What is Patellofemoral Knee Pain?
Patellofemoral Knee Pain is a common condition which is related to pain around the kneecap (patella) region. It is a very common, and particularly prevalent in women and active individuals. It is often a result of imbalances in the forces controlling the movement of the patella. Active individuals engaged in activities like running, jumping, or cycling may encounter this ailment, experiencing pain ranging from a dull ache to sharp discomfort.
Understanding the mechanics of patellofemoral knee pain is crucial. Imbalances in muscle strength, tightness, or poor control of loading around the knee can disrupt the patellar movement, leading to development of this condition.
How do I know if I have Patellofemoral Knee Pain?
Common signs and symptoms of this condition include;
Pain when loading: Pain around the kneecap when loading the knee, especially when squatting, lunging and descending stairs.
Swelling and tenderness: Swelling and tenderness surrounding the kneecap region is a common sign of this condition. It can also b
Irregular Sensations: Occasionally an increase of clicking and locking can be present when loading the knee.
It's also important to be aware of Fat Pad Inflammation, a common condition which can present very similar to Patellofemoral Knee Pain. Features of Fat Pad pain which differ from Patellofemoral Knee Pain include discomfort when resting with the knee straight, more localised knee pain isolated to the fat pad under the knee cap and often sore from prolonged standing or walking.
What are my management options?
Patellofemoral Knee Pain can occur due to differ reasons between people. It's important to have your knee assessed to have confidence you're addressing the factors that are most specific to you. That being said, management options include;
Taping: Taping for the kneecap can be a very effective strategy to reduce your knee symptoms. Here is a video on how to tape your knee your patellofemoral knee pain.
Strengthening: Building strength to muscles in the lower limb is a important component in rehabilitation of this condition. This is particularly important in the gluteal muscles which assist in controlling the position of the hip and knee. Here a few common exercises we use for this.
Motor Control: Two key components in managing patellofemoral knee pain including preventing the knee from tracking inwards (knee valgus) as well as excessively forwards over the toes (anterior tibial translation). These positions can increase loads through the kneecap which may contribute to the presence of symptoms. Completing exercise to work on your control of the knee, such as various single leg squatting and landing exercise can be an important component of rehabilitation. Here are a few of the exercises we use to assist with landing control.
Load Management: It's important to consider the types of exercise which contribute to greater loads around the knee. It may be important to temporarily reduce these activities whilst you're managing this condition. This may include reducing lunging, step ups, running or deep squatting. It's always a good idea to try and continue what exercise you're able during this period of time.
Running Technique: Over striding or heel striking are common patterns which can be present in those with Patellofemoral Knee Pain. Strategies which can assist include increasing step frequency (running cadence), adopting a more midfoot running pattern and running softer can help.
Foot Orthoses: Some people may benefit from the prescription of foot orthoses. Often taping the foot can be an effective strategy to determine if this strategy could be helpful for you.
The True Active Rehabilitation Pathway
Protection / Improve Symptoms: During this phase we will work to improve your symptoms to allow you to start rehabilitation and reduce the pain to your knee. We use dry needling and soft tissue release to the thigh, glute and leg to reduce tightness which may contribute to your pain. We may also recommend taping to reduce your pain and improve your confidence in use of the knee.
Load Introduction: Within this phase we will teach you how to switch on and recruit the correct muscle groups to assist in supporting the knee. We play a particular emphasis to the calf and glute during the phase using light weights and bands, and look to gradually introduce loading the quadricep. Occasionally using tape through this phase can assist in completing your rehabilitation pain free.
Strength Development: Once your able to engage the correct muscle groups, we will assess your strength using forceplates and strength testing equipment to evaluate where your weaknesses may be. From here, we will look to prescribe a strengthening program by further progressing your exercise. We will provide a series of targets we want you to hit related to your age, sport and demands to your knee. As you progress in your strength we will look to retest these markers.
Return to performance: For many, we see a reduction in jumping, running and landing ability which may contribute to risk of recurrence or a reduction in performance. If you're looking to return to return to higher intensity sport, we will assess your running and jumping ability using our forceplates and running analysis software. We will then provide feedback regarding these and goals to hit regarding your jumping and running technique. Generally this will culminate into a exercise program which you can continue ongoing to reduce your chance or recurrence and maintain your performance going forward.
If you're looking for more specific advice or guidance in managing this condition, don't hesitate reach out to the team at True Active Physiotherapy.