Anterior Knee Pain

“Coach, my knee is killing me. I don’t think I can pitch today.” This is what coaches do not want to hear anytime during the season. This article will address conservative management and rehabilitation of one type of anterior knee pain known as patellofemoral pain.

Anatomy

The patella is the largest sesamoid bone in the body, which is positioned within the quadricep muscle, the large anterior thigh muscle. The patella protects the knee joint, but also increases the mechanical advantage of the quadricep muscle.

The patella glides and tilts in a groove or a track in the femur. The back of the patella is covered by a thick layer of cartilage that allows the patella to slide and glide smoothly.

The tracking of the patella is important since the patella moves every time you bend and straighten your knee. This tracking is controlled by the resting position of the patella, the tension of the surrounding tissue and the dynamic control of the muscles on the patella.

Pathology

Problems can start with heavy loading activities of the knee, such as pitching. The patella increases the mechanical advantage of the quadricep, but at the same time its contact pressure can range from four to eight times body weight. If this pressure is not distributed evenly there can be pain and irritation under the patella, resulting in dysfunction.

Common complaints of patellofemoral pain include difficulty going down stairs, squatting and pain with prolonged sitting and squatting.

There are many causes of patellofemoral pain which include (but are not limited to):

1. Mal-alignment or poor patellar tracking due to weakness of the stabilizing muscles or excessive tightness of the supporting structures.
2. Trauma directly on the patella, causing irritation to the under side.
3. Over use, too much training too soon, improper warm-up and cool down, incorrect training techniques.
4. Improper equipment including improper shoes for the specific sport or too hard of a running surface.
5. Knee ligament deficiency, causing hypermobility.
6. Poor alignment at the foot. Excessive pronation or supination can increase stress of the patella.
7. Muscular weakness that would cause poor dynamic control of the patellar tracking.

Treatment

This would follow evaluation and diagnosis by a physician and evaluation and treatment by a physical therapist/athletic trainer.

1. Rest – modify activities to reduce aggravating causes.
2. Ice to control pain, swelling and inflammation.
3. Exercise designed for specific needs which may include increasing muscular strength, flexibility and functional training to return to activities safely.
4. Possible external tracking patellar brace.
5. Possible orthotic for lower extremity alignment if needed.
6. Home exercise program for maintenance and prevention.

Patellofemoral problems can range from a minor distraction to a sport ending injury. Proper identification and treatment is the key to successful management of this problem.