Patellofemoral (front knee) pain, caused by an alteration in the alignment or function at the knee cap is a common problem for athletes. There are many contributing factors to the injury: from flexibility concerns at the hip, knee or ankle, muscular imbalances at the hip, knee and ankle; to biomechanical and functional mechanical issues at the hip, knee or ankle.

If you’re battling knee pain and can’t find a fix, don’t give up, you can improve your condition. In the knee diaries, I’ll tell you my story and outline what you can do to improve your chances of recover from knee injury.

How it started 
Over the years I’ve battled with ongoing knee pain – it’s the classic case of an unknown cause - runners knee, Patellofemoral joint dysfunction, tight ITB (the large band on the outer side of the leg), altered biomechanics, excessive pronation at the foot, and poor firing of glut medius and piriformas muscles. Does this sound all too familiar?

It all started fifteen years ago when I was involved in a surfing accident where my knee cap (patella) came into direct contact with a rock—ouch! Clearly a case of poor judgement on my behalf! I fractured my patella, disrupted my articular cartilage and caused bruising under my knee cap – it turned the size of a tennis ball, the swelling lasted for more than three months, and was always hot, squishy and sore, atrophy came knocking at my door and pretty soon my VMO (Vastus medialis obliques, thigh muscle) had nearly diminished.

I commenced a rehab program that involved quad setting exercises, cycling, ice treatments and proprioceptive (balance) activities. After a period of time I was able to fire my quad muscles and training soon took precedent. That was about the time that I noticed something different. 

The difference
My knee no longer behaved in the way it had always done, I started to notice a few little niggles or bouts of sporadic pain in and around my anterior knee. I was able to play for an hour or two but after that I started to have to fight an ongoing battle with my old mate ‘pain’. As the years of playing sport continued, my ability as an athlete was undermined by the ever-growing presence of knee pain — to the point where walking up stairs started to feel painful and the execution of my favourite sprint drills had to be stopped. My training started to revolve around how to avoid knee pain and keep playing. 

WTLF (Why the long face)?
In 2010 I played my last tournament, and was relatively pain-free. Four months later however, while turning sharply to the left and driving off my right foot, I collapsed after feeling a sharp pain piercing its way through my knee cap. I thought at the time this would be the end of my playing career, but was it? Part two coming soon …

Got knee-pain? Here’s how to start on the road to recovery

Get evaluated 
This part of the puzzle is a key component to success and I cannot stress the importance of getting qualified professionals to assess your injury profile or current conditioning, here’s the magic—assessing the injury is only part of the puzzle, those that look at the entire kinetic chain are going to provide a far better treatment perspective and options. So choose an expert who takes a holistic approach to treatment. See the right providers for your treatment, generally the experts are experts for a reason! You will soon find the good ones; what works for one person may not necessarily work for the other.

I had tight hip flexors, adductors and glut med/piriformis syndrome and of course my ITB/TFL were ropey and tight as a knot. On a muscular and movement screen I displayed wasting of my VMO (Vastus medialis) on the right side, a poor ability to perform a single leg squat and late engagement of my VMO, clearly there was some medial movement and rotation at the hip and knee and this was highlighted by pronation at the foot and a collapsing of the knee when performing activities. For those of you without a physiology background, this basically means that the muscles in my hip and thigh were tight, my thigh muscle was atrophying, my foot was rolling inwards more than it should have and unsurprisingly as a result my knee was having a hard time handling any stress it was put under.

An expert will address your movement mechanics through a functional muscular/movement screening test. This type of testing highlights weaknesses in all areas of the hip, knee and ankle —from flexibility, strength and endurance to proprioception (balance) to find the type of blueprint they’re working with. 
The goal to success in rehabilitation is continuation – once you start you must never stop. I made the mistake of prioritising training and playing over getting my body back into full functioning form. 

Exercises for rehab of Patellofemoral injury 
Although they don’t replicate the movement patterns specific to all sports, yoga and pilates are useful tools in rehabilitation, as they help address weakness in flexibility and strength. I cannot understate how important these two are for me, both have now been added to my regular training schedule, if I miss one of these the rest of the training suffers. 

Phase one: 
Warm up with cycling (VMO alignment and function is key) and yoga/pilates activities (dynamically loosens up joints and muscles prior to rehab strengthening session) or specific stretches to tight areas. 

*All exercises must be performed pain-free. As soon as pain is present the VMO switches off and will hinder your progression. This programme does not specifically cater for those with flexibility issues – that’s where yoga and Pilates comes in.