Knee pain is very common. There are a number of different types of knee pain. The one described above is called Patello-femoral Syndrome or Chondromalacia Patellae. Other less common types of knee pain include Sinding-Larson-Johansson Disorder, Patella Tendinitis and Bursitis. Another more common form of knee pain is Osgood-Schlatter Disease which occurs only in children and adolescents. Another term for Patello-femoral pain is Runner’s Knee.
Patello-femoral Syndrome is the most common form of chronic knee pain and is characterised by pain occurring between the knee cap (patella) and the underlying thigh bone (femur). It causes pain and tenderness in the front of the knee. It is also known as Anterior Knee Pain. (In contrast, pain behind the knee is very rare.) Patello-femoral pain is worse when you sit for long periods and get up out of a chair or the car, or when climbing stairs. Often, people experience a grinding or crunching sensation in the knee joint.
The knee forms the link between the upper and lower leg and is a hinge joint, designed to flex and extend the lower leg. Unlike our ankles and hip joints, the knees are not designed to rotate. However, when the foot rolls inwards due to over-pronation, the lower leg is forced to rotate, placing abnormal stress on the knee joint and resulting in poor knee function. This will inevitably lead to excessive wear and tear to the knee cartilage, causing long-term damage and chronic pain.
Many people suffer from over-pronation and most physiotherapists in Singapore now include assessment of the patient’s feet in the diagnosis of knee pain.
Knee pain treatment
Different types of knee pain demand different types of treatment. Athletes and runners often present with knee complaints as a result of injury. Sports injuries are usually treated by (sports)physiotherapists using the RICE method: Rest, Ice, Compression and Elevation. A typical sports injury in rugby and soccer players is rupture of the anterior cruciate ligament.
However, normal knee pain which has come about over time as a result of ageing, strenuous labour etc will require a different treatment regime. Chronic knee pain is best treated by a physiotherapist, but there’s a lot you can do yourself. In some cases of chronic knee pain surgery is the only option left to achieve permanent pain relief.
Exercises for knee pain mostly involve strengthening of the VMO muscles (Vastus Medialis Oblique) which are part of your quadriceps (the muscles and ligaments in the upper leg in front of the thigh). The VMO is placed just above and to the inside of the knee cap. The VMO acts as a dynamic stabiliser of the knee cap. In pain-free individuals the fibres of VMO are active throughout the range of movement, contracting with ease. In people with Patello-Femoral pain these muscle fibres contract inconsistently and fatigue rapidly.
A strong VMO ensures the patella stays in the patella groove, controlling the tracking of the patella when the knee is bent and straightened. Please see the section below for more details on strengthening exercises. Most physiotherapists will recommend strengthening exercises to their patients as part of their knee pain therapy.
Knee braces are often prescribed by physiotherapists to stabilise the knee joint. There are many different types of knee braces available, the most commonly used being the Patella-Femoral brace, designed to improve patellar tracking and help relieve anterior knee pain. Patellofemoral braces resist lateral displacement of the patella, maintaining patellar alignment and tracking. They are not expensive and can be used in conjunction with other treatment options.
How foot orthotics can help relieve knee pain
Like knee braces foot orthotics are inexpensive and can be very helpful in the treatment of knee pain, provided they are used in conjuction with other forms of knee pain therapy, in particular strengthening exercises. By re-aligning the feet and ankles, orthotics prevent internal leg rotation, one of the causes of patella mal-tracking.
A number of studies have shown the benefits of orthotic insoles in patients with patello-femoral knee pain. A recent study by the University of Queensland showed significant improvement in patients with knee pain who were given a combination treatment of physiotherapy and orthotics, compared to patients who only received physiotherapy treatment. (See extracts from Knee pain and Orthotics research below).
Most top athletes wear orthotics to ensure proper alignment of their feet, legs and knees. Footlogics orthotics help restore proper knee function by correcting over-pronation, eliminating one of the causes of patello-femoral pain. If you have fallen arches and/or rolling inward of the ankles, there is a good chance that orthotics will provide you with some degree of knee pain relief.