Anterior knee pain. What to do to fix it for good.
Anterior knee pain, or pain at the front of your knee, is often termed patellofemoral pain. This is a chronic condition characterized by retropatellar and or peripatellar pain that worsens with sitting, squatting, climbing stairs, and running. This diagnosis is one of the most common conditions presenting to sports medicine clinics and often leads to decreased participation in sport or other social participation.
The pain is often a nagging ache or occasionally a sharp twinge that happens around the patella, or knee cap and traditional treatment often includes bracing, taping techniques, and strengthening of the quadriceps (thigh muscle) which collectively aims to improve kneecap tracking in the contact area between the patella and the femur. Recent evidence in a systematic review with meta-analysis suggests that strengthening your hip muscles also plays a huge roll in resolving anterior knee pain.
The etiology of patellofemoral pain is not currently understood and is likely multifactorial. Theoretically we attribute the pain to maltracking of the knee cap due to weakness and due to poor movement quality. The goals of therapy need to to encompass addressing the poor movement quality by changing from a knee dominant strategy to a more hip dominant strategy with squatting and lunging to take away the high forces at the knee that often cause the patient’s pain. With improvements in movement strategy and quality, it is important to follow up with hip and knee strengthening as the combination has stronger evidence to improve knee pain compared to quad strengthening alone. There is no greater stimulus to the tissue than appropriate loading of these muscles and tendons surrounding the joint.
For patients, know this. We will help you in all of these areas to find ways to decrease your knee pain. So, if we ask you to do your home exercise program know that your effort is a critical component to your success. If done 3x a week for 6 weeks you can expect a decrease in pain and improved participation in your favorite activities. Those quad exercises and band exercises are going to pay off!
For clinicians, know this. You are doing a disservice to your patients if you do not include the most current evidence in treating patellofemoral syndrome.
Improve movement strategy and quality. Block learning to start is very helpful.
Increase hip strength and quad strength by training appropriately at 60-70% of 1RM for beginners. BFR training would be a great way also achieve strength gains and may be applicable to your patient.
Use tape or bracing as an adjunct, but emphasize HEP for success.
Andrew Nielsen, PT, DPT, CSCS
EXOS Performance Specialist
Cited: J Orthop Sports Phys Ther 2018;48(1):32. doi:102519/jospt.2018.0501