In our last blog, we’ve discussed the common causes of anterior knee pain and highlighted the importance of getting an accurate diagnosis. This follow-up blog will highlight the differences in the exercises to solve these issues!
If you have not read Part 1 of the blog you can read that here
We can classify the exercises into 3 main groups which all need to be addressed in varying degrees depending on the individual.
1. Mobility exercises
2. Strengthening exercises
3. “Functional” exercises
*to keep things simple, we will be focusing our exercises on a single muscle – the quads!
We often see patients with anterior knee pain (of all diagnosis) presenting with tight quadricep muscles. This tends to increase the amount of load going through the front of the knee – which the knee doesn’t want when it’s in pain!
It is unknown whether tight quads increases the risk of knee pain. But when its painful, releasing and stretching the quads out often help to ease the pain!
Try these stretches and foam rolling techniques to loosen off your quads!
Standing Quad Stretch
Active Release Technique-Quads
Once we have addressed the mobility, it’s important to start some simple strengthening exercises. Muscles tend to be inhibited when we experience pain – this means that they “switch off” in an attempt to reduce the pain.
It is important get the muscles strong again so they can move and stabilise the joint. Stronger muscles also reduce the risk of re-injury, allowing you to enjoy your activities!
This stage is where the exercises performed can start to differ depending on the diagnosis of your anterior knee pain.
With patella tendinopathy, the first choice of exercise involves some form of isometric load. This means the muscle is working without lengthening or shortening. It is an easy way to control the amount of load going through the tendon as you are able to adjust the amount of force exerted. This allows you to control the amount of pain experienced when doing this exercise.
Isometric wall squats are a great way to do this! You will experience some amount of pain in the knee with this if you have PT, but keep it to a 3-4/10 pain score. If your pain levels exceed this, straighten your knee abit so that you are standing higher up.
With PFPS, there usually isn’t too much of a structural “defect” that requires “healing” per se. Therefore, the exercises to strengthen the quads are typically a modification of the movements aggravates the symptoms.
The aim of this is to reduce the sensitivity of the structures around the knee while strengthening the quads.
A squat or lunge for example can typically aggravate PFPS. A few pointers to take note – have a look and see if your knees tend to cross your toes.
If they do, try modifying it by sitting back, such as performing chair squats or box squats. This prevents your knee from going forward which reduces the amount of stress on the front of the knee.
With these tweaks, what you can expect is that you can do more before the pain comes on, or it will be a more manageable level!
For example, if you could only do 5 repetitions before it’s too sore, these changes should allow you to do more than that before the pain limits you. Somewhere between 10-15 reps is ideal (this rep range challenges the quads enough to strengthen it).
Compared to PT and PFPS, Meniscus pain is typically more mechanical in nature – this means that the pain will often come on quickly when the meniscus is loaded in weight bearing. Contrast this to the other 2 conditions where there is usually some leeway before the symptoms become unbearable.
Thats why with meniscus injuries, we suggest starting off with non-weightbearing exercises to begin with.
Using a simple exercise band, we can do knee extensions at home to help strengthen up our quads so that we can better handle load through the knees. In the meantime, we give space for the knee to settle and for healing to take place.
Knee Extensions with Resistance Bands
The last type of exercise we prescribe is largely to address the biomechanics during the aggravating movement. The aim of this is to optimise the movement patterns after the pain has mostly settled to prevent the load going through unwanted areas.
These exercises can be introduced earlier in PFPS versus a PT or meniscus problem. The appropriate timing to introduce this varies greatly between individuals, but usually done when the pain has almost settled.
“Runner’s” Single Leg Squat
That brings us to the end of this two-part blog. Hopefully everyone has learned about anterior knee pain and picked up some useful exercises to do for your injury.
These exercises, although effective, are just the tip of the iceberg in the treatment options for anterior knee pain. A specific diagnosis along with a combination of hands on treatment with a personalised exercise program works extremely well to rehab and prehab this injury.
And that’s what we do at ESP Physio! You can expect a thorough assessment and personalised treatment plan all from your very first session!
You can book yourself in for a physiotherapy appointment with us here or if you prefer to speak to someone, call us at 01324 227 370 or drop us an email at firstname.lastname@example.org and we will get you going in no time!
Written by Andrew Linn