Anterior Knee Pain

Patello-Femoral Pain Syndrome(PFPS) or Anterior knee pain is a condition characterised by disabling pain in the anterior aspect of knee.

CAUSES of Anterior Knee Pain:

1. Patellofemoral Instability due to Abnormal Q- angle, Dysplastic trochlea, Patella Alta, Tight lateral retinaculum, weak medial stabilizers.
2. Patellofemoral biomechanical dysfunction due to increased Q – angle, femoral anteversion, external tibial torsion, genu valgum, foot hyperpronation.
3. Soft tissue injuries like Plica Syndrome, Fat Pad Syndrome, Patellar Tendinitis, Iliotibial Band Friction Syndrome (Housemaid’s Knee), Osteochondritisa dissecans, Traumatic Patellar Chondromalacia, Patellofemoral Osteoarthritis, Apophysitis and trauma.

WHEN TO CONSULT A PHYSIOTHERAPISTIf any of the following sign or symptom is visible in your knee consult a physiotherapist:

Weakness- It is due to reflex inhibition of Vastus Medialis Oblique(VMO) or simply Quadriceps.Pain- It is on the anterior aspect of knee and around the margin of patella.Redness- The affected knee may be swollen around the patella and in lower thigh.Redness- It is also visible in some cases in the upper part of patella and around it.Disability- Difficulty to perform ADLs like sitting cross- legged, climbing stairs, walking, jumpingStiffness- Pain and stiffness in the morning or after sitting in one posture for long hours.

Physiotherapy Management

PROTECTION PHASE

1. Heating modalities like SWD, Therapeutic currents, Hydrocollator packs, Paraffin Wax Bath
2. Healing of tissues using Ultrasonic therapy
3. Rest
4. Gentle motion
5. Muscle Setting Exercises for Preferential Activation of Vastus Medialis Oblique (VMO)

RETURN TO FUNCTION PHASE

1. Isometric exercises of the quadricep femoris and hamstrings
2. Gentle Patellar Glides
3. Progressive Resisted exercises for the Quadriceps
4. MET and Hold Relax for the Hamstrings

PATIENT’s COLUMN

1. Until the knee is symptom free, the patient should avoid activities that are painful.
2. Avoid stair ascending and descending.
3. Avoid sitting with the knees flexed excessively for prolonged periods e.g. sitting with legs crossed, using ground level toilet.
4. Follow the Home Exercise Program as given by the physiotherapist.