Module 1: Understand your pain

Have I got knee cap pain?

Before continuing with the course it is important to understand if you have knee cap pain. The following resources do not replace a consultation with a healthcare professional but may help you to understand if knee cap pain is the most likely diagnosis. If you have seen a clinician or your GP in the past, they may have described your knee pain as patellofemoral pain syndrome, chondromalacia patellae or runners knee. These all fall under the umbrella term of knee cap pain.

Where is your knee pain?

In individuals with knee cap pain, it is common for the pain to be felt at the front of your knee, around or behind the knee cap. Pain in other locations can suggest an alternative diagnosis. This video looks at the common locations of knee pain and helps to indicate where pain is felt in knee cap pain.

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Do you have other symptoms?

There is no definitive clinical test to diagnosis knee cap pain, however, certain criteria make the diagnosis more likely. The most important criteria are pain at the front of the knee, around or behind the knee cap, that is made worse by activities such as squatting, walking up and down stairs, running, jumping and squatting. Additional, but non essential criteria, include a grating or grinding sound during movements where the knee is bent, tenderness when pressing on the knee cap, mild swelling and pain when sitting or on standing after sitting for a prolonged period of time. One thing you can do at home is to see if you have pain at the front of your knee during a squat. This is positive in 80% of people with knee cap pain.

Is imaging required?

Some people believe that changes in the structure of the knee joint is the cause of knee cap pain. However, research suggests that there is no difference in knee structure between people with knee cap pain and people without on MRI and x-ray. Therefore, imaging is not likely to help with knee cap pain diagnosis or in determining appropriate treatments.

Why does it hurt?

Knee cap pain is complex and varies from person to person. It results from many different factors including knee structure, movement patterns, exercise habits and non-physical aspects. These can cause signals in the knee to travel to the brain resulting in the feeling of pain. With such variation, it is important for treatments to tackle the likely contributing factors in an individualised way.

The following video explores the common reasons for knee cap pain.

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• Patellofemoral pain – another term for knee cap pain
• Biomechanics – the way in which a person moves
• Nociception – a neural process involving signalling from the tissues (peripheral nervous system) to the brain (central nervous system) resulting in the feeling of pain
• Psychosocial – the relationship between psychological and social factors

Anatomy of the knee

• Quadriceps muscles – thigh muscles
• Patella – knee cap
• Ligaments – strong fibrous tissues which hold the knee together, found either side of the knee and within the knee itself
• Patella tendon – strong fibrous tissue connecting the patella to the tibia (shin bone)
• Tibial tuberosity – a bony prominence at the top of the tibia (shin bone)

How much exercise should I do?

Doing ‘too much, too soon’ may be a key reason you develop or continue to have knee cap pain. That’s why managing load is very important. The best way to tell if you are doing ‘too much, too soon’ is by monitoring pain levels during and after exercise. Generally, if you have a large increase in pain or pain that stays increased for more than 24 hours after exercise it might be ‘too much’. Avoid a varied and rapid increases in exercise quantity and instead gradually build up exercise to help improve pain levels.

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Module 1 quiz

Check your understanding of module 1 with the following true or false questions. If you are getting most of them right then move onto module 2, otherwise recap module 1. Click on the question to reveal the answer.