Introduction
The Anterior Knee Pain Masterclass, taught by Dr Lee Herrington and Ros Cooke provides a complete overview of the assessment and management of Anterior Knee Pain. This executive summary provides clinically relevant, actionable information that may be useful to health professionals.
Part 1 - Structures that could be causing anterior knee pain
The structures around the anterior knee that could cause pain include the fat pad, PFJ, patella tendon and/or growth plates (e.g Osgood Schlatter and/or Sinding Larsen Johansson syndrome). It is important to accurately diagnose anterior knee pain due to the varying healing time frames associated with different structures. Taking a comprehensive subjective history as well as education remains an integral part of the physiotherapy consultation.
- When dealing with fat pad pain, avoid isometrics into extension as often it will cause symptom flare ups.
- Only use tape as treatment if it provides a meaningful change in the patient’s symptoms.
- With the elite sporting population, understanding their training loads will help with management strategies.
Part 2 - Osteochondral Issues
Patellofemoral osteochondral issues are very common in people with anterior knee pain, especially in those who have had ACL surgery. The typical signs and symptoms include a poorly localised ache, pain around the retropatella, presence of a painful arc and/or swelling. Objective examination include the Break, Crit, Motion palpation and/or forward step lower tests.
- With post knee surgical patients, gradually increase their load to reduce risk of creating an unhappy joint.
- If you see a swollen knee joint, make sure to refer back to the GP to rule out underlying medical problems.
- The Crit Test is where the clinician tests the quadriceps isometrically for 8-10 seconds at 120, 90, 60 and 30 degrees to assess the level of force and whether there is a break in contraction.
Masterclass Preview
Enjoy this free preview of Lee talking about pain stemming from the fat pad.
Part 3 - Acute Management & Early Loading
It is crucial to understand the patient’s baseline measurements (e.g step count) and their main aggravating factors. Modifying loads include looking at the ankle/foot and gluteal/core muscles. Exercise prescription could come in the form of simply moving the joint or more specific tasks (e.g hip or knee dominant movements).
- Step count and activity trackers are helpful when establishing a baseline measure.
- Encouraging your patient to wear a simple knee brace may give them the sensation of increased stability which allows them to move with less pain initially.
- Start with increased velocity contractions through the quads to reduce the time under tension, as this may be less aggravating.
Part 4 - Rehabilitation and Reloading the Joint
Rehabilitation is all about bridging the gap between the patient’s current level of function and their desired level of function and goals. Exercise considerations include open/close chain, squats, jumping/landing progressions and running modifications. It is crucial to expose your patient sufficiently through their rehab to mimic the forces required for their sport.
- The Couch to 5km program is a structured program to ease someone back to running.
- Horizontal jumping/landing can expose the knee to more force compared to vertical.
- Running uphill and a faster cadence can reduce loads going through the knee.
