We know that some of you may have had the misfortune to suffer from anterior knee pain during lockdown and we are here to help!
Anterior knee pain (AKP), also known as patellofemoral pain (PFP), appears as the second most common complaint for individuals presenting to physiotherapy or sport medicine clinics after back pain. AKP is described as pain arising from the anterior or retropatellar knee region that increases with activities such as running, squatting, stair ambulation, hopping and jumping. Studies report a high incidence in active populations, with females, particularly young females, affected more often than males. Pain influences short- and long-term prognosis requiring clinicians to deliver early interventions.
What is the best treatment ?
Multimodal physiotherapy can significantly reduce AKP. This includes manual therapy, acupuncture, taping and exercise therapy. However, with the sudden escalation of the Covid-19 global emergency, either physiotherapy clinics are less accessible, or your medical conditions may prevent you from attending a face-to-face consultation. This could represent a problem especially for those experiencing severe symptoms.
So how can you manage your AKP?
We will list three important bits of advice for managing in autonomy this common musculoskeletal injury.
Firstly, try performing regular low resistance cycling. It is believed that the articular cartilage is often involved in the onset of pain and early degenerative cartilage changes can be observed during MRI scans in people with AKP. Additionally, the cartilage is avascular (meaning it does not have blood supply) so massage or heat will not work. Yet, performing low-resistance cycling can help stimulating the cartilage cells to reproduce, preventing further degeneration and pain.
Secondly, carry out knee strengthening exercises. As a general principle, the stronger your knee muscles, the less patellofemoral joint stress. Squatting, stepping, or lunging exercises are our favourite, and they are particularly useful to improve ‘patellar tracking’ when there is a patellar misalignment underpinning the pain.
Lastly, make sure to perform a lot of gluteal muscle strengthening work. Abnormal hip joint movements are associated with AKP as weak gluteal muscles are observed in people with this problem. This seems to promote knee valgus, which is when your knee collapses inward, during single leg bending activities. Knee valgus has a significant impact on AKP because it increases patellofemoral joint stress, and therefore pain. Gluteal muscle strengthening exercises are shown to improve the alignment of the hip, knee and ankle joints when you move your legs, which in turn will decrease patellar stressors and pain. Good example of exercises are the single leg bridge, side plank and clamshell.
The American Collage of Sport Medicine states that for strength development you will need to carry out for each knee and hip exercise at least 3 sets of 8 to 12 repetitions, 3 times a week and rest about 2min between each set.