Anterior knee pain

[jwilso]

I recently attended a meeting with senior physios and one of them claimed that he could resolve 95-100% of anterior knee pain cases with neural tension stretches. ( ie SLR exercises ). i have personnally never looked at ANT with these patients but would be interested if anyone else has tried this approach and i would also be interested in other peoples opinion on this physios claim.

[neurospast]

Maybe I am a fool, but what does anterior knee pain mean? In case it is a none specific terminology I would say that physiotherapist who claims 95% is a miracle worker, because apparently the cause of pain has become irrelevant and only the symptom pain is relevant. This means to me we have to redesign the philosphy of physiotherapy. If the claim would be e.g. in case of anterior knee pain caused by R.A. I use this or that modality of treatment, and I have 95% of succes rate, I would say fair enough. Anyhow it seems to me some form of pre pilot study sataement and should be thought of as so.
Cheers

[physiobob]

Originally Posted by jwilso

I recently attended a meeting with senior physios and one of them claimed that he could resolve 95-100% of anterior knee pain cases with neural tension stretches. ( ie SLR exercises ). i have personnally never looked at ANT with these patients but would be interested if anyone else has tried this approach and i would also be interested in other peoples opinion on this physios claim.

I would agree that the use of neural mobilisation is useful in the treatment of anterior knee pain when the pain is referred. I tend to make the comment that a lot of knee pain and subsequent surgery is actually referred pain. Thus the use of neural mobilisation (I would use prone knee bend with hip extension more for the femoral components and also the iliopsoas rather than SLR).

However often the use of neural mobilisation can create temporary pain relief even when the issue itself is within the knee. Keep an open mind on this. Assess the knee and if you cannot find anything to support an initial diagnosis then look further afield. As a routiene I always check hip and lumbar spine in knee pain as to overlook it will have you chasing your tail in the weeks ahead. Also the lack of hip and lumbar mobility during activity is often one of the factors that leads the knee to damage in the first place. Thus you need to assess and treat this region anyway.

I would not however make a comment that 95% of knee pain can be "cured" by SLR, although many might get a temporary reduction of symptoms using this as a treatment technique.

[toad]

this claim, could it not be due to a stretching effect on the hamstring muscle, as opposed to ANT.
As tight hamstrings can cause 'anterior knee pain'.

[physiobob]

Originally Posted by toad

this claim, could it not be due to a stretching effect on the hamstring muscle, as opposed to ANT.
As tight hamstrings can cause 'anterior knee pain'.

A SLR (straight leg raise) type stretch does not really stretch the hamstring muscle a such. This is because in 99% of people the tight connective tissue and neural structures will cause pain before the hamstring gets to it's end of range. You need to slightly flex the knee to stretch the hamstrings effectively which would release the neural and some of the connective tissue 'stretch'. Therefore the two techniques mobilise different tissues, the former stretching the sciatic and connective tract but not the hamstring muscles themselves.

[sdkashif]

Anterior knee pain (AKP) is not a specific disease, but refers simply to pain experienced around the front part of the knee, and which may arise from any of several conditions, some of which may not even involve the knee itself.

Anterior Knee pain is caused by a number of different aetiologies. So if the cause is an irritated nerve tissue, neuromobilization has certainly a definite role in relieving it. But if the the cause is different, then neuromobilization has no effect at all and in that case you will have to address the appropriate cause prediposing of Anterior Knee pain. Have a look over some of the possible aetiologies which are:

Patellofemoral Overload

Maltracking
Overuse

Patellar Instability

Patellar subluxation
Patellar tilt

Intra articular pathology

Plica syndrome
Meniscal disorders
Osteochondritis dissicans
Patellofemoral arthritis

Peripatellar disorders

Bursitis
Tendonitis
Apophysitis

Disorders of Patella

Bipartite Patella
Bone Tumours

Referred Pain

Mostly hip disorders, e.g. slipped femoral epiphysis
Spinal disorders with root compression symptoms
Disorders of sacroiliac joint

[arkesh_physio]

why should a hell lot of research be done on knee if only a SLR addresses to 95% of knee problems...
seems too vague!!!!