Knee pain

My knee started to hurt a little bit while climbing stairs, a pain that I ignored as it was only a little bit and  felt only when climbing has recently started getting worse. Are you wondering what happened to your knee? You have never injured it, never fallen, then why is it hurting?

A gradual onset of knee pain is usually due to a mechanical defect that has been setting in over the last few weeks to months.  Most common diagnosis in a condition like this is Patellofemoral Pain Syndrome or PFPS. PFPS is a broad term used to describe a gradual onset of pain in the front of the knee, around the patella or knee cap. Pain resulting from PFPS makes it difficult to perform activities like climbing stairs, kneeling down and any activity that involves squatting or lunges.

Knee Joint Anatomy

Looking at the anatomy of the knee joint and muscle function will help you understand why your knee is hurting and what physiotherapy/individualised exercise program can do to treat this condition.

The knee joint consists of three bones, the lower part of thigh bone (femur), upper part of leg bone (tibia) and the knee cap (patella). The patella is resting in a groove on the femur and is moving up and down in this groove (track) during knee movements. The soft cartilage covering the joint surfaces and the fluid (synovial fluid) filled in the joint space keeps the movements very smooth.

Patellofemoral Pain syndrome( PFPS)

Pain felt beh­ind or around the patella is known­­ as Patellofemoral Pain syndrome. Damage to the structures around patella usually causes patellofemoral pain, which is most commonly of gradual onset.

Common Risk factors

Over use of the knee joint, while exercising or doing sports is a risk factor for PFPS, as in running, jogging, squatting, ­­step classes or spinning classes. And improper training techniques can predispose PFPS. Poor foot/knee hip biomechanics, quadriceps and gluteus muscle weakness or dysfunction, tight thigh muscles like IT band, hamstrings etc. are also responsible for poor patella tracking in the groove resulting in wearing out of the cartilage leading to patellofemoral irritation resulting in PFPS. Any trauma to the front of the knee or patella can also produce PFPS.

Symptom presentation

Usually it starts with slight pain during activities like climbing stairs, running or squatting to sit on to a chair or getting up from a chair. Later on this can become a dull or constant ache causing irritation during activities or sharp pain during an activity. For example pain after sitting for long duration with knees bent as in long drives or watching movie. Most of the time it is activity dependent and staying away from the irritating activity will temporarily help to manage the symptoms. As your PFPS gets worse it can also present in the form of swelling or joint effusion and severe pain.

Diagnosis and treatment

Diagnosis of PFPS is done through a thorough evaluation of the lower back and the lower extremity biomechanics. Physiotherapy is the best way to manage and clear the symptoms of PFPS. If  you have started  experiencing pain while climbing stairs, during your gardening  or sitting down/ getting up from the floor and the pain is been kind of consistent without getting better. A consultation with a physiotherapist will help you with proper assessment of the lower extremity biomechanics and the presence of PFPS.

Once PFPS is diagnosed patients will be provided with a specific exercise program along with manual therapy and taping. The exercises will mostly focus on strengthening the weak hip and thigh muscles and stretching the tight ones. Depending on the assessment findings you may also be suggested to use a patella tracking brace and/or orthotics during physical activity or at work.

From my experience 6-8 weeks of passive physiotherapy followed by another 6-8 weeks of prescribed home exercise program will help in improving the PFPS symptoms in a majority cases.  If symptoms are not improving with 6-8 weeks of physiotherapy and home exercise routine, it will be a good option to go see your family doctor to analyse the need for further diagnostic imaging and consultation with an orthopedic specialist.

So please do not wait till that knee pain gets worse and starts affecting all your activities of daily living. Consult a physiotherapist and you can easily fix it when things are still under your control.


Knee pain