Knee Pain… it’ a right pain in the … well, KNEE!
What can we do about it? There are many causes of knee pain, but as I’ve said several times before, one of the most common is anterior knee pain, also called patellofemoral pain.
Patellofemoral pain, or PFP is pain that originates from the underside of the patella, or kneecap caused by its maltracking (doesn’t articulate in a straight line up and down the femur as you bend and straighten the knee). Its causes are thought to be multifactorial with local, distal and proximal factors proposed to contribute to it. Good evidence now exists that long axis femoral rotation (turning inwards of the femur) in relation to the patella is a key contributor to maltracking and a valid rehabilitation target.
Rather than focus all our rehabilitation and conditioning efforts on the distal muscles -i.e. the quadriceps, given that internal femoral rotation might contribute to this type of knee pain, shouldn’t we be focussing also on the muscles that externaly rotate the hip?
I came across a great paper yesterday that systematically reviewed and then meta analysed all the quality evidence in this field. See below for a link to the full paper:
Effectiveness of proximal muscle rehabilitation on patellofemoral pain (PFP).
So, what did the authors find?
– In the short term, strong evidence indicates that proximal muscle rehabilitation (rehab to hip / lumbo-pelvic muscles [defined as strengthening, but we may question if it’s ‘true’ strengthening]) combined with quadriceps rehabilitation is signiﬁcantly better at reducing pain than quadriceps rehabilitation alone.
– Moderate evidence indicates that proximal rehabilitation is better at improving pain compared to quadriceps rehabilitation alone, and very limited evidence indicates that proximal rehabilitation reduces pain compared to a no intervention control.
– In the longer term, limited evidence indicates that proximal muscle rehabilitation combined with quadriceps rehabilitation is more effective at reducing pain than quadriceps rehabilitation alone.
What to Rehabilitate and When?
Well, at least in the short-term there’s a good chance that including rehab of for example the external hip rotators, abductors etc. in conjunction with quadriceps will elicit a quicker recovery. Thereafter, perhaps there’s a need for a maintenance exercise programme and, or, assessment of gait or running style…?