Our knees are complex joints, designed to provide stability from side to side and smooth movement forwards and back as you walk, kick and run. The patella, or kneecap, is a small bone embedded in the tendon of the quadriceps muscle that protects the knee and also provides extra leverage to the quadriceps, amplifying their strength. The patella moves up and down in a groove at the front of the knee as the knee bends and straightens. Usually this movement is smooth, with little friction, however, occasionally the soft tissue between the kneecap and the knee can become irritated, causing pain in a typical pattern. This condition is often referred to as ‘runner’s knee’, PFJ Syndrome or patellofemoral pain syndrome (PFPS).
What causes patellofemoral pain?
The patella usually sits in a balanced position in the shallow groove at the front of the knee and moves easily without friction. The patella is attached to the quadriceps muscle at the top and connected to the lower leg via the patella tendon at the bottom. When the quadriceps contracts, this pulls on the patella and acts to straighten the knee. There's a number of factors which play an important role on how the patella, quadriceps tendon and surrounding soft tissue is loaded. Commonly we see people with deconditioned gluteal muscles or overpronating feet who end up suffering from patellar pain. But it's important to understand that on their own these aren't necessarily harmful characteristics. What normally ends up triggering pain is the load that we are putting our knees through and whether they can withstand those loads. Often this all starts with training load errors or badly planned training regimes.
What are the symptoms?
This condition is characterized by pain felt around the patella with activities that require repetitive bending of the knee. The pain may be on the inner side, outer side or underneath the patella. There may be a sensation of, clicking or grinding and some people report that their knee suddenly gives way. The pain is commonly felt when running, going up and down stairs or when doing squats and is relieved with rest. The pain may start as a small niggle and gradually become worse over time.
How can physiotherapy help with Patellofemoral pain?
The first step in effective treatment is to exclude any other conditions and have a physiotherapist confirm the diagnosis. Your physiotherapist is able to determine which factors are contributing to this condition, which could include poor posture, a lack of arch support in your feet or poor running technique. Once these factors have been identified, you will be provided with a specific treatment program to best approach your condition. PFP syndrome is usually an overloading injury so it responds well to load management strategies like relative rest and progressive reloading. Biomechanical analysis and correction of any muscular weakness may also be important. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping and manual therapy which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.
Many people know the value that physiotherapy brings to their life and some have even been visiting their physiotherapist since childhood. However, for those who have never been to see a physiotherapist before, there can be a question mark over exactly what it is that physiotherapists do. In fact, this is one of the most common questions physiotherapists are asked.
The answer is tricky, because physiotherapists do so much. Primarily, we might be described as pain management experts, as we work to reduce the pain of our patients, from those who have suffered a new injury, to those who have had pain for several years. We first identify the cause of the pain and then provide manual therapy techniques, education and management strategies to help our patient understand, manage and reduce their pain.
While pain is usually the first thing that brings patients to see a physiotherapist, this pain has often caused patients to give up activities that they love and can even be getting in the way of everyday tasks. Many of us reduce our activity levels to reduce pain without even realizing it. Physiotherapists are able to identify which areas you are struggling in and why this is occurring. By identifying the cause of your symptoms, we can help to get you back to full function. Physiotherapists are able to do this for everyone including elite athletes and those dealing with serious disabilities.
In fact, physiotherapists have a role to play at practically every stage of life. We can assess infants to monitor their motor skills development and as they grow we help them deal with the pains and vulnerabilities of a growing body. Among other things, we can help improve the function of athletes, assist in preventing injuries, help those with pelvic floor dysfunction and work to prevent falls in the elderly.
Not just manual therapy
Physiotherapists offer a range of treatments, from targeted stretches, manual therapies, dry needling, exercises and massage. Physiotherapists are also committed educators and take our role as such seriously.
A huge part of recovering from pain and injury comes from understanding what is happening and how to best manage these issues. Rather than create a dependency on their therapist, we aim to empower our patients to improve their health independently as much as possible.
Physiotherapists aim, to improve your quality of life and remove any barriers to full participation, whether these barriers are due to pain, weakness or stiffness.
Here are some quick tips on how to fast track your progress onto your first pull up or chin up. - Starting on a step or just jumping to the top of the pull up, holding the position and slowly lowering down, as slow and controlled as you can all the way to the bottom.
- Progress from taking 5 seconds going down, to taking 10 seconds, twice the amount of time, and more time and tension to strengthen all the muscles.
- Try to hold yourself at the very top. So, from the start try to pull yourself back up, even if you can’t just really try to pull yourself back up as you are slowly lowering down.
These are our top tips for progressing onto your first pull up or chin up.