Having pain in the front of the knee when you come down the stairs? Pain when you perform a deep squat (i.e. asian squat) or pain when you jog? Is it serious? Are you able to continue jogging?
What is happening? I didn’t fall or hurt myself! I just continued to be…me.
Patellofemoral pain syndrome, chondromalacia patella, lateral patellar tilt, anterior knee pain etc. are sometimes synonymously used to describe the same thing — pain in the front of the knee.
You might typically experience pain coming from the back of your knee cap i.e. the bone that sits between your thigh and leg and takes your weight when you kneel. Yes, that one! This condition is termed patellofemoral pain (PFP).
You don’t have to fall or take a hit before you experience pain there (though you may). Surprisingly (or not), it is very common in young and active populations who are involved in sports that require repeated bending and straightening of the knee, such as jumping, landing, running or stair climbing.
But I’ve always been engaging in those activities… So why now? And why this?
Why does it happen?
There are several contributing factors that can increase stress at the knee and cause PFP. For instance, some factors include weak or tight lower limb muscles, lack of control of the lower limbs, suboptimal lower limb movement pattern, ill-fitting footwear, body weight and bony or structural anomaly. A sudden increase in physical activity or high intensity training programmes may predispose you to such pain. It could sound like this: “The pools and gyms are closed due to the Circuit Breaker BUT I still need my cardio. So I went jogging instead…everyday for 5km. Oh yes, I forgot to add that I don’t usually run. I only swim and use the elliptical. What’s wrong?!”
Well, it’s great that you try to remain active despite the restrictions…but herein lies the problem — there is a sudden change in your activity levels and your body (in this case, your knee) is not used to the load and activity that you’re putting it through. You have essentially overloaded your knee joint, causing you to have knee pain!
Even climbing down the stairs hurt! Is there anything I can do?
For the geek in us, studies have shown that patients who received supervised Physiotherapy interventions that include exercise therapy and proper education for self-management, have better outcomes and lowered risk of future or recurrent PFP. It has been demonstrated that a combination of both hip and knee exercises is the most helpful for the management of PFP. One-third of the people with PFP may have persistent knee pain lasting 12 months from their initial diagnosis due to delayed treatment. Hence, the faster you get your knee treated, the better the outcome will be!
Physiotherapists at PhysioX will take a detailed history about your pain and how it started. They will also assess how you perform your daily tasks, to identify the source and cause of your pain — you might be surprised that the source of your knee pain could actually be from your hip! Factors that contribute to PFP (as explained above) can be corrected using exercise, manual therapy, taping, as well as education to help manage your pain.
Your Physiotherapist will also advise you on the management of your pain in the short and long term — i.e. loading your knee in a pain-free manner, footwear changes, how to progress and regress exercises based on your symptoms etc. This helps you to take charge of your own condition, while still keeping an active lifestyle. The last thing you want to hear from a Physiotherapist is to stop moving and rest, or worse — that you cannot run…FOREVER!
DISCLAIMER: These exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve with these exercises. Your Physiotherapist will choose exercises that suit your specific needs.
Ashton, T. (2020, September 10). Patellofemoral Pain Syndrome. Rural Physio at Your Doorstep. https://physiodirectnz.com/patellofemoral-pain-syndrome/.
Lankhorst, N. E., van Middelkoop, M., Crossley, K. M., Bierma-Zeinstra, S. M. A., Oei, E. H. G., Vicenzino, B., & Collins, N. J. (2016). Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. British journal of sports medicine, 50(14), 881-886.
Nascimento, L. R., Teixeira-Salmela, L. F., Souza, R. B., & Resende, R. A. (2018). Hip and knee strengthening is more effective than knee strengthening alone for reducing pain and improving activity in individuals with patellofemoral pain: a systematic review with meta-analysis. journal of orthopaedic & sports physical therapy, 48(1), 19-31.
Winters, M., Holden, S., Lura, C. B., Welton, N. J., Caldwell, D. M., Vicenzino, B. T., … & Rathleff, M. S. (2021). Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. British journal of sports medicine, 55(7), 369-377.
Filed under: Knee