Module 3
FAQ
It is common for you to have knee cap pain at the beginning of your treatment. However, your pain should not achieve high levels in any physical activity you perform.
Knee cap pain is one of the most common knee conditions among adolescents, affecting up to 7% of this population. In adults, knee cap pain affects 17% of runners, and 11 to 17% of the general population.
Fear of movement may exist in patients with knee cap pain. However, the most recommended intervention for knee cap pain is exercise, passive treatments are not likely to help.
Despite being quite common for patients with knee cap pain to be fearful of some movements (e.g. running, jumping and walking on stairs). Some studies report that reductions in fear of movement are related with reductions in the level of knee pain. Therefore, it is highly recommended for patients to keep doing all daily activities alongside the exercise program.
Knee crepitus or noisy knee is a common complaint/concern of people with knee cap pain. We don’t know what causes the noise on the knees. But, recent data show that people with knee cap pain who have noisy knees have similar levels of pain, function, fear of movement and knee strength compared to those who don’t have noisy knees. In other words, if you have knee cap pain and a noisy knee, it doesn’t mean your condition is worse than those who have knee cap pain and no noisy knee.
Additionally, a previous study investigated 250 asymptomatic knees (knees with no pain) and found that 99% of people had knee crepitus.
The exact reason why people develop knee cap pain is unclear. However, experts around the world tend agree that doing ‘too much, too soon’ in relation to exercise may be a key reason.
There seems to be a spike in the number of people with knee cap pain following rapid increases to how much exercise you do – e.g. basic military training or ‘start to run’ programs (e.g. couch to 5K).
In ‘start to run’ programs it can be as high as 17%.
There are no specific rules on how much exercise you should complete in order to avoid developing knee cap pain. It is also not clear exactly how quickly to increase exercise when returning to sports and other activities if you are recovering from knee cap pain.
The most sensible option is to monitor your pain levels during and after exercise. Experts frequently recommend that if you have a large increase in pain, or pain stays increased for more than 24 hours after exercise, you may be doing ‘too much, too soon’.
Further guidance on how much exercise you should do and how quickly to increase it can be provided by your physiotherapist.
The following graphs taken from the education leaflet titled ‘Managing My Patellofemoral Pain’ provide a great visualisation to guide you on returning to exercise.
SUPPORTING ARTICLES
It is important that you find the exercise that works your body to the correct level. No exercise should be painful in the knee, but some discomfort that settles within a few hours of finishing your exercise is okay.
If you find the exercises you are doing are more than uncomfortable or increase symptoms for longer than few hours, try the exercises that are one level easier. If you are managing the exercises without pain or discomfort and you can maintain good technique, you should aim to progress one level at a time.