Download Anterior knee pain

PATIENT INFORMATION
Anterior knee pain
Femur
(b)
Knee
Patella
(a)
Problem area of
‘wear and tear’
Quadriceps exercise: Tighten muscle
by straightening the knee to position
(a) from the relaxed position (b)
What is anterior knee pain?
It is a variety of knee pain in which the
discomfort is felt in the front of the knee in
and around the kneecap (called the patella).
The usual cause is a relatively non-serious
condition called “chondromalacia patella,”
also known as the patella-femoral syndrome. There are other causes of anterior
knee pain but this is by far the most common and needs to be distinguished from
arthritis of the knee joint.
It is one of the most common problems in
sports medicine and is referred to sometimes as “jogger’s knee”, “runner’s knee” or
“cyclist’s knee”.
How does it happen?
The basic cause is repeated flexion (bending) of the knee in activities such as sport,
climbing stairs and bushwalking — especially on uneven ground. Usually there is no
history of a preceding injury but it can follow an accident such as falling directly and
heavily onto the kneecap. It is a type of wear
and tear on the cartilage on the underneath
surface of the patella which becomes soft
and stringy, and sometimes inflamed.
People who have an abnormal shape or
position of the patella are more likely to
develop the condition.
Who gets anterior knee pain?
It may affect people at any age but is
more common in adolescents or young
adults and is associated with active participation in sports.
What are the symptoms?
The main symptom is pain or an ache in
the front of the knee that sometimes can
be felt deep in the knee. The pain may
come on slowly “out of the blue” and then
gradually get worse with activities such as
running or going up and down stairs.
The pain is worse with the following:
• Walking up and down stairs (especially
climbing).
• Running (especially downhill).
• Walking on rough ground.
• Squatting.
• Prolonged sitting.
A cracking sensation (called crepitus) or
clicking or clunking on bending the knee is
often heard. Occasionally the knee may give
way. Knee swelling is relatively uncommon.
Movie-goer’s knee: This condition is
sometimes called “movie-goer’s” knee
because patients prefer to use an aisle seat to
stretch the leg out straight into the aisle.
These people get a diffuse ache when they
sit for long periods with the knee bent.
What is the outlook?
The outlook is very good and a steady
recovery can be expected with attention to
relatively simple guidelines.
Elite athletes require more guidance
from therapists if they wish to remain
competitive.
Surgery is rarely necessary. X-rays of
the knee are usually normal.
What is the management?
The key approach is to rest from aggravating activities such as running, cycling or
excessive climbing of stairs and to retrain
muscles, especially the quadriceps.
Correction of any biomechanical abnormalities of the patella or the feet with the
use of taping, orthotics or footwear will be
important.
Referral to a sports medicine therapist
may be necessary to supervise rehabilitation.
Acute inflammation: This is relieved
by relative rest and the application of
icepacks. Sometimes a short course of
NSAIDs will be necessary. Otherwise,
aspirin or paracetamol will control pain.
Taping: If the patella is “off centre”,
taping of the patella will help relieve
acute pain.
Muscle retraining: Your doctor or
therapist will advise on the most appropriate exercises. For straightforward cases
of anterior knee pain simple quadriceps
exercises can be very effective.
Quadriceps exercise (see figure
above): Tighten the muscles in front of
your thighs (as though about to lift the leg
at the hip) and bend the foot back but
keeping the knee straight. Hold your hand
over the lower quads above the knee to
ensure it is felt to tighten.
This tightening and relaxing exercise
should be performed at least six times
every two hours or so. It can be done sitting, standing or lying.
AUTHOR: PROFESSOR JOHN MURTAGH
Copyright of Professor John Murtagh and Australian Doctor. This patient handout may be photocopied or printed out by a doctor free of charge for patient information purposes.