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Pain at the front of the knee.

The patella-femoral tendon is very short and powerful, it extends from the “ Quadriceps “ goes over the “ Patella “ and attaches to the “ Tibial Tuberosity “ at the top of the Shin bone ( the visible lump below the knee cap).
It works as focal point for the Quadriceps during knee movements like kicking, bending, jumping and going up and down the stairs.

As the knee is involved in many movements it is also prone to overuse or overwork injuries, running uphill, jumping, kicking a football are some of the movement which can cause overuse injuries to the knees but also kneeling to clean floors and gardening are among the causes.

“ Anterior Knee Pain “ is term used to describe overuse injury to the knee.
This injury builds up over time, then suddenly becomes painful, the pain is usually described to be in the front of the knee ( Anterior ) just below the knee cap ( Patella ) painful in the morning then as the day goes by it becomes more bearable.

(Note: in children ' anterior knee pain ' could lead to a different problem:
Osgood schlatters disease - where the bony protrusion below the knee ( tibial tuberosity) becomes inflamed, the reason for this is due to overuse combine with a growth spur where the bone grow first and the muscle later so it become over stretch and pull away from the bone attachment, this become so inflamed and extremely painful and swollen and not very pretty to look at.)

What exactly happens?

When the tendon is injured at first few fibres might tear, the tear is then repaired as the healing process take place, scar tissue forms resulting in thickening of the tendon.
This may limit some of the movement or cause pain and further irritate or injure the tendon, adhesions may form gluing fibres together or to the bone causing more pain and more injury.
In other words now the in jury has entered a vicious circle.

How to fix it:

Stop immediately offending activities.
R.I.C.E
Identify the cause before you cure the symptom.
Bio-Mechanics need to be addressed and the use of Orthopaedic insole may be advised.

The Massage therapist role:

Massage the Quadriceps as they are likely to have become tight and hyper-tonic and might be adding tension to an already weakened tendon also the Quadriceps muscle itself could be one of the main culprit for this injury, consult with a Physiotherapist.

Friction the PF tendon to prevent scar tissue build up and breakdown existing adhesions, this is a very painful process and should be accompanied by cryo-therapy or cold spray and stretch techniques, wrap ice around the knee during stretching can work as well.
Passive Stretching to the limits of pain to restore flexibility.

The Physiotherapist role:

Maintaining Quadriceps muscle tone is also important to avoid secondary problem to the knee joint stability, static squatting or wall slides would be very beneficial also very beneficial would be the use of a leg press with gradual increase of intensity and weight while cycling could be a good non impact exercise to maintain cardio- fitness.

Gradual introduction to light stretching knee bending exercises are advised to increase and maintain healthy flexibility.

The Doctor role:

As the pain can be severe anti- inflammatory prescription tablets might be a necessary step.
Avoid if possible steroids injections unless absolutely necessary , they might weaken the tendon further risking a possible rapture, before you take this option make sure it is the right one ( consult with the Physiotherapist for advice).
If there is a suspected rapture or partial rapture the patient may need a scan and eventually surgery to repair the tendon, to get a scan you need a referral letter from a Doctor.

The natural health advice:

Drink plenty of fluids, your muscle tissue may be dehydrated.
Take Fish Oil supplements to maintain optimum joint health and lubrication.
Prevention is the best cure, listen to your body.

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