Patellofemoral pain (anterior knee pain)

Patellofemoral knee pain accounts for approximately 25-40% of all knee problems. It is particularly prevalent in adolescence and affects women more than men.

Physiotherapy has proven the best form of treatment for this condition, as there is no strong case to suggest that surgery is of any great benefit. The key is to catch it early and set in place a rehabilitation programme to address the cause. It can take some time for patellofemoral pain to go away and it is important to continue with the exercises prescribed by your physiotherapist in order to build up the required strength to cope with everyday demands.

Success rates are high if patients comply.

What is patellofemoral pain?

Patellofemoral pain is used to describe pain around the knee cap (patella) without signs of other damage or problems to the knee. It usually begins gradually and gets worse over time.

What are the symptoms?

Pain around the knee (this can be anteriorly, posteriorly, medially or laterally)

Intermittent pain that may feel worse performing certain activities (Such as climbing or descending stairs or certain sports). It may also arise when sitting still for a long period of time

You may experience a grating or grinding experience known as crepitus

You may see swelling

What are the causes?

It is thought that there are several contributing factors to patellofemoral knee pain, which increase the pressure between the patella and femur (thigh bone). This is likely to be as a result of overloading the muscles and joints through activities such as cycling, running, squatting and going up and down stairs.

Here is a list of some of the contributing factors mentioned above:

Tightness or weakness in associated muscles (quadriceps and hamstrings) causing mal-alignment of the kneecap as it moves. This may cause the patella to rub on the lower femur rather than glide over it

Overuse of the knee when technique is incorrect (or positioning is incorrect such as on a bicycle if the saddle is too low or too close to the handlebars)

A combination of alignment problems and overuse

Weak hip muscles causing the femur to sit inwards resulting in the patella being pulled to one side

Over pronation – where the feet roll inwards (also known as flat foot)

What will we do to treat it?

We will perform a visual examination, looking at how you walk, stand, squat, etcetera

We will perform certain tests to rule out other knee problems

We will educate you on what the cause of your problem is

Provide you with a rehabilitation programme

Address any biomechanical concerns

Manage pain with hands on manual therapy to reduce tight structures

Suggest recommendations for daily activities you can resume and those you should consider cutting down on

Suggest foot orthotics where relevant

Set realistic goals

Monitor your progress over time and adjust the exercise programme as you progress

Gradually re-introduce activities back in as you get stronger

If you are experiencing patellofemoral pain, don’t worry, the outlook is good.  Most people can improve with physiotherapy, just be prepared that it is not a quick fix and can take several months to get better.

To begin your steps to recovery, pop in, or give us a call.