April always brings a rash of knee injuries with many people training for the London Marathon, local half marathons and fun runs and of course the Boundary Walk on May 1.
People often come to us with a sudden pain around the knee cap which occurs when walking or running. They also complain of pain when going down stairs and report they need to take one step at a time due to this.
Pain in our joints that occurs while we are moving is usually caused by a mechanical problem within the joint. Most problems occur because the joint is not staying in its’ proper alignment so things catch or rub causing pain and/or inflammation.
The knee is a common site for this type of problem. As we walk and run our muscles have to hold the knee joint over the foot and ankle.
Normally our knee cap moves up and down in a groove at the end of the thigh bone so we can bend and straighten our knee to walk and run normally.
If there is a problem with any of the leg muscles due to weakness, tightness or injury the tendency is for the knee cap to slide up and down slightly out of its’ groove.
As this happens the knee cap often tilts or moves sideways, catching and rubbing structures inside the knee and this causes pain at the front of the knee, which is termed anterior knee pain. Another cause can be due to problems with arch collapse in the foot.
This is often due to how our feet have grown, which is often an inherent trait from our parents or it can be caused by problems with muscle control of the legs and hips and can be exacerbated by being a bit overweight.
The pain is often worse down hills and stairs because of the increased knee bend which means it is the harder for your muscles to keep the kneecap in the right place. The kneecap is pulled harder into the groove on the thigh when the knee is bent. The harder the kneecap pulls, the more strength our muscles need to control the kneecap. If the pain only occurs as you move it is unlikely there is any inflammation and so medicines such as Ibuprofen will not seem to help. If the pain continues without treatment for some time, you may start to find the ache occurs when you are not walking or running as the pinched structures start to become inflamed due to the repeated rubbing in the knee.
Physiotherapy is a great starting point for these patients. At an assessment with one of our physiotherapists we carry out an examination of the whole of the lower limb to find the cause for the knee pain.
If we assess that the foot is involved we may suggest you see our podiatrist to have any problems in the feet investigated fully. You may need to shoe inserts that will make your walking better aligned, thus stopping the poor kneecap movement and rubbing.
If the problem is due to your muscles you may need some stretches or muscle exercises to hold the kneecap in its’ correct position. Sometimes people have problems with both the feet and the muscles and require both therapies.
Doing the specific exercises that we can teach you it may take up to six weeks to see an improvement, but these exercises are very successful.
Left untreated anterior knee pain will lead to arthritic problems as the cartilage in our knees is damaged by the altered movement patterns and can become a chronic problem that can’t be healed.
If we keep our joints working correctly as we age this wear and tear is less likely and we decrease the risk of conditions like osteoarthritis, chronic knee, hip or back pain, ongoing disability and the likelihood of surgery.