Pain at the front of the knee and under the kneecap is a frequent complaint we see at Hinterland Physio – this discomfort can be due to conditions such as fat pad impingement, patellar tendinopathy or more commonly – Patellofemoral Pain Syndrome. In this article we will tell you more about knee pain and how to get rid of it.
The typical Patellofemoral Pain patient presents with a history of a generalised ache at the front of the knee, placing the palm of the hand directly over the kneecap to indicate the region of pain. The pain is often aggravated by running (especially downhill), stairs and sitting for prolonged periods with the knee bent- this is termed a positive “theatre sign” or “movie sign” with patients preferring to sit in the aisle seats to allow them to keep the knee extended during the performance.
Effective management of Patellofemoral Pain Syndrome starts with a full physiotherapy assessment to identify the problem and outline the best course of treatment to get the patient back to full training and activities as soon as possible.
The initial stage of treatment (as with most overuse injuries) is to actively control pain and inflammation – this is best achieved with a combination of ice, rest from aggravating activities, anti inflammatory medication and the use of Patellofemoral taping to reduce pressure on the injured joint.
An important component of the rehabilitation process is the need for an effective strengthening program to restore pre injury function. The majority of exercises should be performed pain free with close attention being paid to any post exercise pain and especially increased pain the morning after a rehabilitation session – the need for appropriate strengthening must be balanced with possible aggravation of symptoms.
The exact exercises chosen will depend on the severity of symptoms and will be guided by your physiotherapist but the majority of programs initially focus on isolating the VastusMedialis Obliques (the small muscle on the inside of the knee) to contract prior to the activation of the rest of the quadriceps group.
Other important components of a successful Patellofemoral Pain rehabilitation program will include specific stretching of the iliotibial band, hamstrings, calves and quadriceps, as well as effective (and sometimes uncomfortable) deep tissue massage of the ITB – this can also be augmented by the patient using a foam roller to “self massage” the lateral structures of the knee.
Many patients with Patellofemoral pain have issues relating to excessive subtalar pronation (flat feet) which can act to increase internal rotation of the lower limb contributing to alignment issues – these patients are often best treated with an individually moulded orthotic device placed in their shoes to assist in controlling foot function – ask your physiotherapist about our new gaitscan technology.
While patella femoral pain is a very common injury it is also very treatable and with the right combination of rehabilitation exercises, stretching and biomechanical correction the sufferer will be back to sport in next to no time.