This is probably the single most common knee problem presenting to the medical world. It is non operable – surgeons have tried various strategies in the past – all of which, without fail, do not work and often worsen the situation – so they have stopped offering surgery as an option by enlarge. Physiotherapy is really the only solution.
So what is it? Well the title is vague and just means pain in the front of the knee – that could mean anything! In the past it was thought to be due to softening of the cartilage and referred to as “Chondromalacia Patellae” (CMP). Research has shown a poor correlation between CMP and anterior knee pain (AKP). It can be a cause though it is rare. If you are told this is the cause and there is nothing you can do – my advice is to seek another opinion!
- More common in females (3:1 ratio)
- Commonly starts in teens
- Nothing shows on X-Ray or MRI scan
- Is not the result of injury
- In essence any structure at the front of the knee can cause the pain so the key to successful treatment is isolating the exact structure.
It can be:
- Patellar tendon irritation.
- Fat pad irritation
- Synovial plicae (small folds inside the capsule of the knee getting pinched)
- Referred pain from muscles higher up the leg
- Referred pain from the lower back
- Mechanical issues at the hip or pelvis
- Biomechanical issues in the feet – eg: flat feet / pronated feet
- *Patellar mal-tracking – due to imbalances in the soft tissues which control the movement of the kneecap / patella. This is the most common in my experience.
What can we done about it? Thankfully – LOTS!
- Orthotics / shoe insoles specifically created for your feet to address biomechanical issues in the feet.
- Soft tissue release techniques and and specific stretches to tight structures – commonly the good old iliotibial band ITB, calf, inner thigh muscles and rectus femoris in the front of the thigh.
- Ultrasound to locally irritated structures like the patellar tendon or extensor retinaculum.
- Gait analysis and re-education to retrain running or walking patterns. We use video gait analysis and the experienced eye to evaluate the way you move.
- Exercises to strengthen weak muscles – most commonly the VMO – one of the quadriceps muscle group in the thigh
- Other more unusual causes:
- Ankle restrictions affecting the stresses up the leg.
- It can be connected to other more general health issues such as digestive issues and breathing problems – mainly due to restrictions to energy flow in the body and restrictions thro the connective tissue matrix of the body called the myofascial system which connects almost everything in the body.
- Sacro-iliac joint issues
- Training issues
- Running style
- Bursa irritation from kneeling, friction or direct blow
Thankfully, provided an accurate assessment is made, the outcome with appropriate physiotherapy is generally good! We have specialists in the management of anterior knee pain in the Practice / clinic.