One of the most common conditions seen in physiotherapy clinics. There has been a significant debate regarding the cause of this pain and indeed its name has changed many times over the years. This problem affects athletes and everyday people of all ages. However, more often than not the symptoms tend to be more severe in the older population. Perhaps this is because the root causes have gone without investigation for a longer period of time.
It used to be thought that pain was purely down to poor alignment of the kneecap against the femur (thigh bone). This poor alignment leads to wearing of the cartilage underneath the kneecap and then lead to pain. However, it has been shown time and time again that the correlation between cartilage wearing (in this instance) and pain is very poor.
It is now considered that mechanical stresses can lead to a chemical type irritation of nerve endings around the front of the knee. In particular, there is a covering layer to the knee called ‘synovium’ and this has an abundant nerve supply. If this were to become inflamed, normal activities would aggravate it and symptoms would go on and on.
Common issues that lead to increased mechanical stresses are weak or tight muscles of the hip, knee or calf. A tight ITB (Iliotibial band) or poor leg biomechanics, particularly flat feet.
However, it must be noted that a lot of people have poorly aligned kneecaps and they never experience pain whilst others with well aligned kneecaps can suffer.
Signs and Symptoms
- Pain at the front of the knee, usually behind the kneecap.
- Pain on going up and down stairs.
- Pain on walking/ running.
- Difficulty crouching down.
- Pain and stiffness after sitting or driving for a long time.
Subjective questioning considering age and any changes in activity levels/trends.
Clinical assessment to test the strength and flexibility of the muscles of the knee and hip, along with the ITB.
Assessment of the biomechanics of the legs, particularly the feet.
X-rays and Scans are rarely required and are generally only used if significant damage to the cartilage behind the kneecap is suspected.
Acute symptoms can be managed with ice and relative rest.
If the condition is more long term, a specific strengthening and stretching program of the muscles noted on the assessment will be required.This will be monitored by your physiotherapist and your feedback is key for its success. Correction of any biomechanical issues with orthotics may be required.
Strapping/Taping your kneecap and massage can help, but tends to only provide short term relief. Acupuncture can help with the pain.
In persistent cases cortico-steroid injections behind the kneecap can be useful, but again will generally only provide short term relief.