Anterior Knee Pain

Anterior knee pain is one of the most frequently seen symptoms in the clinic at Sports Physio Ireland. Common causes of this pain in athletes and the general population is patellofemoral pain syndrome. Another common cause mainly in sportspeople is patellar tendinopathy (injury to the tendon running from your knee cap to the front of your shin). Osgood Schlatter’s disease is often the cause of anterior knee pain in young athletes. If a sudden growth spurt occurs the plate can overgrow and cause irritation of the insertion of the patellar tendon.

 

Patellofemeral syndrome is generally the result of a movement or mechanical abnormality. Whereas patellar tendinopathy is generally caused by overuse but mechanical abnormalities may predispose the tendon to being stressed excessively.

 

Distinguishing between the two is sometimes difficult as the clinical signs and symptoms can be similar. Running downhill, steps and repetitive activities like distance running are the common aggravating activities at the onset of pain in patellofemoral syndrome, although it may present in the sedentary population with gradual onset or after a dramatic episode such as falling on the knee. Patellar tendinopathy is mainly brought on by a history of repeated loading of the patellar tendon such as jumping and landing. The specific location of the pain is the main determining factor between the two injuries.

 

Knee injury associated with pain and or swelling may result in the quads not firing correctly. This can set up imbalances on the forces acting on the knee cap, with a tendency to patellofemoral pain. The same is true with excessive tightness of the IT band and hip muscles that could also cause your knee cap to be pulled outwards. More commonly, it’s weakness in the glutes that results in your hip and knee dropping in. Causing the structures on the outside of the knee to be in a lengthened position and pull on the knee cap.

 

The majority of the client’s that come in with knee pain tend to be knee and quad dominant which means they load these structures excessively during everyday movements. If the glutes are not activated then there can be excessive force through the knee, creating irritation at the back of the knee cap on the thigh bone. This is purely due to overuse and degeneration of the structures. If the knees are painful, using the glutes to offload them is a key component of retraining movement patterns.

 

Examination will include a thorough history taking, observation, palpation, special tests and functional tests to determine the cause of the client’s pain. For an example a squat done on a decline will stress the patellar tendon more and is therefore more specific to patellar tendinopathy.

 

Treatment will depend on the underlying cause of the pain and may focus on lengthening structures in one person and strengthening of the quads or glutes in another. One of the main components of the treatment is looking at how the individual naturally moves and ensuring they are not loading their knees excessively.

 

Catherine Simpson

MISCP, MSc. Sports Medicine

www.sportsphysioireland.com

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Iliotibial Band Syndrome-Lateral Knee Pain

Iliotibial (IT) Band Syndrome, or Lateral Knee Pain is an overuse injury caused by friction and compression of the structures between the IT band and the outside of the knee. Training errors and biomechanical abnormalities are some of the factors that predispose to IT band syndrome.

It is commonly an issue seen in cyclists, runners, army recruits and endurance athletes. IT band syndrome accounts for 15- 24% of overuse injuries in cyclists and 1.6 – 12% in runners. Pain generally worsens the longer the person persists with the sporting activity and may be associated with local swelling and inflammation of structures between the band and the inside of the knee.

A full assessment should be carried out to rule out other causes of lateral knee pain such as lateral hamstring tendinopathy, degeneration of the lateral meniscus of the knee, osteoarthritis of the lateral compartment of the knee or referred pain from the low back.

A general misconception is that the IT band can be stretched; when in fact it is just a thickening of the fibrous tissue that surrounds the thigh like a stocking and is restricted by strong attachments to the lateral side of the knee. The TFL (tensor Fascia lata) and ¾ of the gluteus maximus muscles insert into the IT band and it is these muscle that should be targeted to reduce the tension in the IT band and therefore leads to compression of the inside of the knee.

Manual soft tissue therapy through foam rolling, stretching and trigger point release of the hip musculature are useful techniques to reduce the tension through the IT band and relieve the irritation of IT band syndrome.

Catherine Simpson

MISCP MSc. Sports Medicine

 


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