This is a common condition, often referred to by clinicians as Patellofemoral pain or anterior knee pain.
You may feel pain around the front, or behind the kneecap (patella). Sometimes you might hear or feel a grating sensation from the kneecap.
Often the pain occurs without a specific traumatic event. It may arise due to your particular biomechanical make-up and/or the way you use you muscles. If you rotate you knee inwards when you walk for example, it will alter the load between the knee cap and femur (patellofemoral joint). Changes in the surface of the patellofemoral joint may contribute to the grating noise that is sometimes heard.
Symptoms may vary in severity and are typically aggravated by prolonged sitting, squatting, stair climbing and running, kneeling, hopping and jumping. Problems often occur whilst, or after you have played sport or performed everyday activities such as gardening or walking. Pain may be worse, come on more quickly and last longer if the aggravating activity is performed repeatedly.
Patellofemoral pain is most likely to be caused by a combination of the following factors:
- Weakness or imbalances in the muscle around the knee or hip.
- Reduced muscle flexibility in the thigh, buttock or calf.
- Structural or alignment problems at the spine, pelvis, hip, knee, ankle or foot.
- Increased general joint mobility.
- Excessive use of the joint, high training loads or sudden increase in activity level.
When to seek help
Pain is a warning sign, a bit like that dreaded red warning light that shows up in your car if something is not quite right. If you address the reason for that red light early, the consequences are often much better than if you wait until your car breaks down!
Research suggests that the longer pain lasts, the harder it is to treat, therefore as soon as you feel your pain, even a niggle, it is important to address the cause and/or seek advise early.
Patellofemoral pain can sometimes get better on it’s own without any treatment, especially if it is associated with a new activity, one you haven’t done for a while or with high training load. If this is the case, rest or stepping back from that activity for one to two weeks can help settle the symptoms. A gradual return to that activity is then recommended.
If your symptoms persist or prevent you from returning to your activity it is important to seek advice.
Pain killers and Physiotherapy are the mainstay treatment.
Evaluation of patellofemoral joint pain is complex and first requires a comprehensive assessment by a Physiotherapist. Your Physiotherapist will identify what structure is causing your pain and what factors may have contributed to your symptoms.
Your Physiotherapist will then design and agree a treatment program with you to meet your specific needs. Research suggests some kind of loading activity always needs to be involved before the risk factors above become important. Loading patterns during sporting and every day life will be considered. The aim of your Physiotherapist will be to get you moving well, and back performing your sport or every day activities to a level that you would like.
Treatment often requires a multidisciplinary approach. Your Physiotherapist will lead you in the right direction. Overall management of your condition may include:
- Podiatry assessment to help address lower limb biomechanics. Sometimes insoles and specific foot exercises are needed.
- Physiotherapy (manual therapy, acupuncture, taping and exercises) to help address pain, strength deficits, muscle imbalances, altered movement patterns, training loads and characteristics.
- Bike fitting assessments or running re-training if pain is associated with these activities.
- Massage therapy to help optimise muscle flexibility, circulation and tension.
- Personalised exercises to help you return to full fitness, sporting and everyday activities.
- Pilates exercises to help improve your knee and core stability and to teach you how to move well.
These methods are very effective in treating patellofemoral pain, however, there are occasions when symptoms persist. In this situation, you may need the opinion of an orthopedic specialist or treatments such as injection therapy; these can be arranged by your Physiotherapist.