Knee pain is a very common complaint in both the sporting and non-sporting populations. Patellofemoral Joint (PFJ) pain is one of the most common causes of knee pain. It generally involves patients reporting pain on the front of their knee, but can spread around to the sides and even the back of the knee. Patients normally report pain going up and down stairs, and in the sporting population high impact activities such as running or jumping.
The PFJ is the articulation between your patella (kneecap) and femur (thigh bone). As you can see from the picture, the patella is situated on the front of the knee. It is located within the tendon of the quadriceps muscle and attaches to the top of the tibia (shin bone). It also sits in a groove known as the trochlear groove.
As we bend and our knee, the patella glides down the groove, and as we straighten our knee it glides back up (https://www.youtube.com/watch?v=Q-80Qi5cx9o). The clicking felt or heard in the knee is due to the patella not gliding smoothly in the groove. New research suggests there is no link with this and causing damage. In fact over 90% of people who don’t suffer with knee pain report clicking.
PFJ pain normally is as a result of overload of the joint due to muscle imbalances. The most up-to-date research recommends strengthening of the gluteal, quadriceps and calf muscles and making sure ankle that flexibility is also optimal. Strengthening and improving ankle flexibility helps to offload the pressure on the PFJ.
To improve ankle flexibility, calf and soleus stretches are a very useful (see below). We normally recommend holding for 30 seconds and repeating immediately 3 times, at once and 3 times per day.
The most important way of avoiding pain in the PFJ is to improve gluteal and quadriceps strength. In particular, gluteal muscle strengthening can help, as it reduces the hip falling into internal rotation (picture B), which irritates PFJ.
To determine where to start with strengthening it is important to see a health professional so that you do not start with exercises too difficult and to make sure that your technique is correct.
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