Knee pain is 1 of the most common types of knee pain, particularly among athletes, active teenagers, older adults, and people who do physical labor. Patellofemoral pain is the most common in active individuals, and osteoarthritis is second but more common in the elderly population. Patellofemoral pain affects more women than men and accounts for 20%-25% of all reported knee pain.
What is Patellofemoral Pain or Anterior Knee Pain?
- Weakness, tightness, or stiffness in the muscles around the knee
- An abnormality in the way the lower leg lines up with the hip, knee, and foot
These conditions can interfere with the ability of the patella to glide smoothly on the femur (the bone that connects the knee to the thigh) during movement. The friction between the under-surface of the patella and the femur causes the pain and irritation commonly seen in PFPS.
PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, running, stair climbing, squatting, or repeated carrying of heavy loads. If you are older, you might have age-related changes that cause the cartilage on the under-surface of the patella to wear out. The result is pain and difficulty completing even the simplest daily tasks without pain.
Usually, patellofemoral pain is worse when you walk up or down hills or stairs and on uneven surfaces. This pain tends to increase with activity and improve with rest. You also may:
- Feel pain after sitting for long periods of time with the knee bent
- Occasionally hear or feel a “cracking” or “popping” when you bend or straighten your kne
How Is Patellofemoral Knee Pain Diagnosed?
Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Physical therapists use tests such as the patellar apprehension test, the Q-angle test, the patella alta test, and Clarke’s sign (patellar grind test) to determine whether the patellofemoral joint is the source of pain.
In addition, your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Finally, your therapist will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.
Generally, x-rays are not needed to diagnose PFPS.
How Can a Physical Therapist Help Treat Patellofemoral Knee Pain or Anterior Knee Pain?
- Strengthening exercises targeted at the hip (specifically the abductor and rotator muscles of the buttock and thigh), the knee (specifically the quadriceps femoris muscle, which is located on the front of your thigh and straightens your knee), and the ankle
- Stretching exercises for the muscles of the hip, knee, and ankle
- Taping of the patella to reduce pain and retrain muscles to work efficiently
- Exercises for improving your performance of activities that have become difficult for you
If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by excessive rotation or impact during walking and running.
If your pain is persistent, your physical therapist may:
- Have you try a lightweight brace
- Use pain-reducing treatments such as electrical stimulation
- Recommend that you apply ice or heat at home for relief
Your physical therapist will work with you to help you stay active and maintain your fitness level. You may need to modify your activity level or change your training activities until you recover; your therapist will show you how to do activities and exercises that will not increase your pain. Most important, your therapist can make recommendations to help prevent PFPS from returning.
Can Patellafemoral Knee Pain be Prevented?
What is Osteoarthritis of Knee?
Osteoarthritis of the knee (knee OA) is a progressive disease causing inflammation and degeneration of the knee joint that worsens over time. It affects the entire joint, including bone, cartilage, ligament, and muscle. Its progression is influenced by age, body mass index (BMI), bone structure, genetics, strength, and activity level. Knee OA also may develop as a secondary condition following a traumatic knee injury. Depending on the stage of the disease and whether there are associated injuries or conditions, knee OA can be managed with physical therapy. More severe or advanced cases may require surgery.
How Does Osteoarthritis of the Knee Feel?
- Worsening pain during or following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position
- Pain or stiffness after sitting with the knee bent or straight for a prolonged period of time
- A feeling of popping, cracking, or grinding when moving the knee
- Swelling following activity
- Tenderness to touch along the knee joint
Typically these symptoms do not occur suddenly or all at once, but instead they develop gradually over time. Sometimes individuals do not recognize they have osteoarthritis because they cannot remember a specific time or injury that caused their symptoms. If you have had worsening knee pain for several months that is not responding to rest, it is best to seek the advice of a medical provider.
How Is Knee Arthritis Diagnosed?
How Can a Physical Therapist Help Treat Osteoarthritis of the Knee?
Range of Motion
Often, abnormal motion of the knee joint can lead to a progression of OA when there is more contact between, and wear on, the bones. Your therapist will assess your motion compared with expected normal motion and the motion of the knee on your uninvolved leg.
Strengthening the muscles around your knee will be an essential part of your rehabilitation program. Individuals with OA who adhere to strengthening programs have been shown to have less pain and an improved overall quality of life. There are several factors that influence the health of a joint: the quality of the cartilage that lines the bones, the tissue within and around the joints, and the associated muscles. Due to the wear and tear on cartilage associated with knee OA, maintaining strength in the muscles near the joint is crucial to preserve joint health. For example, as the muscles along the front and back of your thigh (quadriceps and hamstrings), cross the knee joint, they help control the motion and forces that are applied to the bones.
Strengthening the hip and core muscles also can help balance the amount of force on the knee joint, particularly during walking or running. The “core” refers to the muscles of the abdomen, low back, and pelvis. A strong core will increase stability through your body as you move your arms and legs. Your physical therapist will assess these different muscle groups, compare the strength in each limb, and prescribe specific exercises to target your areas of weakness.
Physical therapists are trained in manual (hands-on) therapy. Your physical therapist will gently move and mobilize your muscles and joints to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own. In patients with knee OA, the addition of manual therapy techniques to exercise has been shown to decrease pain and increase function.
Your physical therapist may recommend therapeutic modalities, such as ice and heat, to aid in pain management.
Compressive sleeves placed around the knee may help reduce pain and swelling. Devices such as realignment braces are used to modify the forces placed on the knee. These braces can help “unload” certain areas of your knee and move contact to less painful areas of the joint during weight-bearing activities.
Physical therapists are trained to understand how to prescribe exercises to individuals with injuries or pain. Since OA is a progressive disease, it is important to develop a specific plan to perform enough activity to address the problem while avoiding increases in stress on the knee joint. Activity must be prescribed and monitored based on type, frequency, duration, and intensity, with adequate time allotted for rest and recovery. Your physical therapist will consider the stage and extent of your arthritis and prescribe an individualized exercise program to address your needs and maximize the function of your knee.
What if I Need Knee Arthritis Surgery?
In some cases of knee OA, the meniscus (shock absorber of the knee) may be involved. In the past, surgery to repair or remove parts or all of this cartilage was common. Current research, however, has shown in a group of patients who were deemed surgical candidates, 60-70% of those who participated in a physical therapy program, instead of surgery, did not go on to have surgery. Further, after 1 year those outcomes were unchanged. This study suggests that physical therapy may be an effective alternative for those patients who would like to avoid surgery.
Sometimes conservative management strategies are not successful. When these strategies fail surgical intervention such as arthroscopy or a total knee replacement, may be recommended. There are many factors to consider when determining the appropriate surgical treatment, including the nature of your condition, and your age, activity level, and overall health. Your physical therapist will refer you to an orthopedic surgeon to discuss your surgical options.
BECOMING PAINFREE IS EASIER THAN YOU THINK
Call our expert team.
We’ll work with you to find and treat the root of your pain.
Get back to doing what you love.