Knee pain is one of the most common injuries in sport. If you’re a runner, rider, or athlete you have probably suffered from knee pain of some form or another – it’s an occupational hazard! We caught up with Dr Claire Minshull, a Rehabilitation and Conditioning Specialist, to learn how you can remedy a common type of knee pain – anterior knee pain.
The Dreaded Knee Pain!
Knee pain is a complex topic because it can occur for so many different reasons. One of the most common types of pain is anterior knee pain so we’re going to focus on this and look at how you can solve it, either as a Fitness Professional for your client, or just for yourself.
What Is Anterior Knee Pain?
Anterior knee pain (AKP), as the name suggests, typically presents as a pain or aching at the front of the knee. However, it can also radiate around to the back of the knee. It’s typically quite a diffuse pain, in that you’ll be unable to place a single finger over the source of the pain. If you were to show someone, you’d use the palm of your hand and indicate a generic area.
The pain/discomfort typically comes from the underside of the patella (knee cap), and the joint between the patella and the end of the femur (thigh) bone. This is also referred to as patellofemoral pain syndrome (PFPS).
How and Why Do You Get Anterior Knee Pain?
There can be numerous things that cause AKP. It may occur due to acute trauma e.g. falling on to a bent knee, but it is usually a pain that develops gradually and becomes worse over time.
You’ll notice it initially perhaps at the end of an exercise session. The symptoms then likely worsen, or present sooner and for longer periods, as the weeks progress.
The reason for this can be due to a slightly abnormal movement of the patella when the knee bends and straightens. This means that the patella fails to move properly along the groove in the femur as the knee bends and straightens under load. The patella often moves subtly more laterally (towards the outside of the knee) than it should, and this can be the cause of the pain.
Why does it do this? Muscle imbalance and poor biomechanics are some of the most common causes of AKP. If you imagine that your quadriceps all work together, pulling on the patella (and then tibia) to straighten the knee, if the muscles on the outside are more conditioned than the ones on the inside, then you might reasonably expect that the patella would be pulled more towards the outside.
Situations that might bring on this problem may be:
- An increased level or change in physical activity
- Change in footwear
- Deconditioning due to other injury
- A fall on to a bent knee
‘Poor’ biomechanics causes can include excessive internal rotation of the femur and pronation of the ankle (‘knock-knees’ and ‘flat feet’)
How Do You Know If You Have Anterior Knee Pain?
Think about when you experience pain and discomfort. Do any of the following sound familiar?
You feel pain:
- During sitting for prolonged periods where the knee is maintained in a bent position, for example during long car journeys
- Kneeling or squatting
- After exercise
- Ascending/Descending stairs
- Wearing high-heeled shoes (there’s a tendency not to fully straighten the knee when wearing these shoes)
Experiencing pain during any of the above activities can be indicative of anterior knee pain.
What Can You Do About It?
Immediately, straightening the knee may give some relief, as may the application of ice. If it’s not painful, make sure that you sit with your foot up above hip level so that the back of your knee can sag towards the floor. If you want to apply ice, make sure you don’t apply it directly to the skin and only apply it in 20-minute stints, no more than every 2-hours. These are short-term remedies of the symptoms, but not the cause.
In terms of the cure, the good news is that surgery is very rarely needed. A structured programme of exercises to condition the musculature around the knee, especially the vastus medialis will normally be sufficient to correct the problem. Likewise, exercises to remedy any excessive internal hip rotation can also help.
Some simple exercises that you can do to get you started include stretching and strengthening. Make sure you stretch your calf muscles, quadriceps and hamstrings regularly, holding each stretch for 20-30 seconds.
For The Knee:
Strengthening your vastus medialis is really important, but is quite difficult to do in isolation. However, there are several good exercises you can perform:
1) Single-Legged Mini Squats
Perform these with one foot flat on the floor and the other leg off the floor, slightly bent. Your foot should be turned out a little (ten to two on a clock face for the left foot and ten past two for the right foot).
When you squat down, make sure that you don’t bend your knee more than 40 degrees, as this will help you focus the majority of the work on the vastus medialis and help correct the movement of your patella.
Focus on control and feel the inside of your knee to check the muscle there is active.
2) Leg Press
Where possible, try this exercise single-legged. As above, focus on the last 40 degrees of extension to bias the vastus medialis (i.e. you’re not working through the whole range of movement).
Initially, aim for 8-10 repetitions maximum. You should be using a weight that is too heavy to lift, with correct form, more than 10 times.
3) Leg Extensions
As above, focus on the end-range of movement i.e. only working through the last 40 degrees of extension (see picture) and perform single-legged.
Aim for 8-10 repetitions maximum.
For The Hip:
Lie on your side and bend your hips to approximately 45 degrees and knees to 90 degrees. Make sure your hips are stacked on top of each other.
You then need to try bring your knee towards the ceiling whilst keeping your feet in contact with one another. Be careful not to let your hip position change – you may feel that you want to roll backwards.
At this point pause and return to the starting position.
Try to achieve 10 repetitions per set with good form. You can make this harder by using a resistance band wrapped around your knees.
Anterior knee pain often responds well to a change in activity and a programme of specific exercise therapy. If it doesn’t, then you might need a little more help to get over the problem, such as shoe inserts (orthotics) or taping to realign the kneecap.
Are you having problems with anterior knee pain or another injury? If so, I would love to hear from you. Get in touch with me at email@example.com to book a free Skype consultation.
Are you a fitness professional who works with injured clients? Fear not, there are range of courses available at www.getbacktosport.com and a free injury starter pack to download. E-mail me at firstname.lastname@example.org for a complimentary discount code.
About Dr Claire Minshull
Dr Claire Minshull is a Rehabilitation and Conditioning Specialist. She has spent the last 16 years doing research, teaching, and designing/implementing interventions to help rehabilitate and prevent injuries.
Claire is the founder of Get Back to Sport which provides access to leading rehabilitation and conditioning that is rooted in cutting-edge scientific research and years of experience working with professional athletes.
If you want to learn more about Claire and injury rehabilitation/prevention, visit www.getbacktosport.com where you will find a range of news articles on injury and musculoskeletal problems.
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