Anterior knee pain

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With the London marathon on the horizon there is a common theme amongst the people I see here at Wandsworth Physiotherapy – that is anterior knee pain (AKP). AKP is a common complaint in many people especially runners and those you take part in team games such as basketball, football or volleyball complain of. Most people will go to the GP thinking they need to have the knee assessed but the first port of call for such a problem should be your local physiotherapist. Painkillers and anti-inflammatories prescribed by the doctor may help initially but to resolve the problem a physiotherapist needs to assess exactly what the problem is. There are a number of common problems that affect the front of the knee.

They include:
• Patello-femoral pain syndrome (PFPS)
• Patella tendonopathy
• Fat pad impingement
• Synovial plica

Regardless of what problem you have at the front of the knee the physiotherapist will carry out a number of assessments in your initial session. Typically the physiotherapist will look at the following:
• Your gait
• Squat, single leg squat, hops
• Palpation – medial and lateral facet and joint lines, retinaculum, patella tendon, fat pad, inferior pole of patella
• Patella glides
• VMO activity
• Muscle length tension tests

Once they have carried out these assessments they will be able to establish a diagnosis as to what is causing your anterior knee pain. The most common diagnosis for anterior knee pain is patellofemoral joint pain otherwise known as patellofemoral pain syndrome (PFJ syndrome). This is where the kneecap rubs on the underlying bone and creates a peripatella synovitis (swelling behind the kneecap).

This type of pain usually worsens with activity such running as well as going up and down stairs, getting on and off the toilet, or standing out from a chair. Risk factors for this type of knee pain include what is known as intrinsic factors such as:
• Pronated foot type (flat feet)
• Inadequate flexibility (tight quads, hamstrings and ITB)
• Patella position (usually a lateral tilt from a tight ITB)
• Poor neuromuscular control of the Vasti muscles (VMO)

Treatment for this type of me pain should initially be aimed at reducing pain and swelling. This will include the use of RICE – rest, ice, compression and elevation. You should also take some paracetamol and / or ibuprofen. The next thing to do is to reduce the amount of loading that goes through the knees. This means resting from your sports or running for a predetermined amount of time. Your physiotherapist will help to address local and remote intrinsic factors using things such as:
• Patella taping / brace
• VMO strengthening
• Orthoses
• Stretching
• Retraining hip function

Once you have had a number of physiotherapy sessions controlling the pain and addressing some of the biomechanical issues that you may suffer from your anterior knee pain should begin to resolve and you can get back to your sporting activities.

If you are suffering AKP come along and see a physiotherapist at Wandsworth Physiotherapy on Old York Road in Wandsworth Town.

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