Pain in the front of the knee is a very common problem that physiotherapists frequently treat. The most common type of frontal knee pain is Patello-Femoral Pain Syndrome (PFPS). Patients will describe an ache around the knee cap (patella) region which is commonly brought on by running, squatting and stair climbing. The actual area of pain may vary amongst patients, with some describing their pain on the inside (medially) and some describing their pain on the outside (laterally).
So, what causes PFPS in the first place? Well, there are a few different causes for this problem. It may be due to overload, in that the person is undertaking too much running or jumping in ther training. Maybe they have simply increased the volume of their running or training too quickly, not allowing for the body to adapt to the training intensity.
In our experience, most people who presents with this problem, have excessive lateral tracking of their patella in its groove. This produces irritation in the articular structures of the joint and subsequent pain. There are two main reasons for developing this problem. Firstly, there may be a weakness in the person’s hip abductor muscles (Gluteus medius), causing an abnormal Q angle of their knee.
The increased Q angle, produces a medial deviation or ‘buckling’ of the knee joint, ultimately causing a lateral mal-tracking of the patella in its groove. The second most common cause of PFPS is excessive ‘rolling in’ (pronation) of the foot whilst walking, running and jumping. This ‘rolling in’ of the foot produces an internal rotation of the tibia or ‘lower leg’. This too, ultimately produces a lateral mal-tracking of the patella in its groove.
To treat this problem effectively, we must firstly ascertain what causative factors led to the development of this problem in the first place. Looking beyond the knee joint is crucial! Assessment will include a biomechanical examination, thorough history of person’s training/recreational/work activities, orthopaedic tests to confirm diagnosis.
Treatments can consist of
- Soft tissue therapy to quadriceps, ITB, calves and hip muscles
- Taping of patella to unload patello-femoral joint
- Modification of training / recreational / work activities
- Referral to podiatrist for orthotics to correct excessive foot pronation
- Re-training of weak hip abductors to prevent medial deviation of knee
- Flexibility program
If you are currently experiencing pain in the front of your knee please contact us on 02 87328888