Anterior Knee Pain(front) also known as chondromalicai patella, patella malaignment, knee cap pain & Iliotibial band syndrome.  This is the most common cause of knee pain and the most common reason to see an orthopedic surgeon.

Symptoms 

• Pain just behind the knee cap

• Pain to the outside or inside of the knee

• Aggravated by crossing the knees also known as movie theatre sign

• Worse going down stairs  more so then going up

• Hiking down is worse then going up

• Grinding, clicking or catching behind the knee cap

To understand what has gone wrong we must understand what was normal. The knee cap has a ridge on it’s backside that rides in a groove that is in the front of the femur (Upper leg bone). Most often  when we have anterior knee pain in the knee cap it has moved to the outside due to the tightness of the Ilio-tibial band and hamstrings and the weakness and poor control of the inside quadriceps muscle (vastus medalis). Also, an imbalance in the ligaments that hold the knee cap in place (patella ligament, patella menisci femoral ligament) 
 
In its early stages the cartilage between the knee cap and femur begins to get damaged and starts to wear away. In its later stages the cartilage is gone and the bone is starting to get worn away, essentially bone against bone. This bone against bone is arthritis.

The causes are

Poor alignment of the knee, feet, hip and low back. These can be identified by examining the bones, ligaments, tendons, joints, nerves, and the corrected by foot orthotics, muscle balancing exercises, stretching, chiropractic adjustments

Adhesions (Scar Tissue)in the Iliotibial band(ITB), Quadriceps muscles, Hamstring muscles, knee capsule

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Post knee replacement Rehabilitation

Great case study to accelerate rehab and great way to prehab so surgical outcomes are better. Antigravity treadmill training during the early rehabilitation phase following
unicompartmental knee arthroplasty: A case series. The anti gravity treadmill is available  at https://www.selectphysicaltherapy.com/contact/find-a-location/ca/truckee/truckee-donner-pass/?ty=xt

Rehabilitation

For knee cap pain we use backwards bike pedaling but not for ACL rehab. As per this article 

Knee joint loading in forward versus backward pedaling: implications for rehabilitation strategies

R R Neptune 1, S A Kautz from the Journal of Clinical Biomechanics

Landing Pattern Modification
to Improve Patellofemoral Pain
in Runners: A Case Series.

Ways to decrease heel loading and therfore patella loading

Biofeedback exercise improved the EMG activity ratio of the medial
and lateral vasti muscles in subjects with patellofemoral pain syndrome

A way to balance out the quads to help knee cap/patella pain

Distinguishing Quadriceps Tendinopathy and Patellar Tendinopathy: Semantics or Significant

How to tell the difference between patella and quad tendon problems. To stress the quad tendon a high degree of flexion is  need and to stress the patella tendon use the eccentric part of jumping.

Patella femoral pain syndrome rehab

Get your crutch on before surgery

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