Though there are many strategies that could be employed for helping with anterior knee pain. I think there are some general strategies that can be used to help alleviate symptoms. A good diagnosis and understanding of the injury is step one. Once you have that, here are some simple strategies to get you on your way.
As I was writing it was going a bit longer than expected…so I’ve turned it into a 3 part series. Today we will be part 1 and I will post parts 2 and 3 later this week.
Part of the problem when dealing with anterior knee pain is that you are looking to increase muscular strength, but exercises hurt.
These are the 3 strategies I use when treating anterior knee pain:
Find Your Starting Point
Vary your Movements
Find Your Starting Point
Sounds obvious, but one of the first things you need to do is find your starting point. I really like to start with success. Often people will have dug in for a while with this kind of injury. It is often intermittent and will gradually increase over time. So people commonly put off getting it seen for quite while. This is completely normal, but it will mean that a lot of movements will have become quite sensitive.
It can be tricky, if the sensitivity is very high even early range squats, lunges, step ups/downs, etc can be painful. So, where to start?
The starting point is to get the sensitivity down. Finding your exercise starting point is part of this. Other strategies include:
Good pain education
Regular use of heat/ice
Getting these in place is key in every injury really. If you were to put them in priority order I would say it’s ‘Good Pain Education’ first. This is because the other strategies stem from the knowledge of pain. The slight issue can be that the patients priority might not be pain education!! This sounds weird, but if the patient is looking for something else…the best pain education in the world might not help them! If they want hands on physio or a good rehab plan they may not be satisfied. So, striking a balance to meet the patients individual needs is key, as ever.
Exercise Strategies for Anterior Knee Pain
However, from an exercise point of view, my first thoughts are to see what the patient can and can’t do. See where in the common movement patterns the pain starts and then build your exercise starting point around that. I want them to be successful. We need to build confidence to help decrease the sensitivity.
The easiest strategy is to start with the least provocative, yet most productive exercise, single leg balance. It’s a great starting point. Much less likely to provoke their pain since it’s not moving. The bang for your buck is massive, the motor learning is great. The muscle coordination will come in handy later on too.
Biggest thing is you are starting to put some load through the knee. If you can do that successfully and repeatedly you will get a positive move forward.
Increasing Muscle Recruitment
If the patient is a bit more capable you can use squats, lunges, step ups/down, etc. If they can move through some range successfully you can often increase this by recruiting more muscle.
For anterior knee pain you are looking for coordination (from the balance work) and then getting more out of the hips. If you can increase glutei recruitment you will likely get more out of the knee. By this I mean either greater movement or less sensitivity.
The best way to help increase the glutei in a squat/lunge is to use arm drivers. It’s great because it requires no equipment and so can easily be added to the home exercises.
Since the glutes are fired up by hip flexion, adduction and internal rotation these movements are your goal with the arm drivers. My first thought would be adding in more hip flexion.
Hip Flexion with Anterior Reach
I like doing this on a step as it further decreases knee load, while increasing glute activity.
You can either position in place and rock back fore, or lunge into the position, all depends on the individual.
In this example I start in position and rock onto the right knee adding in the anterior hand drivers to fire up the glutes.
Though this was a video about hip mobility it works for this as you are loading the knee nicely with lots of glute recruitment.
When looking through the videos, there’s also the transverse plane version that will fire up that right glute and help your patient with right knee pain.
Again, this is the static version. You could. lunge into this (not onto a step. that can move!) or you could us an anterior lunge on the flat. The key is that by rotating the arms into right rotation over the right leg lunge will massively increase glute recruitment and help your patients with anterior knee pain.
These videos are from the Increasing Hip Mobility post from a few weeks ago. Which in itself is a great strategy for someone with anterior knee pain.
OK!!! So I had a lot more to say than I thought I would!! I’ll put the other 2 strategies (vary your movement and progressions) into a separate post in the next week.