Anterior Knee Pain – (Patellar Tendonitis/Patello-Femoral Syndrome)

Many runners have experienced knee pain during their running career.  The following is some information to help you to figure out what could be happening and what to do if you are experiencing knee pain.

What is it?

The structures located in the anterior (front) aspect of the knee are the patellar tendon, the patella (knee cap), quadriceps tendon, the distal femur where the patella sits in a specific groove, meniscus (knee cartilage), and laterally the distal aspect of the iliotibial band.
Anterior knee pain can occur when there is poor tracking of the patella in the groove on the femur, when there is irritation of the patellar or quadriceps tendon due to muscle imbalances/weakness, structural imbalances from the femur, tibia, or foot.

Possible causes include:
* Surface/training errors
* Over-striding
* Heel strike alignment
* Increased knee flexion at midstance
* Over-pronation at midstance
* Too little pronation (supinated foot, poor shock absorption)
* Over posting orthotics or greater rigidity than needed
* Structural abnormalities
* BMI greater than normal
* Joint swelling and secondary weakness, especially VMO
* Weakness in quads or decreased timing
* Decreased quad/hip flexor/ITband length
* Tight hip rotators, tight anterior hip capsule
* Poor pelvic control/strength

Pain in the front aspect of the knee at the patella itself, behind the patella, just below the patella (the patellar tendon), above the patella (quadriceps tendon), or to either side of the patella or tendon.  The pain usually begins after increased exertion, progresses to being painful during activity, and can progress to being painful outside of the activity.  There can be swelling present at the joint or either tendon.  Pain may be present with some daily activities such as doing stairs, walking on hills or squatting down.
What can I do?

* Rest (modify activity), ice, stretching, massaging the area (if unsure a physical therapist can instruct you in how to do this appropriately), taping or using a patellar strap, appropriate strengthening for lower extremity and possibly core, proper foot wear, appropriate running drills to improve movement pattern.
When to seek treatment from a PT:

* If symptoms are worsening instead of getting better, if they persist during rest periods, if there is significant swelling, if the knee feels weak or gives out.

By Kristi Moore, MSPT
Alpine Physical Therapy

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