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Child Physiotherapy

PFPS (Anterior Knee Pain)

What is (PFPS) Anterior Knee Pain?


Patella Femoral Pain Syndrome or Anterior knee pain (AKP) is a common injury affecting the Patella and the structures at the front of the knee in children and adults. There are many structures that can give rise to pain such as the patella (knee cap) the joint, fat pad, bursa and the tendon. Common causes of AKP include Osgood-Schlatter's disease, patellar tendinitis, and patellofemoral instability in children. It can sometimes be known as a runner’s knee because it is common with joggers and is also seen with people who play sports that involve running, jumping, or squats. It is seen most frequently in the young, particularly girls and women who are engaged in frequent sports activity.  In 2021 one study found children aged 8–14. AKP occured in 5.7–8.9% of children and adolescents each year. In adults, it typically occurs in physically active people aged <40 years and is responsible for 11-17% of all knee pain in clinical practice. However, it can affect anyone regardless of age occupation, and activity level and frequently is not always related to any one activity or event.

What does it feel like?

  • Pain at the front of the knee

  • Stiffness or Pain at rest or with periods of immobility.

  • Knee pain with stairs, especially down. 

  • Pain is worse following activity, particularly sports participation

  • Swelling may be present in and around the joint.

  • The sensation of clicking or grinding in the joint, sometimes audible

  • May feel the knee will give way or doesn't feel stable

What causes (PFPS) Anterior Knee Pain ?

There are many potential causes and contributing factors for Anterior Knee pain but chronic overloading is the most common. For example, with too much activity, sport or other recreational tasks we can then cause irritation to the joint, tendons, fat pad, or associated structures. Biomechanical factors can contribute as these may create increased stress on parts of the joint or structures creating increased load. For example, factors such as hypermobility. If the knee cap is very mobile then this can irritate the patellofemoral joint through altered patellar tracking contributing to AKP.  Others such as increased foot pronation, poor single-leg stability, muscular imbalances of the hip (weak gluteal muscles)  muscle tightness, and poor landing mechanics can all impact. Many of these can be attributed to growth and development changes in childhood and adolescence however as adults these factors may influence the development of PFPS or AKP. 

Common Training Errors:

  • Too much volume too soon

  • Increased training participation or intensity

  • Increased jumping/plyometric training

  • Increased hill running

  • Lack of variation in training- New sports or activities.

  • Walking up and Downhill often,

  • Sitting down for long periods and lack of mobility

What Treatments can I do? 

If you have Anterior knee pain these injuries can be treated successfully by a Physiotherapist. This will involve a course of specific rehabilitation for the level of irritation you have and what structure/s are involved. There may be other modalities involved to help such as Soft tissue massage, Taping, Acupuncture, Compex Muscle Stim that can help reduce your pain and help your rehabilitation plan. Due to exercises like squats and stairs being irritable and provocative in some, our experts can aid by giving you a very bespoke programme depending on the causative factors and goals.

Treatments for PFPS/AKP can include some of these below.

1. Manual Therapy- Soft tissue release, Massage, Joint mobilisations

2. Stretching- quadriceps, hip flexors, calves, hamstrings, 

3. Strengthening- hip and lower limb being specific on the weakness/dysfunction

4. Electrotherapy- Muscle Stimulation to help improve muscle patterning/activation

5. Taping to support and offload irritable structures such as PFJ, Tendon or fat pad

6. Orthotics if the causative factor is foot biomechanical dysfunction

7. Exercise modification and yearly season exercise planning

Back to:    Knee Physiotherapy,     Contact,      Hom

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