Pain over the kneecap is termed patellofemoral pain (PFP). The most common symptom is pain over or under the kneecap which can be hard to get your fingers on. People often experience pain using the stairs, going from a sitting to standing position, driving, walking, cycling or squatting. It can arise suddenly, and be sharp in nature. People can feel wobbly on their knee. In some people the knee can swell.
Why is there pain?
The kneecap travels up and down in a groove as you bend and straighten the leg. This groove is in your thigh bone. Ideally it travels up and down the centre of the groove.
When pain occurs it is most commonly because the kneecap is no longer travelling in the centre of the groove but starts to be move up and down on the outer edge of the groove. This leads to rubbing of the cartilage under the kneecap with the cartilage on the thigh bone. Lesions can arise which are the source of pain.
We aim to fix it by looking for the factors which led to the kneecap no longer tracking up and down the groove correctly. As the knee lies between the hip and the foot, the source of the problem could be here.
If you have weakness at the hip, in your core or in your gluteal muscles it affects the movement of the knee and the how your thigh bone, kneecap and shin bone line up. If you pronate (roll inwards as you walk or run) or have flat feet, it also affects the alignment of the knee joint.
The silver bullet
The bad news is that there is no silver bullet. Orthotics can give some short term relief in those who need it. A knee brace may help reduce symptoms in the short term. In the long term you need to address the muscle imbalances that caused the problem at the hip, foot and knee. This involves getting a full assessment of your core, hip, knee and foot function and developing an exercise plan from there.
Some people make a quick turnaround and reduce their pain symptoms in 6 weeks and for others it can take a number of months. It can depend on your adherence to your exercise programme, the amount of wear and tear in the knee already, and also how long you have had the problem. Patellofemoral pain can be a very frustrating problem to have, and can recur. If there is significant wear and tear within the joint it can develop into osteoarthritis of the kneecap. In these cases, we work with our clients to reduce the pain as much as possible and improve the function of their knee within it’s limits.
If you would like to read more detail about the various factors that lead to the problem please see the full kneecap pain blog here