Pain in and around the kneecap affects people of all ages and activity levels. This common condition often presents as medial knee pain (inside) and anterior knee pain (front) and is related to the mechanics of the patella (kneecap) and how it moves on the femur (thigh bone). Clinically referred to as patellofemoral pain syndrome (PFPS), this condition stems from poorly coordinated movement irritating the cartilage under the kneecap, which causes pain and discomfort.
Did you know that knee pain due to patellofemoral pain syndrome is usually more of a hip, ankle and foot issue, rather than a knee issue? Physical therapy is the optimal choice for treating knee pain, but during rehabilitation, therapeutic exercises will not only address the knee, but will also include strength, mechanics, and control of the hip and ankle/foot. This evidence-based approach improves the quality of movement of the entire leg.
Our kneecaps are strongly anchored to the front of our hips, and the base of our knees/top of the shin. Our knees work more or less like a hinge, with some freedom to move side to side and to rotate. Our hips, ankles and feet, however, have a huge amount of motion available, and can set our knees up for stronger or weaker mechanics depending on their positioning.
Often, people develop pain in the front or inside of their knees when their knees are repeatedly exposed to weaker mechanics or dysfunctional movement caused by muscle imbalance. This is often the case when the knees don’t track properly and angle inward relative to where the hips, ankles and feet are. This may look like a “knock kneed” position in running, jumping and pivoting motions when a person is moving or training.
Making sure that you have the strength and ability to control your foot and ankle pronation and supination during movement is key to avoiding knee pain and PFPS. It is also necessary to have hip strength and control to resist excessive knee valgus (knock knee) during movement. Activities or sports that place repetitive force on the knee can contribute to overuse injuries, which can include PFPS, especially when weak mechanics are present in the legs.
Footwear choices can either set us up for success or increase challenges in positional control. Shoes with a wide toe box let us use our toes (especially the big toes) to anchor us, resist over pronation and the rest of the leg following inward. However, shoes with narrower toe boxes are not always avoidable, especially in field sports and dress shoes. Arch supports can be very helpful in these situations. Toe spacers can also be incredibly beneficial to support the natural shape of our feet. There are options for spacing out all the toes or focusing on big toe position – usually aimed at caring for or prevention of bunions. These can be worn when not wearing shoes, or some designs may be comfortable worn inside shoes. Choose your shoes wisely.
Though rest can alleviate pain under and around the kneecap, without addressing the root cause, symptoms are likely to reoccur regularly. Patellofemoral pain often increases with activities that cause compression around the knee such as biking, skiing, running and even walking up and down stairs or sitting for prolonged periods. While this condition can affect anyone, it’s more prevalent in teenage athletes – especially females. Knee pain in kids can be concerning, but your local PT can identify the underlying issue and work with you and you child to create a plan of care that gets them back to pain-free activity quickly and safely.
If you or someone you know suffers with knee pain, find a Therapeutic Associates Physical Therapy clinic near you right away! Big picture, there’s no reason to settle for patellofemoral pain when you can take action to fix it with the help of a physical therapist.
Knowing what to expect at your first physical therapy appointment can alleviate any reservations you might have, and you might also appreciate knowing a little about who we are at Therapeutic Associates. Direct access means you can choose a PT that fits your needs without the need of a doctor’s referral. Start your journey to pain-free living today.
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