Concepts for assessment and treatment of anterior knee pain related to altered spinal and pelvic biomechanics: A case report

Abstract

Anterior knee pain is a musculoskeletal condition that is associated with symptoms including pain around the region of the patellofemoral articulation and can be aggravated by activities that increase load through the patellofemoral joint (McConnell, 1986). Differentiation of the cause of anterior knee pain based on location of pain is difficult since many conditions are characterized by pain around the patella. Furthermore, aggravating activities including squatting, kneeling, sitting and ascending or descending stairs are similar across numerous conditions. Most clinical practice draws on evidencebased local interventions including quadriceps muscle re-education and patellar realignment procedures including taping and stretching in an attempt to optimize the biomechanics of the patellofemoral joint (Crossley et al., 2001; Cowan et al., 2001; Hinman et al., 2003). In the reported case of a patient with anterior knee pain, improvements in knee pain and range of motion during squatting were found immediately following mobilization of the thoracic spine and the lumbosacral junction. It is the purpose of this case report to explore reasons behind this improvement and to discuss the implications for assessment and management.