This is one of the most common conditions I see as a sports physiotherapist in my clinic. Patients generally describe a deep ache in the front of the knee. It is often felt ‘underneath’ the patella (kneecap). The pain is generally worse with activity which requires repeated knee flexion. Activities which make the pain worse include walking up or down stairs or hills, squatting and sitting for prolonged periods with the knee bent. The good news for people with this type of pain is that it generally does not mean that there is a structural problem with the knee.
The pain is generally precipitated by a change in activity level as well as a number of biomechanical predisposing factors. Athletes with this type of pain may have tight muscles, be relatively weak or have anatomical problems – for example pes planus (flat feet). The pain generally improves or resolves when these are addressed. The following program is a good starting point to treat this problem. It can be personalised to your exact needs if you are not seeing the improvement you would like.
Exercycle Program I feel, and research agrees, that this the single most important part of the rehabilitation program for patellofemoral pain. The idea is to set the bike up so the saddle is a little higher than you would normally like. This limits the amount of knee flexion you are working with. Aim to spin on the bike at a very low resistance (easy) and high cadence (aim of 80-90 revolutions per minute) for 30 minutes. Think ‘polishing the knee’ rather that getting a big cardiovascular workout. Try to do this everyday if possible. You can increase the resistance as you get comfortable with this. Keep the resistance constant rather than doing repeated intervals of higher intensities.
Muncie (Quads) Exercise This exercise was developed specifically for the rehabilitation of patellofemoral symptoms. Sit on the floor and flex the unaffected knee until the heel of the foot is in line with the painful knee. Lean forward and hug your good knee. Keeping the painful knee extended pull your ankle back towards you and turn your foot out to either 2 or 10 o’clock (depending on whether you are working on your right or left knees). Lift the heel up off the ground and hold for 5 seconds. Repeat this 20 times per day. To make the exercise easier pull the heel closer to your butt. To make it harder slide the heel away from your butt. Be sure and stay leaning forward. If you can’t find a place on the floor to do these then just sit on the edge of your chair with the affected leg out straight in front of you and repeat the above. There is no need to hug the knee in this position but you are able to lean slightly forward as above.
Gluteal (Butt) Exercise Lie on your side fully stretched out. You should lie on the opposite side of the hip you are trying to strengthen. Flex the top hip and knee until your foot is resting on the lower knee. Lean forwards onto your top arm. You should be in the position shown below. From this point slide the top knee a few centimetres away from you. Lift this knee 5cm off the ground and hold this for 5 seconds. I tell my patients to try and join ‘the 100 club’… i.e. to do 5 sets of 20 reps through a day! As with all problems it is important to have an accurate diagnosis to make sure that the rehabilitation is going to be successful.
If you are unsure about your diagnosis or are not getting better as quickly as you would like, make sure you book yourself in to see a physiotherapist or sports doctor. You can find me at my clinic The Body Refinery in Newmarket, or our new location in St Heliers, Auckland.