & Barton, C. (2018). How to manage patellofemoral pain – Understanding the multifactorial nature and treatment options. Phys Ther Sport, 32, 155-166. doi:10.1016/j.ptsp.2018.04.010

Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., Lynch, A. D., Snyder-Mackler, L., & McDonough, C. M. (2019). Patellofemoral Pain. The Journal of orthopaedic and sports physical therapy, 49(9), CPG1–CPG95. https://doi.org/10.2519/jospt.2019.0302