What is is ?
Anterior knee pain (AKP) affects up to 40% of runners. Persistent AKP can lead to fear avoidance, changes in behaviour performance , reduced muscle conditioning and guarded movement (Vlaeyen & Linton, 2000).
Also known as patellofemoral joint issues, it can be called jumper’s knee, patella tendon, or osteo arthritis. Anterior knee pain can be treated with;
strength and conditioning training,
load management
manual therapy
running re-education.
Athletes can be empowered by the knowledge that strength and power can not only improve performance but also reduce injury incidence. Through strength training, load management and running re-education, AKP incidence can be reduced (Coppack, Etherington, & Wills, 2011).
What courses it ?
AKP is multifactorial; lower limb deconditioning may contribute to dysfunction and pain by;
Foot position
Reduced hip/ knee strength, poor movement coordination/ control;
Increase knee compressive loads, due to reduced knee control and strength.
Patella tracking (Willy et al., 2019)
HOW DO WE TREAT IT ?
Complete a full biomechanics assessment.
See here for a small example;
Review your running mechanics:
Potentially increase your cadence ;
Increasing cadence will often decrease load placed on the knee joint associated with increased stride frequency (Lenhart, Thelen, Wille, Chumanov, & Heiderscheit, 2014).
Higher cadences, more forefoot/ mid-foot running, result in increased lower limb stiffness and less vertical centre of mass displacement (Farley & González, 1996).
Work on tissue tightness/ muscle imbalance and control.
Using massage of soft tissue techniques or dry needling, may help loosen up some structures to reset your pain patterns and allow you to get moving again.
Address your strength and conditioning plan.
At Move Sports Physio Belmont Victoria we aim to combine plyometrics with heavy weights to build strength, explosive force development, and enhance the stretch shorting cycle and lower extremity stiffness (Hunter & Marshall, 2002) (Cormie, McGuigan, & Newton, 2010; Marques, 2010)(Turner & Jeffreys, 2010). (Spurrs, Murphy, & Watsford, 2003)’
Get in touch with us or book online for a thorough assessment and review of your knee pain.
REFERENCES
Cardoso, R. K., Caputo, E. L., Rombaldi, A. J., & Del Vecchio, F. B. (2017). Effects of strength training on the treatment of patellofemoral pain syndrome-a meta-analysis of randomized controlled trials. Fisioterapia em Movimento, 30(2), 391-398.
Coppack, R. J., Etherington, J., & Wills, A. K. (2011). The Effects of Exercise for the Prevention of Overuse Anterior Knee Pain: A Randomized Controlled Trial. The American Journal of Sports Medicine, 39(5), 940-948. doi:10.1177/0363546510393269
Cormie, P., McGuigan, M. R., & Newton, R. U. (2010). Changes in the eccentric phase contribute to improved stretch-shorten cycle performance after training. Med Sci Sports Exerc, 42(9), 1731-1744. doi:10.1249/MSS.0b013e3181d392e8
Farley, C. T., & González, O. (1996). Leg stiffness and stride frequency in human running. J Biomech, 29(2), 181-186. doi:10.1016/0021-9290(95)00029-1
Hiemstra, L. A., Kerslake, S., & Irving, C. (2014). Anterior Knee Pain in the Athlete. Clinics in Sports Medicine, 33(3), 437-459. doi:10.1016/j.csm.2014.03.010
Hunter, J. P., & Marshall, R. N. (2002). Effects of power and flexibility training on vertical jump technique. Med Sci Sports Exerc, 34(3), 478-486. doi:10.1097/00005768-200203000-00015
Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. The South African journal of physiotherapy, 74(1), 452-452. doi:10.4102/sajp.v74i1.452
Leibbrandt, D. C., & Louw, Q. (2017). The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain. The South African journal of physiotherapy, 73(1), 353-353. doi:10.4102/sajp.v73i1.353
Lenhart, R. L., Thelen, D. G., Wille, C. M., Chumanov, E. S., & Heiderscheit, B. C. (2014). Increasing running step rate reduces patellofemoral joint forces. Med Sci Sports Exerc, 46(3), 557-564. doi:10.1249/MSS.0b013e3182a78c3a
Luedke, L. E., Heiderscheit, B. C., Williams, D. S. B., & Rauh, M. J. (2015). Association of isometric strenght of hip and knee muscles with injury risk in high school cross country runners. International journal of sports physical therapy, 10(6), 868-876. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26618066
Marques, M. (2010). Strength in power events: theory and practice. Journal of Human Sport and Exercise, 5. doi:10.4100/jhse.2010.52.10
Miguel, P. J. P., & Reis, V. M. M. (2004). Speed strength endurance and 400m performance. New Stud Athl, 19, 39-45.
Pazzinatto, M. F., de Oliveira Silva, D., Pradela, J., Coura, M. B., Barton, C., & de Azevedo, F. M. (2017). Local and widespread hyperalgesia in female runners with patellofemoral pain are influenced by running volume. Journal of Science and Medicine in Sport, 20(4), 362-367. doi:https://doi.org/10.1016/j.jsams.2016.09.004
Sanchis-Alfonso, V., & Dye, S. F. (2017). How to Deal With Anterior Knee Pain in the Active Young Patient. Sports Health, 9(4), 346-351. doi:10.1177/1941738116681269
Spurrs, R. W., Murphy, A. J., & Watsford, M. L. (2003). The effect of plyometric training on distance running performance. Eur J Appl Physiol, 89(1), 1-7. doi:10.1007/s00421-002-0741-y
Turner, A., & Jeffreys, I. (2010). The Stretch-Shortening Cycle: Proposed Mechanisms and Methods for Enhancement. Strength & Conditioning Journal, 32, 87-99. doi:10.1519/SSC.0b013e3181e928f9
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317-332. doi:https://doi.org/10.1016/S0304-3959(99)00242-0
Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., . . . Altman, R. (2019). Patellofemoral pain: Clinical practice guidelines linked to the international classification of functioning, disability and health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1-CPG95.
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