The internet is excellent at providing information on a multitude of subjects, but the application of this information is limited because of the existence of individual situations and people. An example of this would be the failure of a one size fits all approach to Physical Therapy. In this example, every patient with a certain diagnosis would be given the same treatment regardless of their presentation. This approach has led to higher costs and poor outcomes in the Physical Therapy research. Conversely, examining each patient and providing specific treatments to match their presentation has been shown to improve outcomes for many conditions including low back pain.
Pain on the front of the knee, anterior knee pain or patellofemoral pain, is a common source of knee pain in the active population. Patients with this diagnosis often present with impairments in flexibility and/or strength at the adjacent joints in the hip and ankle. These impairments above and below the knee joint can affect both the mechanics and loading of the leg during activity. The multifactorial nature behind knee pain limits our ability to find a one size fits all treatment option. Instead new research is identifying sub groups of patients with knee pain to improve our ability to study and treat these patients.
In a recent issue of the British Journal of Sports Medicine authors studied 130 patients with anterior knee pain and placed them through a Physical Therapy examination (Selfe et al. 2016). The authors broke these patients with knee pain into 3 sub groups based on the examination findings. The groups included strong (29 patients), weak and tight (49), and weak and pronated feet (49). Each group consisted of individual exam items which either precipitated or perpetuated their knee symptoms. For example, in the weak and pronated foot group authors found weakness throughout the lower body likely contributing to the poor mechanics during activity seen in this group of patients. Future research is needed to determine if these subgroups lead to more specific and impactful treatments as seen in the low back pain research.
Patients with knee pain are encouraged to avoid a one size fits all exercise approache and instead use a local Physical Therapist to identify impairments like flexibility and/or strength leading to reduced costs and improved outcomes.