You walk up the stairs and feel a sharp sting around your knee. Or you are sitting cosily in the cinema, but after half an hour your knees start nagging and you need to stretch your legs. Recognisable? You're definitely not the only one. Pain around or behind the kneecap is one of the most common knee problems which we see at Fysio Fitaal.
In medical terms, we call this the Patellofemoral pain syndrome (PFPS). Patients often describe it as a nagging or stabbing pain under the kneecap, especially during activities that involve bending the knee under pressure. Think cycling, climbing stairs, squatting or getting up from a chair. While the pain can be very annoying and limit you in your sport or daily life, the good news is that there is rarely any serious damage to the knee. With the right approach and training, the symptoms are excellent.
Patellofemoral pain syndrome is a collective term for pain symptoms at the front of the knee, specifically around the joint between the patella (kneecap) and the femur (upper leg). The kneecap acts as a lever for your thigh muscles, sliding through a groove in your thigh when bending and stretching.
In PFPS, this process does not go smoothly or the tissue around the kneecap becomes overloaded. This is sometimes called a ‘girl's knee’, runners' knee or chondromalacia mentioned. An interesting fact is that the cartilage at the back of the kneecap itself does not contain any nerves and therefore cannot hurt. The pain you feel probably comes from the irritated bone under the cartilage, the knee capsule or the retinaculum (the connective tissue around the kneecap).
The symptoms often arise gradually, without obvious trauma such as a fall or twist. Typical symptoms are:
There is rarely one specific cause; it is often a combination of factors that cause the load on the joint to be greater than what the tissue can handle at the time.
One important factor is a sudden change in activity. Have you just started running, increased training intensity or done a lot of hiking in the mountains? If so, the tissue may have become overloaded.
In addition, the control of your muscles plays a big role. Research shows that people with PFPS often have less strength in the quadriceps (thigh muscles) and the muscles around the hip (abductors and exorotators). If your hip muscles are not strong enough, your knee may rotate inwards during loading (valgus position). This increases the pressure behind the kneecap. The position of your feet can also affect how your knee moves.
A classic symptom of PFPS is the ’theatre phenomenon’ (or cinema sign). This means that you get pain when you sit with bent knees for long periods of time, for example in the cinema, in the car or at your desk. The bent position causes the kneecap to be constantly pressed against the thigh, causing irritation. Just stretching your legs often gives immediate relief.
At Fysio Fitaal, we start with a comprehensive interview and physical examination. PFPS is diagnosed mainly based on your story and ruling out other causes. We look at:
We use ultrasound in Fysio Fitaal mainly to rule out other conditions, such as a jumpers knee (tendinitis) or bursitis. Indeed, an X-ray or MRI often shows nothing abnormal in PFPS because the problem is functional and not structural.
Treatment for pain around the kneecap is almost always conservative (without surgery) and focuses on improving the load-bearing capacity of your knee. Our approach is based on Sports Medicine Association guidelines and consists of three pillars:
In the first phase, it is important to temporarily reduce painful activities (“relative rest”) to allow the irritation to subside. This does not mean not doing anything, but rather avoiding peak activity (such as deep squats, jumping or heavy stair climbing).
This is the core of the treatment. We not only focus on strengthening the thigh muscles (quadriceps), but also intensively train the hip muscles. Research shows that training the hip abductors and exorotators improves leg position and significantly reduces pain. We will draw up a personal exercise programme for you.
If pain is preventing you from exercising, we can medical taping or apply the McConnell taping method. This can instantly reduce pain and improve muscle control, allowing you to exercise more easily and pain-free.
Many athletes fear that they have to quit their sport, but this is rarely necessary. However, it is crucial to build up training slowly to avoid relapse.
The prognosis of PFPS is favourable. Long-term studies show that a large proportion of patients recover well and can play pain-free sports. However, keep in mind that tendons and joint tissue take time to adjust; a trajectory of 3 to 6 months is not unusual.
Don't keep walking around with that annoying stabbing pain or stiffness around your knee. At Fysio Fitaal, we help you move again pain-free with a science-based approach. Whether you enjoy running, enjoy cycling or just want to be able to climb the stairs pain-free: we are here for you.
Make an appointment immediately at one of our locations in Tilburg Reeshof, Tilburg West, Tilburg North or Tilburg South. Together, we work to build a strong foundation.
Many people are startled by a creaking or crackling sound (crepitations) in the knee. Rest assured: this is quite normal. Research shows that even people without knee pain often have creaking knees. As long as the creaking is not accompanied by swelling or acute pain, it is harmless and not a sign of wear and tear.
Complete rest is rarely the solution. It is better to stay active within the pain threshold. Temporarily avoid activities that significantly worsen the pain (such as jumping or cycling uphill). Pain during exercise should not exceed a 3 or 4 on a scale of 10, and should subside quickly after exercise.
There is little scientific evidence that a knee brace is more effective than exercise therapy. Taping (such as McConnell tape) does seem to be more effective for short-term pain reduction, allowing you to do your exercises better. We will be happy to advise you on what works best in your situation.
This varies from person to person and depends on how long you have had symptoms. We often see improvement after just 6 weeks of targeted exercise therapy, but full recovery can take several months. Patience and consistency in your exercises are the key to success.
Cycling is generally good because it is a jerk-free movement. However, cycling with a lot of resistance (heavy pedalling) or with a saddle that is too low can provoke the symptoms. Make sure you use a light gear and set your saddle high enough so that your leg is almost extended when the pedal is down.
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