Anterior Knee Pain in CrossFit

Anterior knee pain is common in most sports. In CrossFit there is a lot of repetitive knee flexion, through full range. Look after your knees to prevent this condition.

Anterior knee pain or Patellofemoral pain is quite the common condition within sports. It affects up to 20% of active individuals (1). With CrossFit athletes, there’s no hiding from repetitive knee flexion. Whether you’re squatting, box jumping, running or doing pistols the load on your knee cap is being carefully balanced. If the load is too much it causes pain around the patella.

Symptoms

Patellofemoral pain usually is at its worst when bending the knee, running, jumping, climbing stairs, squatting or kneeling. It can make a noise when the knee bends and sometimes there’s swelling over the knee.

Potential causes of Anterior Knee Pain

Unfortunately for the knee cap, it’s stuck in a tug of war from forces in different directions. This suspends the knee cap as it tracks within the grooves of the knee.


  • Muscle imbalances: The Vastus Lateralus (outer quad) and Vastus Medialus Oblique (inner quad) are the forces from either side. This is one of the most common issues where your VL is overly tight, sometimes with trigger points. This causes a shift of the knee cap away from midline resulting in more pressure on surface of the patella.

A tightness of the quads muscle, particularly Rectus Femorus causes an upwards force on the patella. When the knee is bent under load this puts extra pressure on the surface of the knee cap.

  • Biomechanics: Our body moves as a functional unit and often the knee pain is a result of something more global. The knee sits between two other mobile joints, the hip and ankle. The ankle may be rolling in or weak Glutes are causing too much internal rotation of the leg. This changes the direction of force through the knee and patella.
  • Overuse: Repeated movements especially with a new movement pattern can put higher demands on tissue. If you’ve only just started doing CrossFit or doing high reps of pistols or box jumps you may feel some anterior knee pain.

Prevention and Self treatment

This word strikes fear into most Crossfitters – REST.

While it’s understandable you still want to train, there needs to be a compromise. We want to reduce the number of days training the initial few weeks to allow symptoms to subside. We also need to restrict the some of the deeper knee flexion movements and high impact activities.

We want to offload the force reaction on the patella when bending the knee. The more knee flexion the more force reaction. Deep squats might not be a good idea to start with when feeling anterior knee pain (see the table).

force.jpg

Activity Force % Body Weight
Walking 334 N 1/2 x BW
Bike 905 N 1.3 x BW
Stair Ascend 1760 N 2.5 x BW
Stair Descend 4000 N 5.7 x BW
Jogging 7.7 x BW
Squatting 6375 N 7.6 x BW
Jumping 20 x BW
Schindler (2011) (2)

If you’re feeling anterior knee pain you want to stick within a comfortable pain-free range. Try to understand that this condition needs to be managed carefully and with patience to ensure a smooth recovery.

Stretching and mobilising is important, especially the quads. If you’re unable to lie on your stomach and pull your heel to your bottom it’s a sign that your quads are in a poor condition. Regular foam rolling and stretches of the quads, glutes and along the ITB will help prepare you for training and prevent the onset of a patella dysfunction.

Practice the movements you’re struggling with. Ask your coach to look at the movement for correction or to be scaled in the interim until you’ve developed the strength. Also, practice soft landings, if everyone in the gym can hear you land, that’s a lot of force being passed through the knees.

What to Expect from Fundamental Physio

If you’re struggling to recover on your own don’t wait too long. The longer you wait the more chronic it becomes and harder to recover from. Putting up with patellofemoral pain has been shown to accelerate the process of patella osteoarthritis (3). 

Firstly, assessing your knee to test the mechanics of the joint with a series of orthopaedic tests to clear for any other pathologies. Then looking at how your knee and leg moves with different functional tests. This will help identify where you’re struggling and where you may be compensating.

Once we’ve identified the problem areas treatment will be more specific to your problems. This may consist of manual therapy such as massage, joint mobilisation trigger point release and dry needling. Depending on the stage of your recovery, strapping techniques with rigid or kinesio tape.

First we must break you down and then rebuild you…

While the aim is to get you back to functional movements, there may be some individual muscles that might have weakened. You’ll likely start off with some isolated exercises to build strength and control. Then putting it all back together in a compound movement. Correcting your on position, weight distribution and depth. You’ll have a lot more body awareness, rather than just doing the movement and it’ll help prevent an injury like this happening again.

If you’re struggling with recovering on your own contact me on 09 5290990

  1. Lack et al (2015), Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis. 
  2. Schindler (2011) Basic kinematics and biomechanics of the patello-femoral joint. Part 1: The native patella. Acta Orthop Belg.
  3. Crossley, (2014) Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? 

Neck Pain

In New Zealand neck pain is a growing problem due to a more sedentary lifestyle. They can be tricky injuries to recover from. Take a look at how physio can help.

Neck pain is a growing musculoskeletal problem with more of us sitting over longer periods of time. But also from doing heavy manual jobs or exercise.

This condition can cause various symptoms, including the following:

  • PainNeck pain Symptoms 1
  • Stiffness
  • Muscle spasm
  • Referred pain (face, arm, mid back)
  • Headaches
  • Altered sensation (ie numbness/tingling)
  • Nausea
  • Dizziness

These symptoms may be caused by strain to any of the structures around your spine. Structures such as the ligaments, muscles, joints, discs or nerves. Acute injuries are often brought on through excessive loading, this could be from an accident playing sport or in your vehicle.

Other more chronic forms of neck pain could have developed from an acute injury that was poorly managed. Or with an increasingly sedentary lifestyle, the sustained postures can overload tissue of the neck.

Preventing Neck Pain

Your next posture is your best posture

Our body is designed to handle multiple positions. Set regular intervals every 20-30 minutes to change your sitting position. Try alternating between sitting and standing. See my other blog Sitting Posture how important is it really”

Lifting correctly

We’re not all Olympic lifters, but understanding the basic principles of lifting are important to preventing neck pain. Also understanding your limits to lifting. If it’s too heavy be honest with yourself and ask for help.

Keeping calm and dealing with stress

Stress can have a significant impact with pain and ignoring stressful situations can lead to the development of neck pain. Dealing with these gremlins will be great for you in so many ways. See my other blog on “Coping with stress”.

How can Physio help my neck pain?

Identifying the source of your injury is our primary goal with a detailed assessment. Once the root cause of your neck pain has been identified you will receive an effective evidence based treatment. Treatment may consist of the following.

The aim of the your rehab is to fully recover with the confidence to use your neck normally, without fear. Also to leave with a greater understanding of your neck to prevent any injuries in the future.

For an appointment, call on 095290990

CrossFit – How can Physio help?

CrossFit has its share of injuries like any sport. An experienced physio with knowledge of the training can get an athlete functioning pain free quickly and performing back to their best.

To perform at your best you need a strong mindset, great coaching staff that are strict with your technique and an experienced physio to prevent aches and pains

Most Kiwi’s are pretty tough, with a ‘she’ll be right” mentality when it comes to injury. You’d think that would be a perfect combination with the image CrossFit portrays. But when you’ve been carrying that niggle for so long and it starts getting worse, it could shut you down completely from training.

Physio and CrossFit work well together

Physio’s are specialists in movement analysis and CrossFit itself is a training regime that goes through gross fundamental movement patterns. So putting yourself through these movements and identifying your weakness’ gives me a lot more insight into where your problem could be coming from.

What are the common complaints?

There have been interesting studies done over the last few years into injuries within CrossFit. Interestingly the studies correlated similar with the same common areas being involved:

  • Shoulder
  • Lower back
  • Knee

Some injuries being severe enough to stop some from working, training and competing. These are the most common areas of injury I see come into the clinic from CrossFit, but I also see others suffering from:

  • Neck and thoracic strains
  • Ankle sprains and hypomobility
  • Hip impingement
  • Patella dysfunction from quad heavy squats
  • Wrist strains

How can Physiotherapy help?

As a physio it’s my job to get you functioning pain free as quickly as possible. Being a Crossfitter myself, who performs daily and understands the training styles, philosophy and terminology I can relate to the frustrations that you may face with limitations in training. Also working on site I can take you into the gym, look at techniques of different movements and provide you with additional drills to perform before your WOD.

What do I offer a CrossFit athlete?

  • An assessment of your movement patterns looking for weakness, asymmetry and any underlying mobility issues.
  • Hands on therapy for immediate pain relief, this may involve soft tissue massage, joint mobilisations and dry needling.
  • Localised taping of problem areas to assist you during your next training session
  • Diagnosis and ongoing management for acute or severe injuries, including referrals for further tests such as x-rays/ultrasounds, scans or to a specialist.
  • Educating you on what caused your injury or pain and steps to prevent further problems.
  • A personalised rehabilitation program – listing corrective, strengthening and stretching exercises to assist your recovery.
  • Liaising with and providing regular updates of your progress directly to your coach or trainer to ensure you get a coordinated approach to your rehabilitation. This also ensures that you are scaling or modifying WOD’s as required.

For an appointment, call on 095290990 

Montalvo et al (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine

Keogh et al (2016) The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine

Weisenthal et al (2014) Injury rate and patterns among CrossFit athletes. Journal of Orthopaedic Sports Medicine, Arthroscopy, and Knee Athroplasty