By Tomás Ryan BSc.(AHS), Ph.Th. MIAPT, Registered Physical Therapist based in Thurles
Burning or Achy Pain at the Front of the Knee Joint when walking, standing or climbing stairs can indicate an Infrapatellar Fat pad irritation. The Fat Pad is a highly sensitive structure with strong blood and nerve supply that sits underneath and to each side of the patella tendon. It is injured by a fall or blow to knee joint, a Kneecap dislocation and during rupturing of the Anterior Cruciate Ligament and during its subsequent reconstruction. The pain can be severe at times and it is often misdiagnosed as patella tendonitis and hence treated incorrectly. An Infrapatellar Fad Pad injury is painful when the Knee is fully extended into a straight position, causing pain when standing, walking and especially when climbing stairs. The Fat pad also gets compressed when the knee is held in a large bending position when sitting.
Signs & Symptoms
Burning or Aching Pain located at the front of the Knee
Pain can located at the base of the knee cap or on either side of the patella tendon.
Standing activities can aggravate pain in the Fad-Pad of the knee due to excessive knee extension (known as hyperextension).
Knee Pain with walking and climbing stairs due to excessive knee straightening which places greater pressure on the Infrapatellar Fat Pad.
Sitting for long periods causes frontal knee pain as the knee joint is held in a bent position that is greater than 100 degrees thus placing significant prolonged pressure on the Infrapatellar Fat Pad.
The first goal to reduce pain by unloading or reducing the weight bearing friction on the Fat Pad. Taping techniques are used to tilt the bottom end of the knee cap (patella bone) out of the Fat pad in order to decrease irritation. The patient learns this technique from the Physical therapist and is subsequently able to apply the technique themselves on a daily basis. It is important that the patient avoids locking their knee joint into hyperextension during walking and standing in this early phase.
Exercise under the guidance of your Practitioner should focus on;
Small weight bearing squats
Correction of poor pelvic alignment issues
Strengthening the knee during the foot stance phase of walking
Strengthening of the Gluteus Medius Hip muscle in single standing in order to reduce dysfunctional Hip rotation and poor knee angle.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672
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