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Why Chronic Knee Pain requires a multi-joint approach


Knee pain is one of the most commonly seen conditions in a Physiotherapy Practice and accounts for approximately 25% of consultations. Whilst there are a number of structures around the knee that can be injured in an acute situation (e.g. ligament tear, bone fracture, meniscus tear), the 2 most common causes of chronic knee pain are (1) Patellofemoral Pain Syndrome and (2) Patella Tendinopathy.

Patellofemoral Pain Syndrome (PFPS):

Characterized by widespread knee pain, originating from poor tracking of the patella (knee cap) where it sits in its groove on the femur (thigh bone), especially during activities which put excess compression on the patella-femoral joint, such as:

–       Squatting

–       Walking up/down stairs

–       Sitting for long periods of time

–       Running

Patella Tendinopathy:

Characterized by pinpoint pain below the knee cap and is load-related with activities that have a high and repetitive demand on the knee extensors (quadriceps), such as:

–       Jumping

–       Squatting


Whilst Initial Management should focus on the control of pain and a supervised progression of load tolerance (for discussion on another day), rehabilitation of these conditions must address the full kinetic chain (from the upper body to the ankle) to ensure full return to sports/activity.

Let’s look at the most common biomechanical faults we see in Clinical Practice:

  1. Quadriceps weakness – a confirmed risk factor, which can cause excess loading and stress through the patella tendon or patello-femoral joint.
  2. Hip muscle strength and control – weakness of the gluteals, especially gluteus medius, and delayed onset in weight-bearing activities causes poor femoral mechanics and thus has a direct implication at the knee joint.
  3. Poor ankle range of motion – the foot/ankle is required to absorb shock with every step/stride/hop/jump we take. If the ankle is restricted by either calf tightness, neural tension or joint stiffness, the distribution of force can move up the chain to the knee.

Take-home message:

Chronic knee pain is a common condition that requires a thorough examination to diagnose the cause and what lead to its development in the first place. If you are experiencing any type of knee pain, management of all contributing factors down the kinetic chain is essential to ensure full rehabilitation and return to your desired sport/activity pain free.


joshJosh Kestenberg


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