Anterior Knee Pain

Ever Experienced Knee Pain?

Well take a mo and have a read. 

Pain or discomfort in or at the front of the knee has been proven by Sports Therapists to be possibly the most common presenting symptom in a sporting or fitness environment.

Therefore I’ve been asked by the personal training team at Vibe Fitness Bath to share my experience and knowledge on anterior knee pain (AKS).

It could be said that most of us take our knees for granted so perhaps it’s important to understand the anatomy, the function and generally what the knees have been doing for the human body since we evolved from Homo Sapiens (sorry for any provoked yawning at this stage).

The Knee Joint Outside and Front View:

The knee joint is the largest and one of the most complex joints of the body, although it is classed as a hinge joint (similar to the elbow joint) it has 3 separate articulations which is how it makes two connections (articulations) from our femur (thigh bone) to the major bone in our shin (tibia) and the 3rd articulation from the femur to the patella (knee cap) known as Femorotibial and Femoropatellar. 

We rely heavily on this remarkable joint to stand, walk, run, sit and even kneel!

The majority of our joints cannot withstand these regular extremities to the extent of which the knee joint can.

A healthy knee secures the incompatible functions of stability and mobility because of its interaction of ligaments, muscles and tendons allowing complex movements at the surfaces of the 3 articulations I have talked about. Further to this we have the menisci (cartilage) these structures increase the quality of the complex knee, participating in weight bearing, acting as a shock absorber and aiding in joint lubrication.

An unhealthy knee can struggle however, with any part of these crucial structures failing and causing joint misalignment and instability, in turn leading to one possible symptom which is AKS.

The causes of AKS are varied but two of them are more frequent than others in the practice of sports medicine and I treat these two conditions on a regular basis.

Patella Femoral Syndrome (formally known as Chondromalacia Patellae) and Patellar Tendinopathy (known generally as tendinitis).

At this point my job as a Sports Therapist is to distinguish between the two conditions and rule out other less common causes, this is absolutely crucial to the recovery of the patient.

That might sound like I’m pointing out the obvious, but with these two injuries the symptoms can be very similar, they can both be apparent at the same time and furthermore one rehabilitation style for Patellar Tendinopathy can severely aggravate the symptoms of Patellar Femoral Syndrome.

So finding the cause of AKS is paramount and I can do that by taking a history with the patient, plus an observational and physical examination which include special clinical testing.

If you are experiencing AKS or you are a personal trainer and have clients that are, then take note of the following two most common diagnosis and the subsequent symptoms which you may find interesting:

These two conditions can be treated conservatively with hands on manual therapy and a rehabilitation program specific to each injury, there is no one rehab program that fits all complaints of AKS.

Patella Femoral Syndrome has been commonly labelled as “Runner’s Knee”, running can be a cause of it but there are others as seen in the table above.

A Sports Therapist can determine what is causing it and if it is running then resting from that activity will be needed at the start of the recovery, but complete rest from all activity is not always necessary.

Hands on treatment will be specific to the injury which in Sports Therapy may involve massage, mobilising, ultrasound, passive stretching and exercise therapy.

There are also less common conditions that create AKS such as Synovial Plica, Osteoarthritis, Osgood Schlatters Disease, Sinding-Larsen-Johansson Syndrome, Quadriceps Tendinopathy, Bursitis and Excessive Lateral Pressure Syndrome.

AKS does not have to be the end of your participation in sport or exercise regime, but the knee needs to be assessed and treated as early on as possible.

Otherwise I have seen how recovery can take longer in all conditions and if the severity of cases worsens then unfortunately surgery may be needed if it is too late for conservative treatment.

For all those with healthy knees, prevention is key; allow your knee joints to maintain a balance of flexibility and strength.

The following can be part of that:

• Warm up and cool down
• Stretch regularly
• Foam Roll
• Assure Correct Technique in squatting and lunging (listen to your professionals)
• Get out of bad habits at work (crossing legs, sitting too long etc)
• Take care of the position of your knees when driving, gardening and doing house work
• Asses if your foot wear leads to your leg muscles tightening or knee joints stiffening

Be kind to your knees and they will continue to work incredibly hard for you.

Adeleine Blackman