Have you been experiencing pain in the anterior (front) portion of your knee? Do you find it frustrating not being able to correlate it with a specific event? As physical therapists, knee pain is a very common diagnosis that we see every day. Anterior knee pain without a mechanism of injury is likely related to weakness and dysfunction in the body not related to the knee itself.
“Anterior knee pain” without an onset of injury can be very frustrating to experience. Most of the time, one cannot relate the knee pain to an event or specific activity, but rather one begins to notice pain occasionally and gradually over time. A recent study found that anterior knee pain, or patellofemoral pain syndrome, responded favorably to hip strengthening exercises in regards to overall pain and functional capabilities (1). It can be confusing as to why physical therapists address impairments in the hip when the knee is the area of concern.
Strong evidence has shown the benefits of addressing weakness in the hip and this relating to improved outcomes and reduction in pain in the knee. As physical therapists, it is important when a patient comes through the door that we not only assess what is happening at the knee at the origin of pain, but also assess joints above and below the problem area. In the orthopedic physical therapy world, we call this concept a “regional interdependence approach”. Regional interdependence is the idea that separate impairments in different anatomical locations may contribute to, or be associated with, the patient’s primary complaint. This is an approach that we utilize with every patient as this has been shown to improve overall patient outcomes.
In another example of the regional interdependence approach, Shetty et alacquired patients with anterior knee pain, or patellofemoral pain syndrome, and divided them into two groups— one group completing general stretching and strengthening exercises involving only the knee and the other group performing the same exercises in addition to specific hip exercises. After four weeks total, both groups demonstrated significant improvements, but the group that implemented hip strengthening exercises was found to be more effective in reducing overall pain and improving patient’s overall function (2).
It is important that you find a physical therapist that is up to date on the current evidence and incorporates a holistic approach in evaluating the areas of the body that are not just the location of your chief complaint. Physical therapists are trained and educated in this aspect of “regional interdependence” approach to provide the best outcomes for their patients.
Written by Matthew Schumacher, DPT, CAFS, CSCS
References
1. Santos T, Oliveira B, Ocarino J, Holt K, Fonseca S. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Brazilian Journal Of Physical Therapy / Revista Brasileira De Fisioterapia. May 2015;19(3):28-37.
2. Shetty K, Mathias L, Hegde M, Shanmugam S. Short – Term Effects of Eccentric Hip Abductors and Lateral Rotators Strengthening In Sedentary People with Patellofemoral Pain Syndrome on Pain and Function: A Randomized Control Trail. Nitte University Journal Of Health Science. March 2016;6(1):68-73.
