Road to Recovery Managing Knee Pain With an Expert

Patellofemoral Pain Syndrome (PFPS) is a fancy name for when your knee hurts because of problems in or around your kneecap joint. It’s an issue that gets worse when you squat, sit for a long time, go up the stairs, run or do other daily life activities.

Here is how it works: The patella (kneecap) sits in a groove on the femur (the thigh bone). The back of the patella and the front part of the groove are both covered in cartilage, which lets them slide over each other smoothly. This movement is helped by synovial fluid which is a kind of lubricating fluid produced by the membrane inside the knee joint and it reduces resistance during movement.

The knee is surrounded by a capsule, with ligaments for stability, and special fluid-filled sacs (bursae) near the kneecap and tibia to help with movement.

Common Causes

It can happen due to a direct injury to the kneecap. However, it is usually caused by a mix of different factors:

1. Overuse and Stress on the Knee: When there’s too much strain on the knee and the kneecap is moving abnormally.
2. Kneecap Position and Movement: If the patella isn’t aligned right, it can slide more to one side, putting extra pressure on that part of the thigh bone, leading to pain or irritation. This misalignment can be due to the way someone’s body is built or differences between both knees.
3. Muscle Imbalances and Biomechanical Issues: Weak or imbalanced muscles around the knee can cause the kneecap to move incorrectly. For instance, if the muscle on the inside of the Vastus Medialis is weak, the outer thigh muscle (Vastus Lateralis) might pull the kneecap too much to the side, causing pain.
4. Other Knee and Leg Issues: Problems like knee hyperextension, twisted shinbone, knee bending inwards or outwards, a high angle between hip and knee (Q-angle), tightness in the quads or calf muscles can also lead to knee pain.
5. Foot and Hip Factors: Sometimes, the problem starts elsewhere, like with flat feet (pronation) or high-arched feet (supination). Flat feet, for example, can cause the shin or thigh bone to rotate inward, messing up the kneecap’s movement. Also, weak hip muscles can affect how the knee moves, especially during activities like running.
   
   

Managing Knee Pain

• Manual Therapy: Hands-on techniques to improve movement and reduce pain.
• Exercises: Both open-chain (where the foot is not fixed on the ground, like leg swings) and closed-chain exercises (where the foot is fixed, like squats).
• Quadriceps Strengthening: Focusing on strengthening the thigh muscles.
• Patellar Taping: Applying tape to the knee to help align the kneecap.
• Orthotics: Using shoe inserts to correct foot and leg alignment.
• Proximal Muscle Strengthening: Strengthening muscles around the hip and upper leg.
• Physical Therapy

The most supported treatment is exercise therapy, especially a combination of hip and knee exercises, which is more effective than knee exercises alone. Movement is medicine.

Effective Knee Recovery Exercises

Straight-Leg Raise: Lie on your back, bend one knee at about 90 degrees with the foot flat on the ground, and keep the other leg straight. Lift the straight leg up, keeping the knee fully extended, hold for 10 seconds, then lower it back down. Make sure to maintain a normal curve in your lower back and avoid tilting your pelvis.

Pillow Squeeze Exercise: Sit with your back supported and both knees extended. Place a pillow or towel under one knee (it can be slightly bent). Try to press the pillow/towel down by straightening your knee. This contracts the quadriceps muscle.

Squats: Stand with feet shoulder-width apart. Bend your knees to squat down, making sure your knees do not go beyond your toes. Keep the squat within a comfortable range, ideally between 0° to 40° of knee flexion. Stand back up and repeat.

Eccentric Hip Abduction: Stand on one leg, the other leg lifted to the side. Slowly lower your body by bending the knee of the standing leg, focusing on controlling the movement. Return to the starting position and repeat. This exercise strengthens the hip abductors, important for knee stability.

Hamstring Curls: Use a resistance band to perform hamstring curls, targeting the muscles at the back of the thigh.

Wall Slides: Stand with your back against a wall and slowly slide down until your knees are bent at a 30-degree angle. Hold for a few seconds and slide back up.

Step-Ups: Use a sturdy step or platform to step up and down, alternating legs. Ensure proper balance and control and avoid jumping down to minimise impact.

Bridges: Lie on your back with your knees bent and feet flat. Lift your hips off the ground, creating a straight line from shoulders to knees.

Clamshells: Lie on your side with knees bent at a 90-degree angle. Keeping your feet together, lift your top knee as high as you can without moving your pelvis.

Heel Slides: Lie on your back, bend your knees, and slowly slide one heel along the ground, extending the leg. Repeat with the other leg.

Leg Press Machine: If available, the leg press machine can be a valuable tool for knee recovery, allowing you to gradually increase resistance.

Tips for Safe Recovery

• Consult a Professional: If you’re uncertain about your condition, consult a healthcare provider or physical therapist before starting any exercise program.
• Start Slowly: Begin with low resistance and low repetitions, gradually increasing as your knee strengthens.
• Focus on Form: Ensure proper form during exercises to avoid further injury.
• Consistency is Key: Consistently perform your prescribed exercises to see improvements in knee strength and mobility.
• Listen to Your Body: If an exercise causes pain or discomfort, stop immediately and consult a professional.

For personalised and tailored programs or consultations
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