Patellofemoral Pain Syndrome (Anterior Knee Pain)

As trainers we see a lot of knee pain. In this blog we are going to discuss anterior knee pain, as this seems to be cropping up recently in practice and is a more difficult one to treat. Trainers tend to be good when dealing with medial and lateral knee pain as the causative factors are more straight forward. Anterior knee pain is slightly more complex and can cause a few heads scratching in the gym.

AKP is usually associated with weakness of the vasti and hip muscles (Cichanowski et al. 2007). IT band tightness is usually associated with knee pain if it is acting as a stabiliser due to hip weakness in the frontal plane due to glute med and glute weakness. In this case shortened fascial connections with the distal IT band and lateral patella retincaculum could alter patella tracking (Page 2001).

There tends to be motor control deficit in clients with AKP, usually seeing a reversal in the normal firing order between the VM and VL with the VL firing earlier (Voight and Wieder. 1991).  A typical corrective strategy is to strengthen the VM with isolation exercises to address the muscle firing balance.
EMG evidence does not support support the idea that strengthening the VM vs VL in a attempt to improve patella tracking and control in relation to the patella groove (Kettunen et al. 2007).

Other research (Tyler et al. 2006) showes that it maybe more effective to trat AKP by strengthening the muscles that control the patella directly is not as effective in reducing AKP as improving the strength and flexibility of the hip.

This provides some great guidance for trainers who deal with stubborn AKP as well as another route to pursue. Practically then it is worth screening the pelvis for dysfunction as well as the knee for imbalances which brings us back to the old fall safe 'one should assess the joints above and below the site of dysfunction'.

John