Orthopaedic surgeon Mr Sean Curry continues our series on therapeutic exercises with a guide to patello-femoral pain and when exercise programmes are appropriate. A patient information leaflet and full video are online
One of the common diagnoses of anterior knee pain is patello-femoral pain syndrome (PFPS) – a condition affecting adolescents and young adults. In the past, the term chondromalacia patellae has been used and often the two are used to describe the same entity. But the consensus is that in PFPS, the articular cartilage is normal as opposed to the damaged cartilage seen in chondromalacia patellae.
The typical symptoms are of kneecap-related pain, particularly when sitting with bent knees (cinema sign), squatting or going up and down stairs. Crepitus and giving way are also sometimes seen. The pain often starts in adolescence and women are more affected than men. The diagnosis is clinical, as X-rays and MRI are normal.
One general practice study in 131 patients with PFPS found supervised exercise therapy resulted in less pain and better function at short-term and long-term follow-up than usual care in patients.1
Two useful exercises are described here.
Straight leg raise in external rotation involves patients gently pressing the knee down into the floor when prone, turning the leg out and slowly raising it up slightly.
For static quads, patients lie down keeping the leg straight. While tensing the muscles in the front of the thigh, hold for five seconds and repeat 15 times. A more advanced form involves the addition of turning the leg out and slowly raising it just off the bed or floor.
Patients with anterior knee pain, particularly after loaded flexion/extension of the knee.
Established knee osteoarthritis, patella tendinopathy, Osgood-Schlatter's disease. Previous significant knee injury or surgery.
If patients fall into one of the groups immediately above or do not respond to treatment, referral to an appropriate physiotherapist or orthopaedic surgeon is advised.
Twenty minutes a day for three months.
Mr Sean Curry is a consultant surgeon at the London Orthopaedic Clinic. To contact Mr Curry for more general information, call 020 7186 1000.
The London Orthopaedic Clinic holds free monthly education sessions for GPs. For more information: www.londonorthopaedic.com.
Many thanks to the Princess Grace Hospital physiotherapy team for their contribution.Anterior knee pain exercises Patient leaflet Patient leaflet for anterior knee pain