Knee Pain

THE KNEE

The knee is a modified hinge joint which means it can flex (bend/swing backwards) and extend (straighten/swing forwards). It also can very slightly rotate. The hamstrings at the back of the thigh control flexion of the knee, and the quadriceps at the front of the thigh control extension. The strength, size and position of the hamstrings and quadriceps muscles can affect the way the leg moves, and therefore the way that the patella (kneecap) moves.

The patella is a small triangular-shaped bone within the quadriceps tendon in front of the knee joint. There are tendons and muscles above and below the patella and if they all work properly the patella slides in a groove on the upper leg bone (femur; femoral groove) as the knee joint moves. However when the patella is pulled out of alignment (typically towards the outside (lateral) aspect of the knee joint) it fails to glide easily and centrally in the femoral groove and this is known as Runner’s knee.

CAUSES

Weakness of the vastus medialis (the inner of the quadricips) muscle relative to the other thigh muscles

Knock knees (genu valgum)

Excessive/abnormal rearfoot pronation

Flat feet (can cause internal rotation of the tibia)

Tightness in the iliotibial band

SYMPTOMS

• dull aching pain under or around the front of the patella. Running down hill, walking up or down stairs, squats, leg extensions at the gym, sitting for a prolonged time with the knees bent can all make the problem worse

• sudden, stabbing pain in the knee while running

WOMEN

More women suffer from the problem than men because of the angle of their hips/knees

DIAGNOSIS

patella femoral grinding test to test the quality of the patella articulating surfaces. Lie supine/face up. Get someone to place their hand over your patella and push the patella down and distally i.e. towards the foot, and hold while you straighten your leg. This means you will contract your quadriceps and elevate your knee holding it in extension. The patella should glide easily and smoothly up the groove in the femur. If there is degenerative change on either side of the femur or the patella you will feel a grinding sensation, and sometimes extreme pain.

SOLUTIONS

• Rest

• Wear orthotics in your shoes to control your foot movement

• Buy new running shoes if your old ones are worn out

• Cross training to help muscle weakness/imbalance. Cycling good, Swimming good – crawl rather than breaststroke (the leg movement from swimming breaststroke can irritate the area)

• Stretching the quads and hamstrings after exercise (latest research suggests stretching before exercise can increase chance of injury)

• Exercises – straight-leg exercises are best (knee extensions on a machine might make your problem worse)

• Knee strap – can help for some people

 

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