I decided to write this article on knee pain, as it is something I see frequently, as well as deal with myself.
Knee pain is a common experience for many people and has a variety of possible diagnoses. The most common amongst these are patellofemoral pain syndrome, osteoarthritis, patella tendinopathy and a range of juvenile disorders such as Osgood-Schlatters. There are also multiple traumatic injuries which can occur around the knee, which are commonly seen on the sporting field, such as ACL, PCL, MCL, LCL and meniscus injuries.
Physiotherapy treatment has demonstrated assistance with all of these disorders, and generally will have great results.
I will now focus in on, arguably, the most common cause of knee pain, patellofemoral pain syndrome, which was estimated by Boling et al (2010) to affect up to 15% of females and 12% of males. Patellofemoral pain syndrome, or PFPS for short, is a disorder generally affecting the soft tissue of the patella (kneecap) and underlying joint surfaces, the femur and tibia. Symptoms, however, can arise from any structure in the knee (see Figure 1).
Figure 1 – Patellofemoral joint anatomy
The primary symptom is a diffuse pain, often felt around the sides or behind the kneecap, which is generally worse on bending, squatting or going up stairs, as well as sitting for long periods of time (often called the ‘movie sitters’ sign). There can be occasional stiffness, usually felt first thing in the morning.
As aforementioned, women are more prone to PFPS, with the same study suggesting women are 2.23 times more likely than men to develop PFPS. This is likely due to a number of biomechanical factors, such as pelvic, hip and knee joint angles.
There are many reasons why PFPS develops. Primarily though it is thought to be due to patella maltracking, brought on by factors at the knee joint itself, but also at the joints above and below. The multifactorial nature of PFPS is reflected in the physiotherapy treatment commonly provided. Treatment may consist of RICER, analgesia (pain-killers), exercise rehabilitation, movement retraining, taping and foot orthoses.
A recent systematic review (Lack et al (2015)) looked into the growing pool of evidence surrounding proximal strengthening in the treatment of PFPS. The results of the review displayed strong evidence to support the efficacy of proximal, combined with quadriceps, exercise on improving pain and function in the short, medium and long term. The study was unable to determine a specific protocol for intensity and duration of rehab sessions, though suggested pain-free exercises (generally open kinetic chain (OKC)) be undertaken initially.
Figure 2 – Common biomechanical faults
What does that mean for you as a knee pain sufferer?
Well it means that although massage, dry-needling, taping and other modalities will help with pain in the short term, the real key to long term relief of PFPS is exercise! Specifically gluteal and quadriceps exercises.
There are a slew of exercises I find to be very effective in the treatment of PFPS, as well as recently adding a couple of new exercises learned during time I spent with the Kookaburra’s.
If you yourself is struggling with knee pain, know someone who is or have any questions please don’t hesitate to comment below or message me.
Knee Pain – by Jack Connelly (Roar Physiotherapist)