Anterior Knee Pain

[physiojlb]

I have a patient with anterior knee pain. He has pain walking up stairs, and when carrying his golf bag during a round. Also had pain on patella compression. His patella also tracked laterally on palpation.

His hamstrings were very tight but this has now resolved after prescribing hamstring stretches. I have also prescribed quad strengthening with VMO bias. He has done this for around 5 weeks and his pain has only decreased by half. I have also tried patella taping and lateral taping to offload lateral structures. and also soft tissue work to release his lateral structures.

He still has some pain 1 month on. could the pain left just be used to OA and now he just needs general quad exercises? or am i missing something?

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[physiobob]

How old is he? Think about the joints above and below the knee (proximal tib/fib joint, ankle and hip) and ensure they are optimized in their function. Of course the lumbar spine should also be checked and perhaps mobilized.

A good month on glucosamine probably wouldn't hurt either? Knee pain is often insidious in nature due to prolonged overuse. As long as the pain is reducing you are on the right track. I wouldn't spend to much time doing exercise that will aggravate it as much as strengthen quads.

p.s. On the taping front, if taping is to be successful you should be able to demonstrate a good reduction in pain with stair activity immediately after the application of the tap. If you can demonstrate that then either the taping is not correct or it isn't going to help

[quorthon]

i will agree with physiobob about the lumbar spine involvement....Consider how easily the lumbar spine can refer pain on to the knee joint...I think that in every peripheral joint problem we must ALWAYS exclude any spinal component, for example in a frozen shoulder u should always screen FIRST the cervical spine...the same rule apply on the knee and a possible spine relationship.....Of course it is obvious as u describe the case that there is a dysfunction on patella, but we cannot exclude the lumbar spine...my opinion is to try in the beginning some repeated movements (ala McKenzie) and then proceed to mobilisation techniques on the lumbar and see the symptomatic response

Take care

[pudding_bowl]

If the pain is OA - you may have reached your plateau with the patient. You have decreased his pain by half and hense have done very well this far.
How long has he had the knee pain, why did it come on... as well as the back assess the ankle also. What are his golf shoes like?

[physiojlb]

Thankyou for your replys. Following your comments I assesed his lumbar spine, he has stiffness at L4/5 and whilst treating his lumber spine and he reported a sensation in his knee during mobilisation.

The patient is aged 58. The pain was insidious onset and he has had a history of around 3months.I have assesed his ankle and there are no problems there.

I am also treating him for neck pain/ache. Which is related to a trigger point in upper-trapezius and some tenderness over C4/5. He also has a forward head posture. I have been doing TrP release, and lots of soft tissue work, aswell as stretching, Csp mobs and DNF exs.

I am starting to question my effectiveness with this patient and am wondering how much is due to psychological and OA factors...

I am considering if there is no progression this week I shall recommend glucosamine and refer him on to a personall trainer for general fitness.

[pudding_bowl]

How much treatment have you given his Lx? Don't give up too quick if you'v just established that it's a strong component of the pain you may be able to do more over the coming weeks. Discuss it with your patient and make the decision with him as to what you both feel is the best action from this point.

keep us posted

[quorthon]

give more time....its a chronic problem, as it seems, and of course needs lot of time to get some acceptable level of function rehabilitation