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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.

  • 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


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 1S A Kautz from the Journal of Clinical Biomechanics

Knee evaluation survey

Please download and fill this out. It will help me or any other sports medicine specialist to figure out what is your best course of treatment.

Common causes
  • Improper movement 

  • Abnormal biomechanics 

  • Imbalance muscles 

  • Previous trauma injury 

  • Repetitive micro trauma 

  • Adhesions/scar tissue of Gluteals, Hamstrings, Psoas, Para-spinals

  • Spinal misalignment/subluxation of the Lumbar spine and Pelvis

  • Tight muscles 

  • Acute trauma 

  • Overuse injury 

  • Poor posture 

  • Arthritis

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