Whether you run for fun or play competitive sports, experiencing pain around the knee can have significant impacts on your ability to exercise and take part in daily activities. Knee pain can present itself in many different ways (e.g. dull, sharp, constant ache) and can stem from various factors, including contact and non-contact injuries (e.g. ACL), overtraining/overload (e.g. patella tendinopathy), age related factors such as arthritis, and biomechanical issues. Whatever the case, it is important to identify the root cause of your pain so that it can be managed and treated appropriately.
Why are you experiencing knee pain?
Knee pain can affect people of all ages and lifestyles. For youth athletes going through puberty, pain can occur around the knees during periods of rapid growth and development. As highlighted in our previous blog on injuries in youth athletes (read it here), overactivity and inadequate rest can put repeated stress on the growth plates at the knee; a condition known as Osgood-Schlatter disease. You can read more about the signs, symptoms and risk factors of Osgood Schlatter’s here.
In older persons, knee pain is commonly a result of wear and tear in the joint. One of the most commonly reported conditions is Osteoarthritis (1), where the protective cartilage that cushions the ends of bones in the knee joint deteriorates. This increases the friction between the bones which can lead to pain, stiffness and swelling.
Knee pain can also manifest in people who are sedentary and don’t take part in daily exercise (2). Being inactive increases the risk of developing muscle weakness. At the knee, muscle weakness and/or strength imbalances of the quadriceps and hamstrings can impact force absorption and overall stability, which can increase stress on the knee and lead to pain and stiffness. It is important to also consider the impact of a sedentary lifestyle on body weight, as long periods of inactivity can lead to weight gain which can put additional stress on the joints.
Runners Knee/Jumpers Knee
One common cause of knee pain for active individuals is Patellofemoral pain (PFP), often referred to as ‘Runners Knee’ or ‘Jumpers Knee’ (3). PFP typically presents as non-specific pain around or behind the kneecap during activities like running, jumping, squatting or changing direction (4-6). Sitting or kneeling for long periods may also cause pain and stiffness, and daily activities like walking up and down the stairs can become painful. The root cause of PFP is still not fully understood and more research is needed to understand the risk factors involved. In saying that, physical activity load and biological sex are believed to play a role (5,7).
Physical activity and Overload:
PFP can develop as a result of overuse or a sudden increase in physical activity (3). To learn more about managing physical activity and progressive overload, click here.
2. The influence of biological sex: biomechanics
Females are twice as likely to develop PFP than males (7-9), particularly during adolescence (69% female vs 31% male) (3). One of the proposed reasons for this is because the pelvis widens for females during puberty. This can have an impact the biomechanical alignment of the lower limbs and influence how force is absorbed and transferred around the knee (5, 10-12).
The Quadriceps Angle- AKA ‘Q-Angle’
The Q-angle is a measure of how your thigh bone (femur) and shin bone (tibia) interact at your knee joint (see image below). Compared to males, biological females have a slightly larger Q-angle. Here's a simple way to understand it:
If your Q-angle is too large, it may cause the kneecap (patella) to track towards the outside of the knee. On the other hand, if your Q-angle is too small, it may cause the kneecap to pull inwards. In either case, it has potential to put extra stress on your knee joint and possibly lead to problems like PFP.
Managing Knee Pain
Managing knee pain involves a combination of strategies that are tailored to individual needs.
In some cases, it might only involve some physical therapy and strengthening exercises. In more severe cases, surgery may be required before moving onto physical therapy and strengthening exercises. Such exercises should focus on improving muscle capacity, to increase strength and endurance around the knee joint.
Niamh’s Top Three for the Knee:
Staying active with low-impact exercises (e.g. walking/cycling/swimming), maintaining a healthy body weight, and using proper techniques during physical activities are key for managing knee pain.
For sedentary individuals, addressing knee pain often involves gradually incorporating physical activity and exercises that strengthen the muscles around the knee, and improve mobility, flexibility and stability. Small lifestyle changes (e.g. walking/cycling to work, and avoiding long periods of time sitting down) would also be advised.
Don’t ignore it. Address knee pain early and avoid prolonging your discomfort. You don’t want complications further down the line.
If you’re currently experiencing knee pain that persists or worsens over time, we would be happy to help you.
You can get in touch through our email info@healthandperformanceacademy.ie or reach out on Instagram @jamesgreenehpa
References:
Berteau J. P. (2022). Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions. Journal of clinical medicine, 11(12), 3252. https://doi.org/10.3390/jcm11123252
Park, J. H., Moon, J. H., Kim, H. J., Kong, M. H., & Oh, Y. H. (2020). Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks. Korean journal of family medicine, 41(6), 365–373. https://doi.org/10.4082/kjfm.20.0165
Smith, B. E., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffatt, F., Rathleff, M. S., Smith, T. O., & Logan, P. (2018). Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PloS one, 13(1), e0190892. https://doi.org/10.1371/journal.pone.0190892
Glaviano, N. R., Kew, M., Hart, J. M., & Saliba, S. (2015). Demographic and epidemiological trends in patellofemoral pain. International Journal of Sports Physical Therapy, 10(3), pp.281–290.
Vora, M., Curry, E., Chipman, A., Matzkin, E., & Li, X. (2018). Patellofemoral pain syndrome in female athletes: a review of diagnoses, etiology and treatment options. Orthopedic reviews, 9(4), pp.7281. [Online] Available at: https://doi.org/10.4081/or.2017.7281
Schmidt, E., Harris-Hayes, M. and Salsich, G., 2019. Dynamic knee valgus kinematics and their relationship to pain in women with patellofemoral pain compared to women with chronic hip joint pain. Journal of Sport and Health Science, 8(5), pp.486-493. [Online] Available at: https://doi.org/10.1016/j.jshs.2017.08.001
Bump, J.M., Lewis, L. (2020) Patellofemoral Syndrome. [Online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK557657/
Almeida, G. P., Silva, A. P., França, F. J., Magalhães, M. O., Burke, T. N., & Marques, A. P. (2016). Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function. Revista brasileira de ortopedia, 51(2), pp.181–186. [Online] Available at: https://doi.org/10.1016/j.rboe.2016.01.010
Pazzinatto, M.F., de Oliveira Silva, D., Barton, C., Rathleff, M.S., Briani, V.R., de Azevedo, M. (2016) Female adults with patellofemoral pain are characterized by widespread hyperalgesia, which is not affected immediately by patellofemoral joint loading. Pain Medicine, 17(10), pp. 1953–1961, [Online] Available at: https://doi.org/10.1093/pm/pnw068
Baldon, R., Serrão, F., Scattone Silva, R. and Piva, S., (2014). Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 44(4), pp.240-A8.
Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G. P., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 22(10), pp.2264–2274. [Online] Available at: https://doi.org/10.1007/s00167-013-2759-6
Saad, M. C., Vasconcelos, R. A., Mancinelli, L., Munno, M., Liporaci, R. F., & Grossi, D. B. (2018). Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises. Brazilian Journal of Physical Therapy, 22(5), pp.408–416. [Online] Available at: https://doi.org/10.1016/j.bjpt.2018.03.009