Anterior knee pain
If you google ‘knee pain’ you are faced with a whole list of conditions, injuries and possible causes and an endless list of suggestions for management. Knee pain is the second most common musculoskeletal complaint after back pain and there are all sorts of statistics around who gets it, when and the causes. (Prevalence of knee pain | Background information | Knee pain – assessment | CKS | NICE)
One of the most common complaints is anterior knee pain which is noted in around 23% of adults each year and woman are twice as likely to suffer from this type of knee pain. As with any musculoskeletal pain I would always advise to get it checked out by a qualified clinician (physiotherapist) so you can get the right advice on managing it. Often, the worst thing to do is to just stop any form of exercise. which is what many GPs may advise. This can lead to de-conditioning and a very grumpy patient.
Anterior knee pain is pain at the front of the knee, it could be on the top of the knee cap or feel like it is inside the PFJ joint (the patellofemoral joint) which is the joint underneath the kneecap. It may feel sore after exercise, be sore if you sit for any length of time or start to hurt at night when you are trying to go to sleep. These are all really common symptoms so don’t panic!!
The PFJ is made up of the femur – the long thigh bone, and the tibia- the long shin bone. At the end of the femur is a groove that allows the knee cap to slide up and down with movement. The joint is supported by ligaments and connective tissue. The patella sits within a large tendon that attaches the quadriceps muscles to the top of the shin bone.
For what ever the reason, if the patella is pulled against the joint below this can lead to irritation around the patella or to the surfaces below. The cause is usually overload due to:
- increase in training – more, speed, distance, duration
- increased weight
- poor biomechanics- stiff hips/ankles
- poor exercise form- running, squatting, lunging
- lack of recovery
- change in hormones- peri menopause
You may have some swelling around the front of the knee or notice creaking/grating when you move which can be very worrying. The first bit of reassurance is that ‘noise’ isn’t an indicator of damage!! Healthy joints can click, pop, grind and research supports that. (Song 2018)
Swelling is the body’s way of reacting to some kind of internal or external stimulant. It could be too much stress on some soft tissue or on a joint surface. Our body is perfectly capable of dealing with this and inflammation is a perfectly normal and healthy response to this. With a bit of rest from the aggravating activity this usually settles over 1-2 weeks. Underlying factors however can lead to the symptoms becoming more permanent which then effects training and performance and, if left unchecked, quality of life. If we look at each element that may cause the knee pain hopefully you will gain a little bit of knowledge as to why this may be contributing and what you can do about it.
1- Increase in training– if you increase what you are doing too quickly your body may not be able to adapt quickly enough to the changes you are making. For example if you start to add more weights to your squatting, the tissue that supports your joints may not quite be strong enough to support the joint with the extra load. Change takes months rather than weeks so back off a bit and see if this helps ease symptoms. If you are a runner then ease back on pace and distance to an amount that is manageable.
2- Increased weight – as we age we tend to put on weight as we become more sedentary. More weight means more stress on our joints and soft tissue.
3- Poor bio-mechanics– you may have stiff hips or ankles which can limit natural movement and put load on to other areas of the body. Improving mobility at one joint may help relive another joint
4- Poor exercise form – a big one for this is running. If you run with poor form and tend to overstride with a big heel strike this can lead to excess load through the knee. With the right guidance on which bits to strengthen and how to improve your running form this can help reduce your knee pain. Likewise squatting or lunging with poor form can really aggravate knees
5- Lack of recovery– if you work hard you create damage to your body. Recovery allows the body to repair this damage and make bits stronger so next time you do the activity your body can cope better. Not allowing enough recovery time can lead to muscles becoming stiff or fatigued and the products of inflammation lingering. Recovery is vital to keep your body he
6- Change in hormones– women are twice as likely as men to experience anterior knee pain!!!! Your hormones are vital in keeping collagen healthy. Collagen makes the strong supportive connective tissue so if your collagen is less healthy then this can effect joints. Per menopause symptoms often include joint pain and the knees can be especially sore.
So what should you do if you start to experience anterior knee pain ?? Firstly just rest from the thing that is aggravating it. This may mean a week or two off running or changes in your gym programme to offload your knees. There is a always something else you can do instead so try to adapt around your knee pain so you can continue to exercise. Try a 3-7 day course of anti inflammatories such as ibuprofen. This can help support the body’s own defenses. Try some soft tissue work on tight muscles such as quads or hamstrings. You can use something like a hand roller or a massage gun and some dynamic movements pre and post exercises (check out you tube vidoe on how to use a massage gun safely). Seek advice. With the right guidance and advice early on, anterior knee pain shouldn’t cause you too much lost training time. Once it has settled you can start to look at making sure the knees are strong. Check out my you tube channel @khphysiotherapy for some basic exercises to help strengthen them.
Keep an eye out for my next blog on exercises that can help reduce knee pain and make your knees more resilient
The key to knee pain is understanding what the underlying cause is. Once you know this its simply a case of putting together a plan that allows you to exercise around it whilst it settles. If you would like help with knee pain please get in touch firstname.lastname@example.org