033. How to treat anterior knee pain with Kurt Lisle

01/23/15 • 76 min

Anterior knee pain can occur in your elite sports patients right through to office workers and weekend warriors. In this podcast with Kurt Lisle, we discuss anterior knee pain, the causes, how to diagnose the source of the pain, and the best ways to treat and rehabilitate these patients.

Kurt Lisle is the Australian Socceroos Physio and co-owner of The Knee Joint Physio in Queensland. Kurt and I discussed acute knee injuries on the Physio Edge podcast in episode 29, and I really wanted to get Kurt back on the podcast to discuss the anterior knee.

In this fantastic, detailed episode of the Physio Edge podcast, Kurt and I explore:

Subjective clues that give you ideas about differential diagnosis
Fat pad - location of pain, activities that irritate
Patellofemoral joint - aggravating activities and DDx
Patellar tendon - subjective clues, location of pain
Objective examination of the anterior knee
Tests for PFJ
Functional tests first or examination on the treatment table?
Palpation of the anterior knee
Fat pad palpation and tests
Is the fat pad tender medial and laterally, or can it be tender only on one aspect
Neuromuscular patterning
Squat and one leg squat examination
What causes “catching” pain on movement
Chondral defects - identifying
Is there value in the grind test
When to refer for MRI and other imaging
Important factors that may contribute to AKP
Gait contributors to AKP
Treatment of PFJ pain
Modifying PFJ aggravating activities
Using EMG
Quadricep rehabilitation and strengthening
When to incorporate squats into your rehabilitation program
The role of taping for PFJ or fat pad irritation
Red flags causing knee pain

Links of Interest

In this fantastic, detailed episode of the Physio Edge podcast, Kurt and I explore:

Subjective clues that give you ideas about differential diagnosis
Fat pad - location of pain, activities that irritate
Patellofemoral joint - aggravating activities and DDx
Patellar tendon - subjective clues, location of pain
Objective examination of the anterior knee
Tests for PFJ
Functional tests first or examination on the treatment table?
Palpation of the anterior knee
Fat pad palpation and tests
Is the fat pad tender medial and laterally, or can it be tender only on one aspect
Neuromuscular patterning
Squat and one leg squat examination
What causes “catching” pain on movement
Chondral defects - identifying
Is there value in the grind test
When to refer for MRI and other imaging
Important factors that may contribute to AKP
Gait contributors to AKP
Treatment of PFJ pain
Modifying PFJ aggravating activities
Using EMG
Quadricep rehabilitation and strengthening
When to incorporate squats into your rehabilitation program
The role of taping for PFJ or fat pad irritation
Red flags causing knee pain

Links of Interest

Previous Episode

032. How to rehabilitate ACL injuries with Enda King

ACL injuries can be career ending, or they can be an opportunity to sort out movement efficiency, motor control and and technical skills, coming back from the rehabilitation process with more power, speed and efficiency than they had before they injured their ACL.

In this podcast, Enda King from the Sports Surgery Clinic in Dublin currently completing his PhD in 3D biomechanical analysis after ACL reconstruction, with the aim to assist in RTP decision making and identifying fully rehabilitated athletes, and David Pope discuss ACL injuries, and the most important factors in pre-operative management and post-operative exercise programming to get your patients back to sport with improved sporting performance.

Going deep on the details involved in ACL Rehabilitation, including:

01:20 Enda King and SSC, and working with ACL athletes PhD in 3D biomechanical analysis after ACL reconstruction, aim to assist in RTP decision making and what a fully rehabilitated athlete looks like
What does a fully rehabilitated athlete look like?
Incorporating performance goals into the rehab process
Can athletes achieve better performance post ACL rehab than they were pre-injury
Types of ACL grafts
Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery
Preoperative education
Restoring knee extension, balancing pain and improved range of movement, empowering your patient
Guidelines for pain, swelling when restoring range of movement
Restoring quadriceps activation, normalising gait patterns
Clinical Edge
Clinical Edge’s free webinar program
Preoperative length of time
Post-op - initial management
To use or not use co-contraction exercises of quads and hamstrings
Should you use squatting style exercises Week 1 post op
Activating quadriceps - internal quadriceps cues or external exercise focus
How much pain should a patient experience during or after an exercise
Week 2 post-op
When can heavy gym training commence
Changing movement patterns throughout the kinetic chain
Advice for patients in the early stages of rehab
Frequency of exercise
Week 2 onwards - exercises incorporating balance and proprioception
Open vs closed chain exercises
Advice for patients in weeks 2–6
Nutrition and dietary advice for patients
Gym based rehabilitation
Choosing and modifying exercises for middle stages of the rehabilitation process
Various types of squatting movement, and progressing the types of squats
Goblet squats
Retraining ideal squat patterns
Progressing squats, deadlifts and lunges
Front squats
Front squats and trap bar deadlifts vs back squats during rehabilitation
When can an athlete start cycling
Disadvantages of using cycling as the main part of a rehabilitation program
Hamstring rehabilitation after semitendinosis/gracilis graft
Strength and power development
Strength testing - mid thigh pull, leg press
Should we use open chain strength tests
When to perform strength tests
Strength vs power and rate of force development
Running - incorporating into the program. When can your patient start running?
Preparation for running
Running drills
Ideal movement patterns in running
Enda King and SSC, and working with ACL athletes

Podcast timeline

3:35 What does a fully rehabilitated athlete look like?
5:40 Incorporating performance goals into the rehab process
6:50 Can athletes achieve better performance post ACL rehab than they were pre-injury
8:20 Types of ACL grafts
11:10 Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery - an opportunity to prepare your patients knee, ROM, strength and educate them on the rehabilitation process
14:20 Preoperative education
14:40 Restoring knee extension, balancing pain and improved range of movement, empowering your patient with
15:40 Guidelines for pain, swelling when restoring range of movement
16:15 Restoring quadriceps activation, normalising gait patterns
17:10 Clinical Edge
18:45 Clinical Edge’s free webinar program
19:30 Preoperative length of time
20:35 Post-op - initial management
23:20 To use or not use co-contraction exercises of quads and hamstrings
24:50 Should you use squatting style exercises Week 1 post op
25:25 Activating quadriceps - internal quadriceps cues or external exercise focus
26:30 How much pai...

Next Episode

034. Advanced ACL rehab with Enda King

The advanced stages of ACL rehabilitation are enjoyable to progress your patients through, and at the same time challenging to find the right exercises, and optimise the rate of progression through to return to training (RTT) and return to play (RTP). In this episode, Enda King from the Sports Surgery Clinic Dublin and David Pope discuss these later stages of rehabilitating your patients following an ACL Reconstruction.

We discussed the prehabilitation and early stage ACL Rehab in the Physio Edge podcast episode 32, and episode 34 Enda and I cover in detail:

Return to straight line running and change of direction
Advanced Exercise Programming
What exercises to choose
Proprioception and motor control training
Strength and power programming
Periodisation
Sports specific conditioning
Plyometrics – readiness, what to use and timing of these in the training schedule
Multi-directional performance
Strength testing – what Enda uses, indicators of strength
Decisions on return to training
Return to contact
Decision making on Return to play
Bridging the gap between the gym and the field
Advice for Physios rehabilitating athletes recovering from an ACL reconstruction
When to discharge an ACL athlete and much more