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Anterior knee pain

 

Anterior knee pain is pain that occurs at the front of the knee. It is more common in runners, jumpers, cyclists, skiers, and football players who exercise often.

25% of the population will be affected at some time and it is the most common overuse syndrome affecting sports people – although you do not have to be sporty to be affected.

Anterior knee pain is an umbrella term for numerous injuries including:

  • Patellar tendinitis sometimes called Runner's knee
  • Patella maltracking - instability of the patella on the knee
  • Chondromalacia of the patella - the softening and roughening of the tissue (cartilage) on the underside of the kneecap (patella)
  • Bursitis - inflammation of a small fluid-filled sac (bursa) situated near your knee joint.

What can cause anterior knee pain?

Your patella (kneecap) sits over the front of your knee joint. As you bend or straighten your knee the patella glides up and down over the femur bones which make up the knee. As your bend your knee, the underside of the kneecap is exposed to varying stresses in different areas of the kneecap. These forces may not be spread evenly over the area but may build up in certain areas of the kneecap not designed to tolerate these pressures. This is especially so when the muscles of the thigh and bottom are not working correctly and are ‘imbalanced’ (out of sync with each other). This ‘imbalance’ can lead to further limitation of the joint between the kneecap and the thigh bone which may result in some swelling around the knee.

There are certain underlying factors that can lead to anterior knee pain such as:

  • Skeletal factors: the size and shape of patella, differences in leg length or bony changes in thigh (femur) and lower leg (tibia) bones.
  • Muscle factors: poor muscle control or power around the knee, hip and/or calf muscles.
  • Biomechanical factors: deformities or limited movements at the spine, hips, knees, ankles and feet, such as flat feet
  • Trauma: direct or indirect blow to the knee.
  • Overuse, e.g. cyclists and runners.
  • Unaccustomed activity.
  •  Maintenance of a static position for long periods, e.g. sitting/ driving
  • Hypermobility

Treatment:

  • Physiotherapy can really help with anterior knee problem, with a thorough assessment the physiotherapist can identify the underlying factors that are leading to your pain. They can then advice on modification of training where needed and instruct on specific strengthening, stretching, or biomechanical adjustments, they may also use manual therapy, taping and electrical stimulation to help the muscles function better.
  • Simple analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), may help to relieve discomfort.
  • Proper footwear may be recommended depending on your assessment. Foot orthoses decrease rotational forces in the tibia that affect tracking of the patella during locomotion.

 

Top tips if you have anterior knee pain

  1. Do not push through the pain.
  2. Avoid repetitive activities until pain has subsided.
  3. Avoid walking up and down hills.
  4. Avoid high heels which can worsen the problem by pushing kneecaps back onto the thigh bones.
  5. Avoid kneeling and squatting.
  6. Avoid standing for long periods of time with the knees locked back.
  7. Avoid breaststroke swimming.
  8. If the knee swells – rest it and use ice to settle
  9. See a physiotherapist.

Please have a look at our clinic update/news section which talks about our Bike Fit Service with our cycling expert. They can help you understand and amend your bike set up or cycling technique to help reduce anterior knee pain or help prevent it from occurring.

Do not hesitate to contact us at the clinic if you have any further questions regarding anterior knee pain or e-mail us on enquiries@wimbledonphysio.co.uk    

References:

www.arthritisresearchuk.org/~/media/Files/.../Hands-On/HO04-Oct-2004.ashx

https://patient.info/doctor/anterior-knee-pain

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