The knee is a what we call a modified hinge joint between the thigh bone and shin bone with a knee cap (patella) at the front. It is called a hinge joint because it bends like a hinge. The knee cap is designed to allow the quadriceps muscles to pull the shin bone more efficiently (extend the knee). At the back we have the hamstring muscles over the thigh and the calf muscles over the shin bone. In the back of the knee joint we have the popliteus muscles. To protect the knee we have 2 cartilages called the meniscus and a whole series of ligaments to hold it all together so we can run, kick, jump and climb.
Anterior knee pain is common amongst runners and power lifters. It often involves compression of the patella into the thigh bone when bending the knee. This is also called patellofemoral syndrome. Other cause of anterior knee pain include:
- Fat pad irritation (the fat pad sits under the bottom of the knee cap). It can get squashed and inflamed when you over extend your knee
- Iliotibial band (ITB) friction syndrome (occurs on the outside of the knee cap where the ITB crosses over the outside of the knee). Overactive muscles can pull on the ITB and it can rub against the bone causing irritation and inflammation.
- Degenerative meniscus (the good old warn out cartilage). Can be painful on the inside or outside of the knee. Bits of cartilage can be floating in the joint or there can be less support on parts of the meniscus.
- Make sure you differentiate it from patella tendinopathy
The key features of most chronic developing knee pain is to identify the factors contributing. This can include:
- Balance of the quadriceps muscles – making sure they are working properly and the outside and inside muscles are pulling the knee cap appropriately
- Making sure the hip muscles are controlling the position of the thigh properly to make sure the knee lands in a good position
- Appropriate foot control. Sometimes the way your foot moves can impact the way your knee works and may contribute to your knee pain.
Treatment often involves strengthening programs but they need to be specific to your problems. Taping and orthotics can often help too as well as some manual therapy to reduce the tension on the entire lower limb from pelvis to big toe!!