The knees function as hinges, allowing your legs to swing forwards and backwards smoothly as you walk, kick and run. The knee cap (the patella) sits at the front of the knee and has a variety of functions, including guiding the muscles that straighten the knee, protecting the knee joint and absorbing forces when the knee is bent. When something goes wrong and the patella doesn’t glide up and down smoothly, the soft tissue between the kneecap and the knee can become irritated, causing pain. This is called patellofemoral pain syndrome (PFPS), sometimes also referred to as PFJ syndrome, patella maltracking or runner's knee.
 
Pain is usually felt on the inside of the kneecap when running, squatting, jumping, bending, using stairs or hopping. Sitting for long periods of time or keeping your knees bent can also result in pain. 

What Causes It?
 
The patella sits in a shallow groove at the front of the knee and usually moves up and down as the knee bends and straightens without too much trouble. The quadriceps muscles located at the front of the thigh contract and pull on the kneecap, which then attaches to the shin bone and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull more to one side and over time become irritated. 

The cause of muscle imbalance or weakness can be varied. In general, the outer muscles of the thigh tend to be stronger and tighter than the inner muscles. If you have poor posture and hip position, this can cause the outer muscles to work harder and the inside muscles to become weaker. Lack of arch support in your feet or a physical anomaly of the knees can also contribute to this condition.
 
How Can Physiotherapy Help?
 
Diagnosing patellofemoral pain syndrome correctly is important because pain on the inside of the knee can also be caused by other injuries, dislocations, inflammation, arthritis and a variety of other less common conditions. With that in mind, it is helpful to know that your physiotherapist can diagnosis PFPS accurately and identify its likely causes.
 
Whether it is due to poor posture, a lack of arch support in your feet, or poor running technique, your physiotherapist will assess the problem and provide a specific treatment program to best approach your condition. PFPS usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, massage, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.
 
In the rare case that your condition is not helped by physiotherapy, surgery may be considered as a last resort. For more information, please  ask your physiotherapist.

There is no doubt that the human body can be resilient. The body is capable of recovering from amazing amounts of damage, including broken bones. Perhaps because of this, some people feel that physiotherapy treatment can only speed up recovery and if they are not elite athletes then simply letting nature take its course is the best, most cost-effective choice for them. 
 
Speed of recovery, however, is only one small measure of physiotherapy success and fails to fully represent how important proper treatment is. Here are a few things about injury healing you may not have been aware of.

1. Scar Tissue is more likely to form without treatment. 
Scar tissue can cause ongoing pain and stiffness in your tissues. Physiotherapy can prevent excess scarring through advice regarding movement, massage and other hands-on treatment. 
 
2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained.  
Impaired proprioception is a major factor in reinjury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. Physiotherapy treatment will aim to restore proprioception as a part of your rehabilitation. 
 
3. Once healing has finished, your body may not be quite the same as before.  
Injured ligaments may be weaker, damaged muscles and joints may be stiffer and tighter. While the original pain may resolve, there may still be some residual issues that need to be addressed to prevent reinjury. 
 
4. You may have picked up some bad habits while waiting for the injury to heal.  
While in pain we often change the way we do things, which can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can persist and create further problems down the road. 
 
5. Injuries don’t always heal completely. 
On occasion, circumstances may prevent an injury from healing fully. The most serious example of this would be a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition. Your physiotherapist can guide you on the best path to a more complete recovery from any injury.

Your physiotherapist has a wide variety of skills and can help you with so much more than just pain and injury. Here are a few reasons to visit your physiotherapist that can keep you healthy and pain-free, before injury strikes...

Stiffness and Inflexibility
 
Almost all of us have experienced pain and stiffness after a day of increased or unaccustomed exercise. This kind of stiffness usually wears off quickly and is referred to as DOMS (delayed onset muscles soreness). However, if you find yourself feeling stiff for more extended periods, or even most of the time – it might be time to see a physio. There are many different causes of stiffness and inflexibility. By far the most common is lack of movement. Our joints and muscles both lose flexibility if not moved through their range regularly. Muscle stiffness can feel like a tightness with a bouncy feeling of restriction, and joint stiffness can create a harder ‘blocked’ feeling when you try to move. 
 
When it comes to stiffness that evolves from lack of movement, you may not even notice that you have lost range, as it can be easy to adapt your movements to compensate. Your physiotherapist can help you to identify where you have areas of inflexibility and help you to exercise, stretch and mobilise your joints to get them back to a healthy range. Disease processes such as osteoarthritis and rheumatoid arthritis can also cause prolonged stiffness, and your physiotherapist is well equipped to help you deal with these conditions. 
 
Reduced Strength or Weakness
 
There are many possible reasons for weakness in the body, from generalised disuse, weakness in one muscle group following an injury, neurological weakness or structural weakness of joint following a ligament tear. Musculoskeletal deficiency of any kind can predispose you to future injuries and are difficult to resolve without targeted exercises. Your physio can determine the cause of your weakness and prescibe the best treatment to restore your strength. 
 
Reduced Balance
 
Keeping your balance is a complicated process and your body works hard to make sure you stay on your feet. Humans have a small base of support for our height and we use all our senses together to determine which movements we should make to stay upright, including our visual, vestibular, muscular and sensory systems. As balance is essential for walking, if one system that supports our balance begins to weaken, the others will quickly compensate, so you may not notice that your balance has worsened until you fall or trip over unexpectedly. 
 
As a general rule balance deteriorates as we get older, but this doesn't mean that falling should be an inevitable part of aging. Actively working to maintain or improve your balance can have a significant effect on your quality of life and confidence in getting around. Your physiotherapist is able to test all aspects of your balance and provide effective rehabilitation to help keep you on your feet.

1. Ask your physio questions about your injury
 
Understanding your condition and how to best manage it is one of the most important factors for a successful recovery. Effective therapists allow time for you to ask questions in a non-judgmental environment. There are no stupid questions, if you don’t understand what is happening in your own body it is harder to follow advice and stick to your program. This can also help you to cope with pain and feel less helpless in your recovery.
 
2.  Follow your physio’s advice and do your exercises
 
Home exercises are a key part of your recovery, especially when treatment times are limited. Try to stick to your exercise program as seriously as you would a medicine schedule. It is also important to ensure that you are doing your exercises correctly at home. Don’t be afraid to double and triple check your technique during your appointments.
 
Your therapist will also provide you with advice regarding activities to avoid, how to stretch, when to rest and how to avoid further injury. If you’re not sure about something, ask your therapist to write it down for you.
 
3.  Notice your improvements
 
Nothing can be more disheartening than feeling like the appointments and exercises you’re diligently attending to are making no difference. As therapists, we make regular measurements to track your improvement and know that while  your symptoms might  be lingering, you are  actually moving more and increasing stress on your body as you recover. Set your own measurements to help you track your recovery. This can help you stick to treatment and feel more positive as you complete your recovery journey.
 
4. Set goals and work with your physio to meet these.
 
The goals of recovery are different for everyone. Some of us want to be able to reach peak performance, such as running a marathon. For others, just getting through the day with a little less pain would be a huge success. Know your own goals and take the time to discuss this with your therapist, who will guide your treatment to help you meet these milestones.
 
Our physiotherapists at The Physio Nook are happy to discuss your condition with you and share their tips to help you stay pain-free.  

There is no doubt that the human body can be very resilient. Short of regenerating new limbs, our bodies are capable of recovering from large amounts of damage, including broken bones. With this in mind, many people are happy to let nature take it’s course following an injury, thinking that seeing a physiotherapist will only act to speed up already healing tissues.
​
The speed of recovery, however, is only one measure of healing and despite our body’s incredible capacity for repair, injury repair can be less than straightforward. Here are a few things about injury healing you may not have been aware of...

1. Scar Tissue is more likely to form without treatment.
Scar tissue can cause ongoing pain and stiffness in skin, muscles and ligaments. Physiotherapy can prevent excessive scarring from forming through advice regarding movement, massage and other hands-on treatment.

2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained.
Impaired proprioception is a major factor in re-injury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. The good news is that with a specific exercise program, proprioception can be improved and restored.

3. Once healing has finished, your body may not be exactly the same as before.
Following an injury, ligaments may be lax, joints may be stiffer and muscles are almost always weaker. While the pain may be gone, there might still be factors that need to be addressed to prevent more complicated issues in the future.

4. You may have picked up some bad habits while waiting for the injury to heal.
While in pain, we often change the way we do things, this can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can remain and create further problems down the road.

5. Injuries don’t always heal completely.
On occasion, injuries may not be able to heal completely on their own. The most serious example of this is a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition.
 
Your physiotherapist can assess your injury and develop a treatment plan that will both restore you to the best possible function and prevent further injuries.