There is an indisputable amount of evidence now that when it comes to anterior knee pain exercises… we can’t just treat the knee.
Here is a short and sharp explanation of why and what we should be doing:
Often people are told to strengthen up their quads and get their legs strong to help knee pain but really is this the best way to do it?
The answer is no. There is a lot of evidence when it comes to anterior knee pain (also known as patellofemoral pain) that rehabbing proximally is much more effective the strengthening the knee and quads alone. Proximally means working on the muscles further up the chain, closer to your spine, such as your:
Hip external rotators
In fact, a thorough systematic review was published recently which showed that compared to quads strengthening:
There is strong evidence that proximal rehab, combined with quads strengthening had better pain reduction
Proximal rehab alone and combined with quads strengthening results in better functional gains
Proximal rehab, was better in the short and long-term.
This basically shows us that when it comes to knee pain, it isn’t often the knees fault. We need to look up the chain at what controls the knee – The hip. Including rehab exercises that improve him strength and neuromuscular control has much better effects in outcome in both the short and long-term and cannot be ignored.
So what exercises should you be doing?
Type of exercise: This should be a combination of closed chain (feet/foot in contact with the ground) and open chain exercises in a comprehensive rehab program.
Frequency of exercise: Exercises that aim at neuromuscular training and stretching/foam rolling can be performed daily, whereas strength training should be aimed for 3 x weekly.
What knee pain exercises work well?
Follow this link for a great post for the rehab exercises to get you started, or go the whole hog and download our knee pain rehab guide HERE
Conclusion: Proximal rehab should be included in all rehab programs for anterior knee pain and if in doubt, go and see your local physio for best results.
Common names for Patellofemoral Pain Syndrome (PFPS) are Chondromalacia patella, anterior knee pain, runners knee, patellofemoral tracking disorder.
*Now just a quick clarification: Chondromalacia Patella is not PFPS. Chondromalacia Patella is commonly over diagnosed and is when the articular cartilage on the undersurface of your knee cap is damaged. The prevalence of this is far less than Patellofemoral pain syndrome but generally occurs if PFPS is left too long as the cartilage gradually softens and degenerates. This can be confirmed with an MRI. The below rehab exercises and advice for Patellofemoral pain WILL HELP this also, it will just be a longer recovery period.
What: Patellofemoral pain is felt at the front of the knee and typically comes on gradually typically comes on gradually. Normally the patella (your knee cap) glides in a groove in your femur when bending your knee. It is believed PFPS results from abnormal Patella tracking (not gliding smoothly in the groove) causing excessive compression on the under surface.
This mal-tracking can be caused by:
Quadriceps weakness (particularly poor activation of your VMO/inside quads) causing an imbalance.
Generally, there is always a combination of these factors causing a significant imbalance of forces on the knee cap, leading it to be pulled to one side (like a tug of war!). It is generally pulled laterally.
Symptoms and signs
Anterior knee pain
Knee stiffness with prolonged knee flexion eg. sitting in movie or driving.
Training: Long distance running, training on hard surfaces, hills, stairs
Note: it is important to remember that muscle dysfunction and repetitive loading of the Patellofemoral joint rather than fixed biomechanical factors and the major contributors to PFPS(Baker and Juhn 2000) and so there is a lot that can be done to help.
Prognosis: Depends on co-existing conditions, but poor if causative/aggravating factors and not addressed. If symptoms have been there for over 12 months you will have a poorer prognosis but do lose heart, it can get a lot better, you just need to persevere and stick at it 🙂