Anterior knee pain

When you met the physiotherapist, details When can you return to sport? You should start with taking part in the Sports and activities in everyday life
about your knee pain were explained; why After the first 8 weeks of reducing the activi- warm-up, and 15 minutes of the training. It is important to listen to your body. For
you might have knee pain, and guidance on ties which aggravate your knee, it is impor- example, if it hurts your knee during run-
what you may be able to do to make it bet- tant that you start back slowly. You should Each week you can increase the amount of ning, you can try to alternate between run-
ter. This leaflet provides a summary of tips follow the guide below, and only progress training training by around 5 minutes, but ning and walking. Another example could
and exercises, where you can look if you for- to the next activity on the ladder when you only if you do not experience a worsening of be that you get knee pain when you walk
get something. no longer have knee pain during, or the next your knee pain. When you are able to par- for long distances. Then, you could try to
morning after the activity when you wake up ticipate in the full training without knee pain shorten the distance and cycle part of the
Why does your knee hurt? (max. 2 on the pain scale out of 10 on the for two weeks in a row, you can return to full way instead. Remember, it is always better
The exact causes of your anterior knee pain pain monitoring tool). sports participation again. to try to continue being active (e.g. biking
(patellofemoral pain) can be difficult to ful- or walking) than taking the bus all the time.
ly understand. Often, it is thought that knee Activity ladder: Correct progression
pain is caused by more forces acting on the Step 1. Easy walking / cycling (Lowest level) The important thing is to continue doing
knee joint than what it can tolerate. Some Step 2. Fast walking / medium to hard cy- the activities you are able to, so long as they
people can withstand a lot without getting cling don’t cause pain higher then 2 on the pain
knee pain, whereas, for various reasons, Step 3. Slow running scale during the activity. You might get sore

Training load
others may not be able to tolerate as much Step 4. Stair climbing muscles, but that is just a positive sign that
force. Some of the reasons for too much Step 5. Running and jumping at medium you have exercised them.
force/load on the knee could be e.g. too speed.
much running, too many jumps or other ac- Step 6. Running and jumping at high speed Exercises are important
Time
tivities where you use your knee. Normally, (highest level) During the first 4 weeks, you should perform
the knee pain can disappear after a break for The figure above shows how to slowly in- bridges and static holds (see images) for the
some time, but sometimes the knee pain can When you are able to perform “Running crease your training to return to your sport thigh and hip muscles. This helps keep your
continue for a long time. One reason why it at high speed and jumping” with no pain, safely. To get better, you need to increase muscles strong without putting pressure on
persists can be when people continue with or minimal pain (max 2 on the pain scale the load gradually. Below, you see what your knee. After 4 weeks, you should start
the same high levels of activity that started during, immediately after, and morning af- happens if you go too fast. with dynamic exercises. These exercises must
the knee pain. ter activity), you can start participating in If you return to sport too quickly you may be performed for 8 weeks. They are divided
sports again. need to stop again as you were not yet ready into 2 blocks which change after 4 weeks.
to handle these loads.
The purpose of the exercises is to make your
Pain scale
Wrong progression knee and hip stronger, so your knee can tol-
Worst
No imaginable erate more forces without getting sore. This
pain pain
is done by strengthening the muscles around
your knee and your hip. It is very important
0 1 2 3 4 5 6 7 8 9 10
Training load

/0% 122$3)45$-)% 67(%'$#$)% to remember to do the exercises as often as

OK Not OK
Time

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 Week 1 to 4: Week 5 to 8: the ankles, and then you should lift the leg Clam exercise
You should do the bridge exercises every Exercises with elastic bands and your bod- around 40 cm high. It is important to point This exercise makes your hip muscles strong-
second day, for 3 sets of 10 repetitions. You yweight. The purpose of these 4 weeks is to your foot straight forward when you lift the er. The elastic should be tied around the leg
should do the static holds every day. strengthen the muscles around your hip and leg up. You should perform 3 sets with a just above the knee. The hip must be bent
knees. You should not return to sports yet, band that you can only perform 12 repeti- around 60 degrees, and the knee around 90
The bridge should be performed with both but you begin to return to all of your normal tions before you are too tired. Each repeat degrees. Open your legs like a clam, while
feet on the floor. When you lift your body activities, following the activity ladder: must take 8 seconds, and you need to train keeping the rest of the body steady.
up, it is important to press down your heels. both the left and right sides.
Be careful not to raise yourself too high, and Step 1. Easy walking/cycling (Lowest level)
sway in the back. You should perform 3 sets Step 2. Fast walking/medium to hard cycling
of 10 repetitions. Step 3. Slow running
Step 4. Stair climbing
Step 5. Running and jumping at medium
speed.
Step 6. Running and jumping at high speed You should perform 3 sets with a band that
(highest level) Seated knee extension you can only perform 12 repetitions before
This exercise is to make your knee stronger. you are too tired. Each repeat should take 8
You should only move to the next step on the You should sit on a table with an elastic band seconds, and you have to train both the left
ladder should when you have little/no pain atied round the table legs. You should roll a and right sides.
(NRS 2) during and the morning after the towel under your knee and put a small towel
activity. You should perform 3 sets of all 4 around your ankle so the elastic does not
exercises. The should be performed using a move up your leg during the exercise. Start
band that is strong enough that you can only by extending the leg while the elastic band
perform 12 repetitions of the exercise before provides resistance. You should perform 3
getting too tired. Each repetition must take 8 sets with a band that you can only perform
Static holds for the thighs should be per- seconds, and you need to train both the left 12 repetitions before you are too tired. Each
formed against a wall. You should press and right sides. repeat must take 8 seconds, and you have to Semi squat
your heels down into the floor, and should train both the left and right sides. This exercise is for your
be able to feel the thigh muscle tense. The Lying hip exercise knee muscles. You
holds should be performed every day ten This exercise it to make your hip muscles should stand with your
times for 30 seconds . stronger. You lie on the floor as shown in the feet shoulder-width
picture below. The elastic should be around apart then you squat
down. This should
not hurt the knees. If
it hurts your knees, try
not to bend down as
far. Remember to bend
your knees and push

4 5
 your bum back. Your knees shouldn’t go Standing hip abduction a load that you can only perform 12 repeti-
too far in front of your toes. You should per- This exercise makes your hip muscles strong- tions before you are too tired. Each repeat
form 3 sets with a band length that can only er. You should perform the exercise using a must take 8 seconds, and you have to train
perform 12 repetitions chair. The chair is to help maintain balance. both the left and right sides.
with before you are too You should lift your leg out to the side while
tired. Each repeat must you try to keep the rest of your body steady. Standing hip extension
take 8 seconds, and you You must keep your foot pointing straight This exercise makes your hip muscles strong-
should train both the ahead during the exercise. You should per- er. The elastic band should be fixed to a
left and right sides. You should perform 3 sets with a load that door, or around a heavy table. You have to
you can only perform 12 repetitions before put the elastic around your thigh, just above
Week 9 to 12: you are too tired. Each repeat must take 8 the backs of your knee. Push your leg back-
Training and Gradual Increasing Sports seconds, and you have to train both the left
The purpose of these 4 weeks is to make and right sides.
the muscles around the hip and knee even
stronger and get ready to return to sports Squat
and your typical knee loading. You should stand with
your feet shoulder-
You can start returning to sports if you have width apart. Then you
reached step 6 below. form 3 sets with a band that you can only per- must bend your knees
form 12 repetitions with before you are too to approximately 90
Step 1. Easy walking/cycling (Lowest level) tired. Each repeat must take 8 seconds, and degree angle (as shown
Step 2. Fast walking/medium to hard cycling you have to train both the left and right sides. in the image). The exer- wards against the elastic, while holding the
Step 3. Slow running cise shouldn’t hurt the rest of the body still. You should perform 3
Step 4. Stair climbing Lunges knees. If it hurts, then sets with a load that you can only perform
Step 5. Running and jumping at medium This exercise makes your hip and knee mus- don’t bend your knees 12 repetitions before you are too tired. Each
speed. cles stronger. Start by standing as shown on so deeply. Remember repeat must take 8 seconds, and you have to
Step 6. Running and jumping at high the first picture. Then you have step forward to move your bum backwards, and make train both the left and right sides.
speed (highest level) and bend your front and back knees, while sure your knees don’t move too far in front
keeping the upper body straight -it must of your toes. You should perform 3 sets with
You should only move to the next step on only move up and down.
the ladder should when you have little/no
pain (VAS 2) during and the morning after
the activity. You have to perform 3 sets of
the 4 different exercises. They should all be
performed so difficult that you can only per-
form 12 repetitions before you are too tired.
Each repeat must take 8 seconds, and you
have to train both the left and right sides.

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Main features of the intervention

Block 1 (week 1 to 4)
 •Reduce knee forces (avoid knee-aggravating activities that cause your pain)
 •Static holds of the knee (every day)
 •Bridge exercise (3x10, every other day)

Block 2 (week 5 to 8)
 •4 exercises with elastic band which should be performed every second day

Block 3 (week 912)

Aalborg Universitetshospital
Ergo og Fysioterapi
Hobrovej 18
9000 Aalborg

Februar 2019 . Vester Kopi