Knee Pain

1. What is patellofemoral pain (PFP)?

Patellofemoral pain syndrome (PFPS) is pain surrounding or underneath the patella (knee cap). The pain can be sharp or dull and achy and can come and go during and after activity. Pain usullay occurs with activities such as squatting, lunging, running and going up and down stairs. There may be some associated swelling or puffiness around the knee and you may hear some abnormal clicking from the knee. In some cases you may feel weak or unstable like the knee’s giving out.

2. What causes PFP?

PFP is a very common tennis players. This is because tennis and the high amount of running, lunging and change of direction can put an increased stress or load through the underlying surface and other soft tissue structures around the patella. When the load is too high for the surrounding tissue to handle, irritation and inflammation occurs which causes pain. There are many possible contributing factors to PFP including muscle weakness or imbalance, poor biomechanics and training overload. There are also risk factors to increase your chance of getting PFP including previous injury or surgery to the knee, boney structural abnormalities, hip biomechanics, flat feet and weak core or glute muscles.

3. How do you treat PFP?

Initially the treatment goal is to decrease pain, which may include ice packs, heat packs, medication, soft tissue massage, patella mobilization, taping techniques, braces, decreasing training load, cross training and gentle strengthening exercises.

Once the pain is at a manageable level the treatment focus becomes more exercise based. The goal in this stage is to reduce or take away the contributing and potential risk factors. This is achieved by improving biomechanics and strength deficits with a comprehensive stretching and strengthening exercise program. If you have a weak core Pilates based exercises should also be incorporated in your program. Training and match play loads will be discussed to make sure you can still train and play tennis and not aggravate your knee.

4. Should you keep playing if you have PFP?

On a pain scale of 0-10, 0 = no pain and 10= the worst pain you can imagine, if you can stay within a pain range of 0-3/10 you should be ok. This pain scale should be monitored during activity such as training or a match, straight after (60mins) and the next day. If the pain is >3/10 or you are taking a number of days to recover from a match you will need to adjust your activity loads. Taping a painful knee can help get you through an important match or event but the earlier you address the pain the faster treatment and therefore recovery can begin. If you continue to train with high levels of pain in the knee you may be causing more damage and increase your risk of other injuries.

5. When to seek advice from your Tennis Physiotherapist?

  • Pain around the knee not resolving or getting worse.
  • If you are concerned about an upcoming event.
  • To screen for your risk of injury including biomechanical analysis.
  • To get an accurate diagnosis and assessment of your knee pain.
  • For treatment and a management plan.
  • Activity loading advice and access to training diaries.

Good luck with your training!

Gena Wallis
Tennis Physiotherapist