Knee pain

Chances are that some of the Help the Hospices team will end up with some sort of knee pain over the next few months. Here's our definitive guide to the symptoms and some solutions.

Anterior knee pain (AKP), is a term used to encompass a whole range of painful conditions which affect the anterior aspect of the knee. It is generally concerned with problems related to the Patellofemoral joint i.e. that joint between the under surface of the Patella (knee cap) and the lower end of the Femur - your thigh bone. For this reason, it is also termed ‘Patellofemoral pain syndrome'.

There are some depressing findings, for runners, relating to AKP, such as it is the most common symptom which runners present with, it is the most common overuse injury in sports people and it is high on the list of injuries seen in sports clinics.

So, the questions arising may be: What is it? How is it caused? Can it be treated?

Some back ground info is needed first to allow understanding of this unfortunately common condition.

The patella (knee cap), is a piece of free- floating bone situated within the body of the Quadriceps tendon. It acts as a pulley to allow the Quads tendon to run smoothly and efficiently over the front of the thigh to move and control movement of your Tibia (shin bone).

As the knee bends and straightens the patella tracks up and down groove on the front of the lower end of the Femur (thigh). It is guided and held in place by a number of structures including contractile i.e. muscle and non contractile structures such as the ligaments at the front of the knee (retinaculum) and the patella tendon. Other factors also figure in the equation such as the shape of the patella itself.

Problems arise, when these structures fail in their function or alter how the patella moves.

Other contributory factors which affect the mechanics of the how the patella moves include alignment of the leg and thus how forces when you run are transmitted from the foot .So, over pronation of the forefoot for example, stiff hip joints, tight hamstrings, calf and Quads muscles and poor Quads function and strength, particularly the portion of the Quads known as VMO, all affect the mechanics of the joint and how the patella is loaded during running. You might equate this to having poor tracking on a front tyre of your car which leads to uneven wear of the tyre.

Problems arise as the Patella cartilage is damaged, when load is distributed inadequately across the Patella under surface. This may then lead to trauma and inflammation to the cartilage, which causes pain and possible degeneration of the articular cartilage. Pain may also arise from soft tissue structures around the knee, such as the fat pad which lies just under the Patella (and gives rise to a ‘puffy' knee) and irritation to the nerves supplying the knee joint.

Symptoms

• Pain is typically felt over the front of the knee without being able to pinpoint the source.

• Usually pain is felt during and after running
- it may be acute enough to limit distance or not allow any running at all.

• Pain is often felt when going up or down stairs or squatting.

• ‘Creeking' under the Patella may be noticeable.

• Stiffness and swelling around the Patella may present.

• Possible loss of muscle bulk in the Quads.

• ‘Puffy' knees.

Treatment

Initially, treatment is directed toward reducing the inflammation . The Physiotherapist may use a number of different treatment modalities to do this, such as TENS, interferential, acupuncture along with rest from activities that aggravate the problem.

When able treatment will be directed toward improving the mechanics of the lower limb , for example implementing a programme of stretching for muscles, possibly stretching the retinaculum, along with orthotics as and when necessary.

Strengthening of the Quadriceps muscles is also an important part of the rehabilitation process. This may often be directed toward the VMO, along with restoration of your spatial awareness system (proprioception).

The important message again here is not to ignore your symptoms, and seek the advice of a professional sooner rather than later.