While at the American College of Sports Medicine Summit for 2015, I had the pleasure of listening to Captain Steve Blivin, Orthopedic Doctor and Executive Officer at the Naval Health Clinic in Corpus Christi. He spoke about usual pain syndromes and shared his expertise on treating them with simple exercise programs. He estimates that greater than 80 % of all people get better with these recommendations. He is a big proponent for keeping exercise recommendations simple and easy. His catch phrase during the conference was a fun and smart recommendation for implementing exercise compliance. “The exercise that is best, is the one you will do.” Dr. Blivin chose these exercises to recommend because they do not require any equipment or money and they are easy to teach. They also have low risks of injury due to being completely self-regulated and static (meaning less movement involved). These self-regulated stretches and body weight exercises are suitable for a wide range of people with different training levels and exercise backgrounds. He talked about 5 different regional pain syndromes and their quick fixes. We will break this down into 5 different segments to cover each region. Check the blog for these other segments:

  • Segment 1 “Back” Pain (AKA SI Joint Pain)

  • Segment 2 Anterior Knee Pain

  • Segment 3 Anterior Hip Pain

  • Segment 4 Anterior Shoulder Pain

  • Segment 5 Plantar Fascia Pain

Before starting any exercise programming, it is very important to rule out any major or life threatening issues. This is especially important with back pain and even more important to stress on a blog where I cannot see you. You are doing a self-assessment to see if exercise is suitable for you, I am trusting you to make a sound decision in your best interest. If you have any questions or concerns, contact a doctor. If not, use these red flags to help guide your decision to engage in exercise. American College of Sports Medicine defines a red flag as something that needs immediate attention from a doctor and should precede exercise programming. If you answer yes to any of the following questions, consult a doctor before starting an exercise program.

  1. Is your pain the result of an accident or major trauma?

  2. Have you had a persistent fever that won’t go away?

  3. Do you have a history of cancer that is not being controlled by a doctor?

  4. Do you have any metabolic disorders not being controlled by a doctor?

  5. Do you have any unusual muscle weakness?

  6. Do you have difficulty controlling your bladder or bowels?

  7. Do you have significant night pain?

If you answered no to ALL of the above questions, please feel free to continue to the next section.

What Is Anterior Knee Pain?

Anterior is a term that means front of the body, anterior knee pain is a collective term used for pain in the front of the joint, in this case the knee. It is important to note that we are not talking about injuries involving a trauma like a twist, pop or major swelling. We are addressing chronic pain syndromes that seem to have come on gradually with no injury associated.

The picture above illustrates the knee from the outside angle. The patella is the kneecap, it is the front and center of the knee. The patella lines up with the knee joint between the femur and tibia. You can tell from the picture that the meniscus is right in the knee joint space providing cushion. A wide range of diagnoses can fall into the Anterior knee pain category; patella-femoral pain syndrome, patella tendinitis, different bursitis locations, plica pain syndrome and chondramalacia patella. All of those listed diagnoses result from over use or poor mechanics and can benefit from the simple exercises listed below.

Why do I have pain?

Pain results when an area is too weak and too tight to do the things that it is doing. This is a general term that includes all training levels and is specific to each person. Casual walkers and endurance runners can have the same symptoms and movement patterns, even if their exercise intensity is different. We are dressing the stability and function of the affected area relative to what specific activities each person does. If you are too weak and tight it will cause bone alignment and exercise form to suffer, which may cause rubbing and inflammation. In instances of  anterior knee pain, this means your quadriceps and hip complex is likely too weak while your quadriceps and hamstrings are too tight. Yes, quadriceps are both weak and tight, no that is not a typo! To address this, we strengthen the weak things and stretch the tight things.

Anterior Knee Pain Exercise Protocol: 

Do the following exercises in 3 sets, 2-3 x a day for 6 weeks

  1. Quadriceps strengthening: Wall sits for 30-60 seconds with your knees just above 90 degrees and your back flat to the wall

  2. Hip Strengthening: Hip Hikes until you feel the burn in your outer hip (Sand with your feet at hip width, keeping your knees straight, hike one hip straight up until the foot is off the ground. Repeat until you feel the muscle on the oposite hip burn. Repeat on the other side).

  3. Hamstring stretching: your favorite hamstring stretch, hold 30-60 seconds

  4. Quadriceps stretching: your favorite quadriceps stretch, hold for 30-60 seconds

How long does it take for these exercises to work?

As with any exercise or healing process, the body takes about 6-8 weeks to change. At about 3-4 weeks you should feel better, allow 6-8 weeks to feel “fixed”.

What if I don’t feel better?

New studies are showing links between chronic pain syndromes and untreated depression. Between 30-80% of people who do not get better within 6 weeks using these simple yet effective exercise programs have depression as an underlying cause. Treating the depression with the injury has proven very effective for that population. There is more information on depression now than ever before. I suggest using the tool below to do a quick self assessment.

PHQ2 test

  1. How often in the last two weeks have you felt down, depressed or hopeless?

  2. How often in the last two weeks have you felt little interest or pleasure in doing things that you normally like to do?

If you answer more than 2 days for either of those questions, you might want to talk to your doctor about depression to get more information.

How do I prevent this from happening again?

  • Continue with cross-training exercises to promote body and muscle balance (wall sits, core strengthening, hip hikes, scapular retractions)

  • “Don’t over water” – don’t do too much too quickly to often. Only increase exercise by 10 % each week, any more and you will increase risk of injury

  • Warm up preexercise using foam rollers and joint motion, cool down post exercise using stretching and ice, read more about Foam Rolling on the Blog under the “Exercise Prescription” Category

  • Ice after exercise to decrease inflammation; Icing protocol is 20 minutes on/2 hours off