This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Pain over the front of knee in the medical world can be classified as 'Anterior knee pain' or 'Patellafemoral syndrome'
What does it mean?
Up to 25% of the active population will at some time present to a physiotherapist with this type of pain¹. This can have a significant impact on their daily function, causing pain on activities such as running, squatting and stair climbing. This condition can affect athletes and novice sports people alike and although it can occur at any age, is commonly seen in a young population, thereby affecting their enjoyment of their sport and having significant impact on fitness and lifestyle².
It is a condition that affects the knee cap (patella) and the structures surrounding and supporting it. The patella needs to track in a groove in the thigh bone as we bend and straighten our knee. Commonly, mal-tracking or a change to the biomechanics of the joint can change the forces acting on the patella and its surrounding structures, causing pain and loss of function. To make things more complex, many different structures at the front of the knee can be the cause of this pain, including the fat pad, bursa, tendon and cartilage.
What structures to treat?
This type of knee pain is challenging to treat because normally caused by a combination of factors. A thorough assessment of the anatomy of the lower leg and how it is working is needed to understand each individual presentation². A physiotherapist will assess the strength and length of the muscles surrounding the knee as well as the joint itself and movement patterns of an individual to identify the potential causes of the knee pain.
What treatment options are there?
A physiotherapist can assess you for the appropriateness of many different treatment options. Identifying and targeting your rehab programme for the specific muscles that you are weak in has been shown to be effective in reducing pain² Working on the patella itself and releasing surrounding soft tissues can provide pain relief. These techniques, if useful can also be taught to you to do independently at home.
Recent evidence has suggested that taping techniques can be a useful adjunct to other treatment options for anterior knee pain. The tape can help to improve muscle control around the patella and reduce pressure going through the patella, allowing effective rehabilitation and exercise progression4. If a success then the surround patella strap is a good purchase shown below. (sold by www.orthopaedicsandtrauma.com).
http://www.orthopaedicsandtrauma.com/acatalog/Patellofemoral_Braces.html
An assessment of your lower limb kinematics (the relationship between the hip, knee, foot and ankle and how they move) can be useful in identifying areas of weakness or poor movement. Your footwear is an important part of this chain and should be fitted to your needs and changed when they reach their fatigue point.
The over-riding message….
Identify and seek advice and treatment early for anterior knee pain from a qualified physiotherapist. When pain in the body is present for more than 6 weeks it can be termed chronic and then is much harder to cure. Ensure that any changes to your training regime are done slowly and with adequate time for your body tissues to adjust. Don't assume that after a period of time off (that includes Christmas holidays!) that you will be able to pick up your training at the same intensity and frequency as a few weeks back.
Try to ensure that core strength and muscle tone and flexibility are kept to an optimum to allow you the biomechanical advantage for impact activities such as running.
TRAUMATIC CAUSES OF ANTERIOR KNEE PAIN
Knee cap
Three main injuries can occur to the knee cap and include the following:
1) Fracture of knee cap - will result in extensive pain and swelling and the pain will be located to the knee cap when feeling
2) Rupture of the patella tendon – this tendon passes from the end of the rectus femoris muscle over the knee cap and inserts into the front of the top of the lower leg (tibia). If the tendon is ruptured it will cause sudden onset of intense pain, standing will be difficult and the knee will not be able to be straightened. The knee cap will move position.
3) Knee cap dislocation – this is when the knee cap moves out of its normal position. It will feel like the knee cap popped out. Sometimes the knee cap will reposition itself back alone or may require medical assistance to relocate it. Pain will be intense and swelling will begin immediately.
With the above 3 traumatic causes of pain over the front of the knee a medical review will be required and we can recommend top London knee consultants in this case. The decision will be made by the consultant whether a brace needs to be worn or surgery carried out. In all cases physiotherapy is very important to take you through a specific rehabilitation programme to reduce swelling and regain movement, strength and stability in the knee. They will be able to gradually progress you back to sport as you become physically able.
Posterior Cruciate Ligament (PCL) Tear
The PCL is one of the 4 main ligaments of the knee. It is located deep within the knee joint and joins the bottom of the thigh bone (femur) to the top of the lower leg (tibia). It is important for stability of the knee and can be torn or even ruptured if there is a direct hit to the lower leg while the knee is bent or if the knee is pushed backwards. The pain is most often felt at the back of the knee and not easy to pinpoint exactly where it is coming from. Swelling does not often happen if injured. Your physiotherapist will be able to perform tests to determine whether this ligament has been injured and the severity of the injury. If the tests show significant injury to the ligament or even possible rupture a medical review with a top London knee consultant will be required. The consultant will investigate the problem and decide whether to operate to repair the ligament or treat with physiotherapy only.
Physiotherapy is vital to your recovery in respect of taking you through a specific rehabilitation programme whether the decision was to operate or not. This programme will help to reduce swelling, regain movement, strength and stability in the knee. They are experts in gradually returning you back to your sporting activities when you are physically ready.
Anterior Cruciate Ligament (ACL) Tear
The ACL is one of the 4 main ligaments of the knee. It is located deep within the joint with the PCL and joins the bottom of the thigh bone (femur) to the top of the lower leg (tibia). It is important for stability of the knee and be torn or even ruptured from activities that involve twisting the leg with foot planted or decelerating suddenly. Symptoms often include intense pain, extensive swelling and feeling of pop or something moving within the knee. It will be too difficult to continue with the activity you are doing and there will be a feeling of the leg giving way with activity. The pain can be felt in the back of the knee also. If this injury is suspected a medical referral is required. We can recommend top London knee consultants to see in this case. Depending on a number of factors and the extent of the injury to the ligament the consultant will make the decision whether to operate or not.
Physiotherapy is vital to your recovery in respect of taking you through a specific rehabilitation programme whether the decision was to operate or not. This programme will help to reduce swelling, regain movement, strength and stability in the knee. They are experts in gradually returning you back to your sporting activities when you are physically ready.
OTHER POSSIBLE CAUSES OF ANTERIOR KNEE PAIN
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related.
Complex Regional Pain Syndrome
This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The knee can be affected by this syndrome and the symptoms can extend up or down the leg. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. 'The sympathetic nervous system' has been shown to be involved which controls blood flow and skin temperature.
Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top London pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.
Medically related possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
CONTACT US NOW TO HAVE A PHYSIOTHERAPIST COME TO YOU
Leanne Priestley
www.physiocomestoyou.co.uk
References:
1. McConnell J (1996) Management of Patellofemoral Problems. Manual Therapy.1: 60-66.
2. 2. Witvrouw et al (2003) The effect of exercise regimens on reflex response time of the vasti muscles in patients with anterior knee pain: a prospective randomized intervention study. Scand J Med & Sci in Sports. 13: 251-258.
3. Powers CM (2003) The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Ortho & Sports Phy Ther. 33: 639-646.
4. Chen et al (2008) Biomechanics Effects of Kinesio Taping for Persons with Patellofemoral Pain Syndrome During Stair Climbing. IFMBE proceedings. Vol 21 (3): Part 7: 395-397.
