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There are 2 common causes of pain at the front of the knee; patello-femoral pain syndrome (PFPS) and patellar tendinopathy.  Distinguishing between the 2 is often difficult  and occasionally they may both be present

 

PFPS commonly affects runners or those who incorporate running into their training program.  It is caused by the patella (knee cap) not tracking correctly over the femur (thigh bone).  The patella normally rides in a notch  on the femur and levers the big  muscles on the front of the thigh, the quadriceps.  With PFPS, there is an imbalance of these muscles – usually the outer/lateral muscle overpowers the inner/medial muscle – which causes the patella to track outside of its normal notch.  This causes pain underneath the patella.  Foot posture may contribute by allowing the knee to internally rotate.

 

Patella tendinopathy is commonly referred to as jumpers knee but may also occur in agility based sports. Pain is generally located at the inferior pole of the patella and is related to tightness in the quadriceps, hamstrings and weakness in the calves.  A strengthening program must be incorporated in treatment.

 

What to look for?

 

• Pain whilst running or after running

• Pain under or around the knee cap

• Pain is often worse after activity that involves knee bending – running, stairs, squats, lunges, down thrust on cycling etc

• Feeling of instability and/or pain whilst ascending/descending stairs. 

 

What can I do about it?

 

• Activity modification – stop the aggravating activity. Maintain fitness with activities that don't cause pain. 

• Strapping to support and better track the patella across the femur

• Suitable orthoses to control contributing biomechanical factors

• Appropriate footwear for both foot type and activity

• Stretching and strengthening program aimed at correct firing of the quadriceps

• Ice over the knee when pain is severe.

 

Advice from your podiatrist with assistance from a physiotherapist will guide you through this debilitating problem.