Anterior knee pain is possibly the most common injury seen by many sports medicine practitioners and one which we see in our clinic on a daily basis. There are many different knee pain pathologies, however the most common presentation we experience in our clinic is Patellofemoral Syndrome.
While there is still debate regarding the precise etiology of patellafemoral pain, there are 2 schools of thought which still prevail. The traditional school of thinking suggest pain is a result of malalignment of the patella relative to the femoral trochlea, resulting in abnormalities and resultant pain in the articular cartilage. However, more recent evidence suggests pain may be more a result of increased mechanical loading, leading to irritation of nerve endings and loss of tissue homeostasis, the result of which leads to inflammatory processes that cause peripatellar synovitis.
Despite the debate about the exact cause of patellofemoral pain, physiotherapy intervention has proven to be very effective in reducing a patient’s symptoms and correcting those factors that lead to the condition.
However, due to the complex nature of this condition, it is important to recognise that every patient is a different and may develop pain for a number of varying reasons. Such reasons may include:
- Internally rotated femurs
- A laterally sitting patella
- Lower limb muscle tightness
- Over pronation of the feet
- Poor vastus medialis obliquus muscle function
- External factors such as poor training routines or inadequate footwear
In the majority of cases it is not just one of these factors that will lead to a patient’s condition, but rather a combination of 2 or more of the above, all of which occur for different reasons. As such, the most important step any therapists can take in managing this condition, and ensuring a patient’s return to pain free activity, is to take a thorough history of how the patient’s symptoms behave. This alone can often determine the underlying cause of patellofemoral syndrome, and hence provide a solid framework from which to develop the best possible treatment plan. We have found important aspects to consider include:
- The specific location of pain (although this is often difficult for patients)
- What activities make their pain worse
- A thorough history of when the pain started
- Is the patient experiencing any clicking in, or giving way of the knee
- Is there any swelling present
- Has the patient suffered any previous knee injuries
The more accurate the information gathered, the easier it is to determine the precise cause of the condition and correct any abnormalities, giving patient’s the quickest and most long lasting outcome possible.
If you are managing patients who are suffering from patellofemoral syndrome and believe physiotherapy may be appropriate, or if you believe your patients may be at risk of developing knee pain in the future, please don’t hesitate to refer them to our clinic for an appointment with one of our experienced therapists today.