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What is that pain at the front of my knee?

Patellofemoral Pain!

In this blog we are going to dive into anterior knee pain also known as patellofemoral pain and use two real patient examples to explore the different causative factors of this common injury.

Patellofemoral pain is one of the most common injuries in young athletes, but commonly seen in everyday people going about everyday tasks too.

Anterior Knee Pain can occur due to trauma of the patella (knee cap) but is more commonly attributed to multiple other factors.

These factors can include overload of the patellofemoral joint, individual anatomical or biomechanical variations (how a person is built and moves), muscular weakness, imbalance or movement dysfunction, altered jumping, landing or cutting mechanics.

Just to name a few!

With this type of knee pain you will typically notice symptoms in or around the patellofemoral joint or knee cap in weight baring activities such as walking, running, jumping, climbing up or down stairs, or kneeling and squatting.

It is important to note that these are not the only symptoms that people will experience as each case presents slightly differently.

Any area circled and pointed to in green could be anterior knee pain!

Let's take a look a some real life examples!

We will use 2 of my recent patients as an example of two different presentations coming from the same sport.

Both are soccer players. Both are young athletic males and suffering anterior knee pain during training and games. 

 

Patient A

This patient presented with a 1 week history of anterior knee pain after getting hit in the knee during a soccer game.

He was able to play out the rest of the game without pain.

But upon waking the next day began experiencing a sharp pain in his knee while walking on flat and especially when walking down stairs.

On physical examination of his knee he had slightly reduced knee range of movement due to pain on the affected side and tenderness with compression of his patella.

Performing resisted knee extension reproduced and caused this sharp pain. With a medial glide of his patella repeating the same movement relieved this sharp pain that he experienced.

Therefore a specific taping technique that provided this same medial glide to the patella was applied and again received his pain in resisted knee extension and with stairs. WIN!

Further testing during our consult, also revealed that this young male had reduced strength on the affected side around the hip.

It has been hypothesized in research that weak hip  musculature can affect the angle at which your knee moves while walking and running.

This difference in angle is propertied to put more load on the patellofemoral joint and in turn causing joint irritation and an experience of pain.

With a combination of a graded exercise program targeted at knee and hip strength, along with a taping technique to relieve pain we were able to get patient A back playing soccer without pain in a very short period of time.

Patient B

Now let’s take a look this guy!

He presented to the clinic with a 3 week history of anterior knee pain that was slowly getting worse.

He was unable to describe a specific event that would have caused this pain.

When we dove a bit deeper into his history it was noted that he had quite a high training load with inadequate periods of recovery.

His pain presented similarly to patient A in that he had a sharp pain in his anterior knee with walking and climbing stairs.

During testing of his knee he also presented similarly to patient A, but with one main difference.

This difference was during his resisted knee extension test.

This test reproduced his sharp pain however we were able to relieve this pain this time with a lateral glide of his patella.

This again had a similar response to the same taping technique with a lateral glide. A good result to allow the joint to settle while we focused on two very important factors in his anterior knee pain!

We also provided education and guidance around modifing his training schedule and load to improve and optimise his recovery. As all tissues, including the knee, need time to adapt to the rigours of training and competition.

Patient B, was also provided with a sports specific, graded strength and conditioning program for him to complete at home to assist in doing the right exercises at the right time!

Like patient A, we were able to get him back training and playing soccer without pain in a similar time frame. 

 

Not all Knee Pain is the Same!

Moral of the story here is that not all patellofemoral pain is the same.

Each case presents slightly differently and with the expert knowledge of your physiotherapist they will be able to identify some of the causative factors and guide you until you are pain free.

If you are suffering pain in the front of your knee during sport or in everyday life, please reach out and let us know. 

Some simple tips and intervention early on really do speed up recovery and resolution of pain or symptoms!

Knee pain while running

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