Anterior Knee Pain

A guide to managing Patellofemoral pain and fat pad impingement

The anterior (front) part of your knee is a common source of pain for many people. At the front of your knee there exists a joint be- tween the knee cap (patella) and the thigh bone (femur). This is called the patellofemoral joint.

The patella moves up and down the femur in a shallow groove as you bend and straighten your knee. The patella acts as a pulley for the thigh muscles (quadriceps) to assist movement. When structures around the knee become tight or weak the patella may be pulled or tilted off centre. If this happens the patella does not move as effectively and may cause pain.

Biomechanical factors that may contribute to your patellofemoral pain

  • Excessive Weight
  • Non ideal foot mechanics e.g. flat feet
  • Poor pelvic and core control
  • Tight structures on the outside of your thigh Poor muscle timing
  • Malalignment of the patella

Treatment focuses on managing the factors that you can change

Things you can do:

  • Gradually increase your training program to avoid overuse injuries from doing too much too fast.
  • Stretch your calf, hamstrings and hip flexors after warm up and warm down.
  • Anti-inflammatories may be helpful espe- cially initially.
  • Avoid high impact activities e.g. squat, jump, running.
  • Activity must be within the activity guide- line. See the pain and activity section of the brochure.
  • Stand with soft knees or adopt a ballet third position and try not to hyperextend your knee’s.
  • Avoid “The straight leg raise” exercise.

Things your physiotherapist will help you with:

  1. Decompression taping to deload the painful structure.
    • Taping will relieve symptoms, alter patella position, improve muscle timing, and in- crease tolerance to joint knee loading.
    • Your physio can show you how to do this at home
  2. A graduated strengthening program to restore the dynamic balance of your quadriceps (thigh) muscle.
  3. Decreasing tightness in the local muscles and maintaining range of movement of the knee and surrounding joints.

Pain and activity

Sometimes you may find you can run 2km on a flat surface, but get anterior knee pain when you run uphill for only 500m.

Often people may only notice pain with certain activities like squats or after a particular period of time performing an activity. Below is a graph to demonstrate a healthy zone to work within for your knee so you can avoid pain.

Ask your physio to help identify what activities are ok for you to do, so that you remain pain free. You might find that you are able to walk up 10 steps, but not 20. Your physio can help identify your limits.

Who suffers from anterior knee pain?

Anyone can get patellofemoral pain. It is a common complaint for individuals involved in activities or sports that require a lot of running and jumping. In the workplace you might find pain with lifting heavy loads, stairs or squats. Patellofemoral pain may also follow knee surgery. Many people with patellofemoral pain may also have a fat pad impingement associated with their condition.

Fat pad impingement

Below and deep to the patella exists a fat pad that helps to cushion the front of the knee with movement. The fat pad is one of the most pain sensitive structures in the knee. The fat pad can become impinged between the patella and the femur. Sufferers often describe pain when the knee is straight or with prolonged standing. You may also notice that just below the knee cap is puffy and tender to touch