Anterior Knee Pain

Anterior knee pain is called many different things. You may call it “runner’s knee”, “chondromalacia”, or “moviegoer’s knee”. These names are all describing patellofemoral pain syndrome. In the large majority of cases, this will not become a significant problem. The more educated you become as to the causes of this problem, and the more consistent you are with the correct exercises, the more likely you are to stay active and pain free.

The patellofemoral joint is the joint between the patella (kneecap) and your femur (thigh bone). The patella is shaped like an upside down teardrop. The undersurface of the patella is shaped to fit into a groove on the femur.  As you bend your knee, the kneecap glides down. Patellofemoral pain may occur when the kneecap does not stay in the in the correct place in the groove, or if there is too much pressure on the joint as the motion is happening. Problems at this joint are usually nagging, aggravating injuries. They are NOT like the more serious problems like torn ligaments or cartilage that can occur in the main knee joint.

Bones are full of nerves and arteries. The ends of your bones are also very rough. If you were to rub one bone on another, you would not get very smooth gliding. There would also be a lot of pain and bleeding. Luckily, you have a coating on the ends of all your bones called articular cartilage. This cartilage is present in every joint in your body and acts like a Teflon coating to the end of the bone to allow smooth gliding of one bone on another. There is no direct nerve supply or blood supply, so no pain or bleeding will occur rubbing articular cartilage coated surfaces together. It also acts as a shock absorber to prevent our bones from wearing down.

By having the quadriceps run over the kneecap, the muscle becomes stronger and can lift, squat, jump and walk better. If the muscle is weak, however, it can lead to increased forces on the cartilage under the kneecap. It can also lead to abnormal tracking of the kneecap. Weakness of the hip musculature can also play a large part in abnormal tracking of these patellofemoral joint. The hip muscles control the femur (top thighbone). If these muscles are weak, the femur may rotate out from underneath the patella, which will again lead to abnormal tracking. Strengthening both the quadriceps and the hip musculature will help decrease forces at the joint and normalize tracking.

Tight musculature can also play a role in abnormal tracking and increased forces at the patellofemoral joint. The hamstrings can increase forces at the joint by not allowing your knee to straighten all the way to certain activities. The IT band, which is a thick tendon that runs down the outside of your thigh, has bands that attach to the outside of the kneecap. If it is abnormally tight, it can pull the kneecap out of the groove. Maintaining good flexibility in these muscles by stretching can help avoid these problems.

In order to treat patellofemoral pain, it is important to first decide what is causing the pain, and modify your activities. Here are a few troubleshooting examples:

**You have been running for years on a street, always using the same brand of sneakers. You just recently tried a new brand of sneaker, and started running on more uneven terrain. If you get kneecap pain, go back to the original brand of sneakers and running on the street. The new shoes and trail running need to be introduced gradually into your training.

**you want to lose 20 pounds and start walking up 10 flights of stairs daily instead of using elevators. If you get kneecap pain, go back to using the elevators most of the time and find a safer way to burn calories (walking, swimming, biking).

What should you do to treat kneecap pain?

1. MODIFY ACTIVITIES

– Avoid deep squatting, especially with your knees going over the front of your feet

– Avoid activities that require repetitive bending of your knee with your weight on them, such as stair climbing, step aerobics, and heavy resistance biking

– Avoid excessive pounding on the knees, like too much running, running downhill and jumping

– Increase the number of days you rest between stressful knee activities

– Warm up before exercising. For example, ride the bike or walk before sports, or make the first mile you run the very slowest

– Cross train – mix up your workouts so you are not doing the same thing every day for exercise.

1. EXERCISE PROPERLY

– Do strengthening exercises for your hip musculature to improve your mechanics.

– Prevent an increase in joint compression by avoiding deep squats and full motion leg extensions.

– Maintain or increase the flexibility of your hamstrings, calf, and IT band.

1. ICE IF SWELLING IS PRESENT

• If you are noticing any swelling around the knee, elevate your leg and ice for 10-15 minutes after exercise or at the end of the day.

1. SEE A PHYSICAL THERAPIST FOR AN EVALUATION

-If your pain is not improving, or if you are having an increase in symptoms, see a physical therapist for an in-depth evaluation to get to the root of what is causing your pain and address it properly.