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