Physical Therapist Management of Anterior Knee Pain

Abstract

Purpose of review: Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors.

Recent findings: The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.

Keywords: Exercise therapy; Patellofemoral; jumper’s knee; runner’s knee.

Fig. 1

Pain monitoring system used to guide clinical decision-making of modifications and progression of exercise-based intervention

Fig. 2

Squat variations performed with an elastic band to promote movement patterns and muscle activation that will reduce dynamic knee valgus. Bands can be placed above or below the knees, at the ankles or the forefoot during bilateral or unilateral activities. An isometric hold in a target range can be performed to accommodate pain or crepitus and progressed to a unilateral task with contralateral limb abduction or extension using no, or band resistance. Often a mirror is used to provide biofeedback to assure neutral frontal plane foot, ankle, knee, and pelvis position

Fig. 3

Retraining of movement strategies with feedback of performance, external focus of attention, and sport-specific training to enhance motor learning in performance of squatting and jumping. a Utilizing force plates for real-time feedback of performance to facilitate equal weight-bearing during a squatting motion. b Use of external focus of attention to facilitate appropriate squat depth and frontal plane knee alignment by instructing subject to align knees with cylinders and touch cylinders with hands. c Facilitating symmetric weight-bearing and appropriate squat depth with a volleyball pass. d, e Use of external focus of attention and dual-task conditions to facilitate appropriate stance width and frontal plane knee alignment during squatting and countermovement jumping