REHABILITATION AND TREATMENT FOR ANTERIOR KNEE PAIN Emilie Rowe, DPT Physical Therapist Rochester Regional Health Physical & Occupational Therapy

Common diagnoses causing anterior knee pain  Patellofemoral Pain Syndrome  Quadriceps tendinopathy  Patellar instability  Osteochondroses  Patellar tendonitis  Synovial plica

Is it really the knee that is the problem?  The knee might not be the issue  Evaluate from the lumbar spine all the way to the feet -lumbar spine, hip, knee, ankle  Look at posture, alignment, range of motion, strength(MMT and functional ), joint and soft tissue mobility

Common Issues Leading to Anterior Knee Pain  Poor trunk control  Poor gluteal function  Restricted ankle dorsiflexion  Soft tissue restrictions  Misalignment  Anatomical structural deficiencies

Core Control  Weakness in abdominal and/or gluteal muscles  Leads to increased lumbar lordosis and anterior pelvic rotation  Effects down the chain

Core exercises

Progressive/functional core exercise  Weightbearing exercises

Poor gluteal function  The gluteal complex plays a crucial role in maintaining healthy knee’s  Two muscles primarily help to maintain knee alignment in closed chain positions -Gluteus Medius and Gluteus Minimus  Weakness causes increased Q angle

Fire those glutes!!  Open chain exercises

Don’t forget to add in functional tasks  Closed chain exercises

Decreased ankle dorsiflexion  Normal ankle ROM 5-20 degrees  Caused from gastrocnemius/soleus tightness or talocrural joint hypo-mobility  Leads to compensatory movements: increased knee flexion, subtalar pronation, tibial internal rotation, Q angle

Treatment Interventions  Myofascial release  Joint mobilizations/Mobilizations with Movement  Stretches

Soft tissue restrictions  Muscle imbalance leads to overuse and restrictions  Restrictions most commonly seen in 3 muscle groups -Hip flexors/quadriceps -Hamstrings -Iliotibial Band  Restrictions in these areas effect the mechanics of the knee

Restore proper tissue mobility Manual Therapy  Graston and/or Myofascial release  Passive stretching  Kinesiotape Therapeutic Exercise  Static Stretching  Dynamic stretching

The pelvis plays a role too…  Body designed to be symmetrical  Pelvis is the power house of the body  Misalignment can lead to knee pain

Treating pelvic alignment issues  In order to fix pelvic alignment you must determine the cause of it  Structural vs. weakness vs. soft tissue restrictions  Treatment plan can include manual and exercise -MET, myofascial release -Pelvic and core stability

Common structural issues that lead to knee pain and their treatment  hip anterversion → focus on glutes  pes planus → inserts and posterior tibialis strengthening  patella alta → taping, strengthening patellar stabilizers, VMO and glutes  knee valgus → strengthening of VMO and glutes  Can’t cure them but we can minimize the effects

Take away points…  Ask yourself is it really the knee?  Fire the glutes and the core!!  Restore ankle and soft tissue mobility  Alignment plays a role  PT can not cure the anatomical structural issues but it can help to minimize

Thank you!