How to fix Anterior Knee Pain

Pain at the front of the knee and under the kneecap is a frequent complaint we see at Sport & Spinal Physiotherapy in Canberra. This is commonly known as anterior knee pain. This discomfort can be due to conditions such as fat pad impingement, patellar tendinopathy (injury to the tendon under your kneecap) or more commonly  Patellofemoral Pain Syndrome (PFPS). In this article we discuss this type of knee pain and how to get rid it.

The typical PFPS client presents with a history of a generalized ache at the front of the knee, placing the palm of the hand directly over the kneecap to indicate the region of pain. The pain is often aggravated by running (especially downhill), walking up or down stairs and sitting for prolonged periods with the knee bent, termed a positive “theatre sign” or “movie sign” with clients  preferring to sit in the aisle seats to allow them to keep the knee straight during the performance.

The cause of PFPS is usually related to poor biomechanics. In particular, clients will have a combination of tight lateral thigh structures, poor recruitment of the inner thigh muscles (VMO or vastus medialis obliquus) and the gluteal medius muscle (the butt muscles), and excessive foot pronation (low arch or flat feet). These contributing factors combine to force a lateral translation of the kneecap leading to a stress on the surrounding structures as well as the articular cartilage underneath the kneecap.

Effective management of PFPS starts with a full physiotherapy assessment to identify the problem and outline the best course of treatment to get the client back to full training and activities as soon as possible.

The initial stage of treatment (as with most overuse injuries) is to actively control pain and inflammation – this is best achieved with a combination of ice, rest from aggravating activities, anti inflammatory medication (either prescription, over-the-counter or natural supplements) and the use of taping to reduce pressure on the injured joint. Sport & Spinal Physio has a range of natural anti-inflammatory supplements to control this inflammation, which can be particularly beneficial for those that cannot take the other forms of anti-inflammatory medication because of side effects usually related to an upset gastro-intestinal system.

It is ideal to start the rehabilitation process with a stretching program of the hamstrings, calf, ilio-tibial band (ITB) and lateral thigh structures. Stretching, taping and the use of the methods listed above to control pain and inflammartion, should mean that your symptoms are largely under control within the first one to two weeks.

Analysis of your footwear is imperative particularly if you have excessive foot pronation. In some cases, you may have the wrong type of shoes for your alignment or your shoes may simply be too old and thus no longer effective in supporting your foot structure. In either case, you will need new shoes which we can prescribe here at Sport & Spinal Physiotherapy. If you still pronate in the new shoes, then you will need to see our podiatrist for orthotics.

The next stage of the rehabilitation process is to move onto a graduated strengthening program. At the end of this period, I will encourage clients to start cycling with an emphasis on correct bike set-up and proper pedalling technique. This can help encourage activation of the VMO and gluteal muscles.

Next move to a strengthening program designed to obtain proper gluteus medius and VMO function. It is important to start with the gluteals first, because a well functioning gluteal muscle will help place your VMO muscle in a position of optimal mechanical advantage, thereby making it easier for you to strengthen this muscle when you move to this part of the program.

Hands-on work with physio in the form of deep tissue release of the ITB and mobilisation of a stiff patella is an important adjunct to the rehabilitation process for a faster result. Self-massage of the ITB in the form of rolling on one of our foam rollers can also speed things up.

If you do everything right, there is no reason why you cannot fix this problem. With the right combination of rehabilitation exercises, stretching and biomechanical correction you should be back to sport in next to no time.

 If you do suffer from kneecap pain, call Sport & Spinal Physio now on 6262 4464 and we will guide you on the right path to fix the problem FAST!

About Craig Honeybrook

Craig is the practice principal of Sport & Spinal Physiotherapy. He attained a Masters in Sports Physiotherapy degree in 2000 at Sydney University studying foot injuries in runners and anterior knee pain in cyclists. He has been working as a physiotherapist for over 20 years and moved to Canberra over 12 years ago. He has been consultant physiotherapist for Balmain Rugby League, Eastern Suburbs Rugby, Australian Track & Field and Brumbies Rugby. His special interests include lower limb biomechanics, spinal instabilities and malalignments, bike fitting, running assessments, shoulder injuries and knee injuries. Craig was a former international level middle distance runner but now enjoys endurance mountain biking achieving a 2nd placing in the 2010 World Solo 24 hour Mountain Bike Championships. He also enjoys skiing, swimming, kayaking, gym work and spending time with his family.