Pain in the front of the knee cap can happen to anyone. It is really quite common, and is generally easy to get rid of. That being said, it can be very annoying, and when not addressed properly, can linger for years. Pain with walking, climbing up and down stairs, walking up steep inclines, or squatting are common issues that arise from anterior knee pain.
Anatomy Time!
To dig into this problem, let’s focus on the anatomy of the knee first. It is made of three main bones, the femur or thigh bone, the tibia or shin bone, and the patella aka the knee cap. These three bones make up a pivot joint that also glides front and back, giving the knee maximum range of motion while remaining relatively stable. The knee cap is designed to give the muscles of the thigh a mechanical advantage to pull on the tibia, creating a knee extension or kicking movement.
Now for the pain aspect. The most common of these is called patelo-femoral pain syndrome or PFPS. This occurs due to increased forces pushing the knee cap backwards into the femur and tibia resulting in swelling that occurs either inside the joint itself or just under the knee cap.
This pain is usually brought on by a culmination of increased work or force applied to the knee, such as a day of hiking or walking, running or sport activity more than usual, or more time spent in a knee bent position with load, usually squatting.
The good news is that this pain is usually self-resolving if it is dealt with in the correct fashion, namely rest and potentially ice to reduce swelling, however, identifying the factors that have contributed to this pain are somewhat trickier to address. Mechanics of gait, squat, and body weight load to the knee must be analyzed to maintain proper knee function while performing these movements. Key muscle groups located in other regions of the body can play a role in how the knee functions as well, such as ankle stabilizing muscles and hip muscles.
Lets look at the thigh muscles first. Whenever someone has knee pain, the brain automatically decreases the amount of force that the thigh muscles can create. This will eventually result in decreased strength of the thigh muscles due to inactivity and atrophy. When the muscles are weaker, they cannot control the knee or knee cap effectively when moving. This lack of control can cause more issues because the knee cap may inadvertently be pressing against other structures causing more swelling and the cycle continues to spiral. Here are some exercises to jumpstart the thigh muscles to get more strength when starting from an atrophied state.
Hamstring stretch - Lay on your back and loop a piece of rope or towel around one foot. Lift the leg straight into the air, maintaining tension on the loop with your hands. The leg should not be working as the pull from the hands will keep it in in the air. Keep the knee straight. You will feel a stretch in the back of your leg and knee. Maintain a comfortable stretch for 30 seconds. Repeat 3 times on each leg.
Quad set - Lay flat with a rolled towel under one knee. Bend the other leg while keeping the foot on the ground. Push the back of the knee against the towel and point the toes of the straight leg up. You should feel muscle work in the front of the thigh. Maintain pressure on the towel for 10 seconds and repeat 10 times.
The hip stabilizing muscles can also play a key role in decreasing anterior knee pain. That is because the hip muscles actually control where the knee goes during the squatting movement. If the hip stabilizing muscles, namely the external rotating muscles, are weak the knees will fall in toward each other when squatting. This angle of the knees causes increased pressure under the knee cap and on the knee joint itself, and can increase or prolong anterior knee pain. Here are some exercises that can get those hip muscles working more effectively when controlling the knees.
clamshell - Lay on your side with knees at 90 degrees and hips at 45 degrees bend. Roll the top hip slightly forward of the bottom hip. Lift the top knee so that it is around 1 foot above the bottom knee. Keep the ankles touching. You should feel muscle work on the side and back of the top hip. Add an exercise band as needed. Complete 2 sets of 10 on each side.
hip abduction - Lay on your side with the bottom knee at 90 degrees and hip at 45 degrees bend. The top leg should remain straight. Roll the top hip slightly forward of the bottom hip. Lift the top leg up and back, thinking about touching the back of the ankle to the ceiling. Maintain a neutral lumbar spine throughout movement. You should feel muscle work on the side and back of the top hip. Complete 2 sets of 10 on each side.
For the most accurate and effective exercises, I recommend a proper evaluation by a physical therapist, however a common way to improve anterior knee pain is hamstring stretching. Hopefully, stretching in conjunction with the exercises shown above can start you on your way to pain free knees.
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