Do you have pain “right inside” your knee?
then you might have patellofemoral knee pain.

Pain around, behind or under the knee cap is called patellofemoral pain. It is very common, and has many causes. Patellofemoral pain is generally felt during activities that put load through the knee, like running, sitting, going up and downstairs or even just walking.

What CAUSES Patellofemoral knee pain?

There are a variety of causes of patellofemoral pain. Studies suggest that there are three main categories of cause of pain.

Biomechanical: The first main cause is biomechanical; where the body moves in a manner that causes the knee joint to become overloaded during activities. The overloading causing the patella to start maltracking across the knee joint, which increases stress in the joint, which causes signals to be sent from the subchondral bone to the brain that is translated as pain by the brain. Part of the biomechanical cause is due to poor function of the hip and thigh muscles, which is why part of a successful treatment for patellofemoral pain will involve exercises to strengthen these muscles.

A woman's knees.

Too much or too little activity: Overworking or underworking the knee can cause the soft tissue around the knee to change, and this can result in cells in the area sending messages to the brain that are translated as pain. At a basic level, doing too much in one go, or a sharp increase in activity can cause this to happen, but ironically not doing enough can cause this to happen too, because not using the knee causes it’s functionality to diminish.

Psychological factors: The most modern understanding of how pain affects people is known as the bio-psycho-social model, because it takes into account the biological, the psychological and the sociological aspects of pain. For instance, science shows us that people who are lonely feel pain more intensely, and that there is a distinct psychological element about how pain is processed by the individual dealing with it. Unsurprisingly, studies have shown that people with knee pain also show increased depression, anxiety, catastrophising and even fear of moving (in case the pain occurs again). However, it doesn’t appear that having depression or anxiety will cause knee pain, but that if someone develops knee pain, they are more likely to experience psychological factors that might go on to slow their recovery.

What can be done to help patellofemoral knee pain?

Exercise: Exercise is recommended to both reduce pain and increase function in both the short, medium and long term. The best results appear to be achieved by combining both knee and hip exercises (along with stabilisation training), rather than just knee exercises, because people with patellofemoral knee pain often have poorly functioning hip muscles.

Woman stretching with bent knee

It appears that this dysfunction in the hip muscles is due to people changing the way they move to lessen pain, rather than the dysfunction causing the knee pain in the first place. If the hip muscles do not work well, they are unable to control the femur, with the result that it moves under the patella, causing pain.

Another type of effective exercise is known as “movement retraining”, which involves performing specific exercises in front of a mirror, allowing people to see how their movement is changing over prolonged exercise. Best performed on a treadmill, the person with knee pain would need to concentrate on running with their knees apart with kneecaps pointing straight ahead, and to concentrate on squeezing the buttocks whilst running.

Taping: Taping the knee using kinseology tape (like RockTape) can make a real difference to pain felt when carrying out activities that load the knee, like squats, climbing stairs or running, with studies showing that there isn’t one ideal taping application for patellofemoral pain - instead, the best result is achieved by tailoring the taping application for the individual.

Knee braces: Although allergies to kinseology tape are rare, they do happen. Braces that align the knee can help in a similar way as taping, with studies showing that using a brace whilst exercising gives better results than exercising without any support.

Shoe orthotics: Studies show that show inserts can help reduce pain for between 25% to 50% of people. These inserts don’t have to be individually customised, and that actually pre-made inserts can help to the same extent. To find out if you are one of the people that orthotics can help, you simply need to try the orthotics whilst performing an activity that normally causes pain. If the pain is reduced with the orthotics, then they are likely to help in the longer term as well. If they don’t help immediately, then they are unlikely to help in the longer term either.

Links:

student with bent knees sat on books.

Higher pain level and lower functional capacity are associated with the number of altered kiematics in women with patellofemoral pain at https://www.ncbi.nlm.nih.gov/pubmed/28712512

The psychological features of patellofemoral pain: a systematic review at https://www.ncbi.nlm.nih.gov/pubmed/28320733

Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis at https://www.ncbi.nlm.nih.gov/pubmed/26175019

Mirror gait retraining for the treatment of patellofemoral pain in female runners at https://www.ncbi.nlm.nih.gov/pubmed/22917625

Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and bio-mechanical mechanisms at https://www.ncbi.nlm.nih.gov/pubmed/24311602

Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomised clinical trial at https://www.ncbi.nlm.nih.gov/m/pubmed/27146819

The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome at https://www.ncbi.nlm.nih.gov/m/pubmed/20647297

Need help with knee pain now?

Soft tissue therapy can help improve knee pain - both by easing muscular pain in the hip and thigh, taping across the knee and helping ease any anxiety or depression that the knee pain is causing. We can also help by explaining what is going on with knee pain due to our level of anatomical training which means that knee pain becomes less frightening.

We’re Level 5 Soft Tissue Therapists qualified to assess and treat injuries to muscles and joints, and we can use a variety of techniques including taping, instrument assisted soft tissue massage, cupping, blood flow restriction, soft tissue release and muscle energy techniques to help reduce pain and increase mobility.

We offer online appointment booking with immediate confirmation, including late night and weekend appointments. Treatments are carried out in our custom studio with free, off-road parking in the historical Georgian town of Spalding.

When you come and see us, you get the benefit of all our advanced training as well as personalised advice about how to avoid knee injuries in the future.

And if that’s not enough to convince you - we offer 33% off your first appointment!