Your Physiotherapist has diagnosed you with anterior knee pain also known as patello-femoral joint pain (PFJP). What now? This information page is designed to help you in addition to the advice given by your physiotherapist. By following these exercises, we will guide you through each step on your return to activities of daily living or sporting goals you have
Any exercise has an inherent risk. If you have any queries we would advise you to consult with your physiotherapist.
What is the Patello-femoral Joint?
The Patello-femoral joint is formed between the knee cap (patella) and the thigh bone (femur).
The knee cap sits in a small groove on the femur called the trochlea.
A number of muscles attach to the knee cap providing movement at the knee and help stabilise it within the trochlea to provide smooth pain free movement.
What is the Patello-femoral Joint pain (PFJP)?
There are numerous names for PFJP:
- Anterior Knee Pain
- Patella Mal-tracking
- Chonromalacia patellae
- Runners knee
- Patello-femoral joint syndrome
There is no specific cause for your PFJP, however it generally is related to altered or overloading at the joint due to various reasons:
Strength
The quads are the big muscles at the front of your thigh. Pain at the knee cap can limit how well they work and cause weakness. This can affect the movement of the knee cap and how you carry out your daily activities or sports. You may experience further irritation at the knee however not damage. Looking above the knee, the gluteal muscles, or your bottom muscles, control the movement of your thigh bone (femur). Weakness at these muscles can affect control of single leg movements like going up and down stairs, walking or running.
Overload
Your body will have a level of activity that is normal to you and your knee is happy to accept that level. When you rapidly increase, or vary that load it can cause overload. This can be a good thing; however, it can cause an increase in sensitivity at the knee especially if you don’t allow enough rest or the excessive load irritates weak structures around the PFJ.
Biomechanics
You may have heard your physiotherapist talk about altered biomechanics at your knee when you perform some activities. They may also have discussed an increased valgus movement when you bend your knee in standing. This is when you try a squat type movement and your knee moves inwards.
This can cause pain at the PFJ, however, ensuring you have strong muscles above, at and below the knee can help control the movement at the knee and reduce the irritation.
What can Physiotherapy do for me?
Physiotherapy is the best and most effective method to help manage your pain and help you return to your normal function. Your physiotherapist will help you identify any issues through their initial assessment and will help you with a specific individualised exercise program.Your rehab plan may aim to address the overload at the patella-femoral joint by:
- Reducing pain
- strengthening weak structures (above and below the knee)
- Correcting the way you move
- Improving your movement control
- Stretching tight structures
To achieve your specified goals as discussed with your physiotherapist, you will be required to attend regular physiotherapy appointments and most importantly continue your exercise program at home.
Pain Management
After an injury you may have heard from someone before about RICE (rest, ice, compression and elevation) when managing an injury. However, rest can be harmful and inhibits recovery. Recent research has now advised we use the acronym POLICE.
- Protection
- Optimal-Load
- Ice
- Compression
- Elevation
The key term is Optimal-load, this replaces Rest. You may need to speak to your physiotherapist to discuss what your optimal load might be as it is specific to you but will help speed up your recovery process.
Flare ups
An increase in pain or ‘flare up’ is common with PFJP. The key is to manage this effectively and efficiently. By using POLICE this can help reduce the initial pain. During a flare up manging your optimal load is important. You may need to reduce the stresses at the PFJ, reduce the amount of exercises and daily activities that you do. Over time gradually increase your activity back to previous levels. You can discuss optimal load with your physiotherapist.
How long will it take to get better?
Unfortunately, there is not definite answer to this question. There are no quick fixes and it requires active participation from the patient throughout the process.
We would, however, expect to see improvements within 3-6 months especially if the patient continues to maintain their specific exercise program. Most people will return to their pre-activity levels including sports.
The Exercises
Participating in an exercise program carries a certain element of risk for some people. You should consult with your physiotherapist before initiating this program to ensure your safety.
If you have any issues please do not hesitate to contact the physiotherapy department. If you feel light headed, dizzy or have issues with your breathing please contact your general practitioner (GP) immediately.
When carrying out this exercise program you may feel some discomfort at your knee. It is important that this pain does not exceed 3/10, where 10/10 is the maximal and 0/10 is no pain. Level 1 – you should feel the muscles in your bottom and thighs working!
| Repetitions |
45 second holds |
| Number of Sets |
3-5 |
| Rest period between Sets |
30-60 seconds |
Clam with bandIn side lying with your knees bent to 90°, in line with hips and a band around both knees.Raise the top knee away from the bottom knee without rotating at your pelvis or spine. [wpvideo RG4R6dEr]Hip abduction/extension with bandIn side lying have your bottom knee bent to 90° and the top leg straight, with the band around both knees. Lift your top leg up and back without rotating your pelvis or spine. [wpvideo rVXLB0bw]Fire hydrant with bandOn your hands and knees with the band above both knees. Bring your leg back with your heel towards the sky and turn your knee outwards. [wpvideo qD34AqoL]Wall SlideWith a band around your knees, knees shoulder width apart and feet out from the wall. Slide down until your knees are at 45°. Focus on keeping your knees over your second toe.As this becomes easier you can hold a weight in both hands to make it more difficult. Remember no pain at the knee. [wpvideo QoRBkFtp]Level 2 – you should feel the muscles in your bottom and thighs working.
| Repetitions |
45 second holds |
| Number of Sets |
3-5 |
| Rest period between Sets |
30-60 seconds |
Surfer SquatWith the band around both knees, position your affected leg forwards and the non-affected out to the side. Sit back into a mini squat position keeping your knees over your second toe. [wpvideo vcjcQKSK]Side Plank ClamIn side lying with your knees at 90 ° in line with your hips and elbow directly under your shoulder. Raise your pelvis up into a partial side plank position and raise the top knee away from the bottom knee without rotating at your pelvis or spine. [wpvideo 7QK5kRT8]Fire Hydrant in standingWith the band around both knees, stand on your unaffected leg in a mini squat with knees over your second toe. Bring your affected leg back with your heel towards the sky and turn your knee outwards. Lean forward through the trunk. If balance is an issue try this over a table and progressively reduce the support. [wpvideo c0J0gzDF]Mini SquatWith a band around your knees, knees shoulder width apart. Squat down 45°, focus on keeping your knees over your second toe.As this becomes easier you can hold a weight in both hands to make it more difficult. Remember no pain at the knee. [wpvideo R1AYeLEr]
Level 3 – Muscle Control in Standing (crab walk exercise different reps/sets)
| Repetitions |
15-25 |
| Number of Sets |
3 |
| Rest period between Sets |
60 seconds |
Crab walkWith the band around both knees, assume a mini squat position. Take small steps to the side and back again. Keep the knees controlled and the knees over your second toes.Repetitions: 10-15 paces each waySets: 3Rest period: 60 seconds [wpvideo 8IUSEHOt]Step upStand facing a step of appropriate height. Put the foot of your injured leg on the step and step up by extending through your hip and knee and bringing your other leg through as high as you can. Try to keep the movement controlled and make sure you keep your knee over your second toe throughout. [wpvideo Y1WrOlR4]Fire Hydrant in standingWith the band around both knees, stand on your unaffected leg in a mini squat with knees over your second toe. Bring your affected leg back with your heel towards the sky and turn your knee outwards. Lean forward through the trunk. If balance is an issue try this over a table and progressively reduce the support. [wpvideo 8Z9fgwFl]Squat with glutes activationWith a band around your knees. Preform a squat with knees over your second toes. Keep your bottom back and weight evenly spread out through your feet.As this becomes easier you can hold a weight in both hands to make it more difficult. Remember no pain at the knee. [wpvideo Ku1ADWIX]
