Knee Pain

Anterior Knee Pain, also known as Patello-Femoral Pain (PFP), is common, more-so in young active females, with up to 25% of people experiencing frequent knee pain.

Pain is typically around or behind the patella (kneecap). PFP is aggravated by at least one activity that loads the patellofemoral joint (PFJ) during weight-bearing on a flexed knee. These activities can include squatting, running, hopping/jumping, or going up or down stairs.

There are various biomechanical causes for poor patellar tracking, which is typically in the lateral direction within the groove. This can be driven by either proximal (hip and pelvis) or distal (foot and tibial) rotational changes.

Alternatively, other patients may have a normal femoral or tibial rotational profile and present with central (tibiofemoral-patellofemoral joint) anatomical features.

Finally in a subset of patients the underlying diagnosis may not be a physical cause but a presentation of knee symptoms that are secondary to anxiety and depression with associated poor coping strategies.

Taking a detailed history with symptoms behaviour and location of symptoms is important in differentiating PFP from other knee presentations such as tibiofemoral OA, meniscal lesions and ligament strains.

A thorough physical examination is crucial in determining the physical factors associated with anterior knee pain, but as yet there is no definitive clinical test, however PFP is evident in 80% of people who are positive on this test.

Goals and Expectations are discussed and a management plan is established together.

Current evidence supports strategies such as exercise therapy to address hip and knee dysfunction such as gluteal and quadriceps weakness and tightness, and lower limb dynamic control around the foot and ankle.

There is also good evidence to support education for PFP to allow for self-management, with topics such as load management, weight management, understanding the value of exercise therapy, and addressing any psychosocial factors such as fear of movement or avoidance behaviours.