Spring is here…I can feel it. Longer days, rising temperatures, flowers blooming and, March Madness taking over my television for the next 3 weeks. After the winter we’ve had, I can honestly say that I have spring fever. As spring arrives, we’re all itching to get outside to exercise, play sports, and work in the yard. We use any warm, sunny day as a good excuse to hit the Katy Trail or run the loop at Forest Park. It just feels good, both for the mind and body. However, while these increases in physical activity have many positive effects on the body, sudden increases or drastic changes in activity levels can also lead to injury, pain and dysfunction. It’s very common in the spring for patients to end up in my clinic with a new injury or a flare-up of an old one due to changes in type of activity and intensity levels. A common complaint that I hear is a sudden onset of anterior knee pain (or pain under the kneecap).
Anterior knee pain is often the reason patients seek out my services in early spring. Generally speaking, there isn’t a specific injury or event that results in increased pain. More often, there is a gradual onset of pain in the front of the knee with activities like running, walking, cycling or daily activities like stair climbing. Patients will sometimes complain of a feeling of weakness or the knee “giving out”. This is a very common scenario for individuals who’ve recently changed their activity and exercise routine. Nonetheless, it can become quite debilitating for patients and can limit their activity levels, causing unnecessary frustration.
Pain and dysfunction at the front of the knee and under the kneecap are often termed Patellofemoral Pain Syndrome (PFPS) or chondromalacia patella. Patellofemoral pain is characterized by pain in the front of the knee and is made worse with stairs, sitting or squatting activity. Athletes may have pain with running, sprinting, decelerating, jumping and landing. Others may have pain with simply walking downhill.
A thorough subjective history helps me zero in on a possible diagnosis and differential diagnoses and a complete physical examination is performed in order to identify areas of movement dysfunction, which is often the most common cause of anterior knee pain. Additionally, examination will evaluate strength and motor control of the entire kinetic chain, from the feet through the hips and core. Other tests will evaluate joint integrity, flexibility, coordination, and functional movement. Ultimately, I’m looking for movement patterns and findings that will confirm my initial diagnosis, including activities that result in increased symptoms. For example, a patient may present with knee pain when climbing stairs. My evaluation will be spent assessing the patient’s movement patterns when stair climbing, identifying faulty movements, and providing corrective cues to reduce stress on the patellofemoral joint. Determining the causes of these movement dysfunctions are essential for effective treatment. We’ll also use Video Motion Analysis as an evaluation and teaching tool. Contributing factors can occur anywhere along the movement chain, and can include weakness or abnormal motion at the foot/ankle, knee, hip, and even middle and lower back. An effective treatment plan cannot overlook these factors.
At Axes Physical Therapy, our experienced and highly trained physical therapists listen to you and perform thorough examination to identify the underlying causes of your patellofemoral pain. We then develop a specific treatment plan to address your pain and underlying dysfunction. Our treatments are hands on, evidenced based and progressive to help you maximize your time exercising this spring, whether it includes gardening, running the Katy trail, playing sand volleyball, or all three!
About the Author: John Ruesler, DPT, CMPT, Astym Cert. practices and lives in St. Charles, MO. He is a Missouri native and he received his Doctor of Physical Therapy from Missouri State University in 2013. Since then, he’s received certification in Astym and as an orthopedic manual therapist.