Pain in the front of the knee can be an annoying issue for many young athletes, and is something Physiotherapists tend to see in clinic particularly in our footballers, netballers and jumpers. Often this condition presents in young athletes, particularly in late teenage years which a higher incidence in females compared to males1. There are many different structures and tissues in the knee which can produce pain, and it is really important that your Physio thoroughly assesses your individual condition to ensure best management for you.
The patellofemoral joint is where your kneecap (patella) meets your thigh bone (femur). The patellar is surrounded by soft tissues including ligaments, tendons and muscles which work together to control its movements as you bend and straighten your knee in all activities of life! Sometimes this balance and control can be affected by injury or poor technique which unfortunately lends to increased joint stress and pain.
Research has developed in this field, particularly over the last few years with greater understanding and identification of factors which cause or are associated with this niggly issue1,2. Sometimes the issue originates from the patellofemoral joint itself, however it can also be resultant from other parts of the body not working as well as they could. This is because the body is a fascinating system of connected pulleys and levers. Some factors can predispose to increased forces in the patellofemoral joint and subsequent pain. Your Physio is skilled at assessing to determine those factors relevant to you. These may include:
- Non-optimal shape and position of the patella and the femur (trochlear)3
- Weakness or poor muscle balance of supportive muscles around the knee (quadriceps) 4.
- Non-optimal alignment and posture of leg bones when stationary and with movement5
The way your feet and ankles function including: rolling inwards; stiff ankles; and increased mobility of the midfoot1,2,6
- Weak or altered hip muscle strength 2, 6
- Changed hip movement 2,6,7
- Poor trunk control with increased leaning towards affected side5
The good news is, many of these factors can be improved. This means, that once we have identified which ones are relevant to you we can usually manage your issue to enable full return to sport! Often the best management is not one approach, rather several approaches targeting the big picture and your individual goals. Some strategies Physios may incorporate are: specific rehabilitation exercises targeting identified deficits in muscle length, strength or movement patterns; hands-on techniques such as mobilisation or soft tissue release; taping or bracing advice; reviewing of your technique and sports-specific skills; and working with your coach to incorporate rehabilitation and improved technique into your training. Occasionally we may need to refer you on to our network of specialist doctors or other Allied Health professionals to assist with your care, however your Physio can guide you here as required.
If you would like more information on any aspect of this article, please speak to your Physio in clinic or arrange an appointment time on 9077 2885.
References
- Witvrouw, E., Callaghan, M.J., Stefanik, J.J., Noehren, B., Bazett-Jones, D.M., Willson, J.D., et al. (2014). Patellofemoral pain: consensus statement from the 3rd international patellofemoral pain research retreat held in Vancouver, September 2013. British journal of sports medicine, 48, 411-414.
- De Oliveira-Silva, D., Barton, C.J., Pazzinatto, M.F., Briani, R.V., & de Azevedo, P.M. (2016). Proximal mechanics during stair ascent are more discriminate of females with patellofemoral pain than distal mechanics. Clinical biomechanics, 35, 56-61.
- Stefanic, J.J, Zhu, Y., Zumwalt, A.C., Gross, K.D., Clancy, M., Lynch, J.A., et al. (2010). Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicentre osteoarthritis study. Arthritis care and research, 62(9), 1258-1265.
- Pattyn, E., Verdonk, P., Steyaert, A., Van Tiggelen, D., & Witvrouw, E. (2014). Muscle functional MRI to evaluate quadriceps dysfunction in patellofemoral pain. Medicine and science in sports and exercise, 45(6), 1023-1029.
- Nakagawa, T.H., Moriya, E.T., Maciel, C.D., & Serrao, F.V. (2012). Trunk, pelvis, hip and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. Journal of orthopaedic and sports physical therapy, 42(6), 491-501.Boiling
- Bazett-Jones, D.M., Cobb, S.C., Huddleston, W.E., O’Conner, K.M., Armstrong, B.S., & Earl-Boehm, J.E. (2013). Effect of patellofemoral pain on strength and mechanics after an exhaustive run. Medicine and science in sports and exercise, 45(7), 1331-1339.