Knee pain in women
Knee injuries are becoming more common in female athletes. Interest in women's athletics at the
amateur and professional level has changed the face of sports. Greater participation has heightened appreciation of health and medical issues specific to the female athlete. Studies comparing male to female susceptibility to injury of the knee have shown women to have considerably higher rate of injury.
Statistics gathered over a three year period in the early 90s in the U.S.A showed that women suffered knee injuries more often than men, nearly 4 times as often in basketball, 3 times as often in gymnastics, and nearly 2 and a half times as often in football.
This is a concern for all female athletes.
Knee pain in women - anatomy
The reason may seem complicated at first but its really quite simple when you get your head round it.
Women athletes have a wider pelvis than their male counterparts as this facilitates natural child birth. However this extra width has a negative effect when its comes to lower limb biomechanics. Have a look at the diagram on the right. The angle that is created between the thigh bone and the shin bone is called the Q angle. The greater the Q angle the more unhelpful biomechanical forces operate around the knee. There is therefore more stress placed on the knee itself and the associated structures such as ligaments and tendons.
The two major components that affect the Q angle are
(i) increased pelvic width (as increases the angle that the thigh bone joins the knee)
(ii) Position of the foot during the contact phase (when the foot is on the ground) as this alters the angle that the shin bone enters the knee.
If traumatic injury of the knee occurs immediate medical attention should be sought.
P - R - I - C - E
Protection - Your knee may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
Ice - Place a plastic bag with ice on the knee for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the knee above heart level
Exercises should not hurt, if they do stop!
Here are some exercises to help your knee pain. After you do all the exercises as shown in the drawings, reverse your position, and do the exercises with your other leg, so both knees get the benefit of stretching
| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
Iliotibial band and buttock stretch (right side shown) Position yourself as shown above. Twist your trunk to the right and use your left arm to "push" your right leg. You should feel the stretch in your right buttock and the outer part of your right thigh. Hold the stretch for 30 seconds. Repeat on the other side.
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| Technique: | Hold each exercise 20 seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
Iliotibial band stretch (left side shown). Position yourself as shown above, with your right leg crossed in front of your left leg. Hold your hands together and move them toward the floor. You should feel a stretch in the outer part of your left thigh. Hold the stretch for 30 seconds. Relax then repeat on the other side
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| Technique: | Hold each exercise 20seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
Hamstring stretch Rest the leg to be stretched on a supporting surface while keeping the knee from bending. Lean forward toward your toes by bending at the waist and keeping your back straight. You should feel the stretch but it should not hurt. |
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| Technique: | Hold each exercise 30 seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
Calf stretch Your front leg should bend so that when you look down over your knee, you can see the tip of your toes. Lean forward aiming to keep a straight line with your heel, hip and head. | For best results, push against a wall. |
strengthening exercises
| Technique: | Hold each exercise 30 seconds at a gentle stretch. |
| Frequency: | 2-3 repetitions/exercise, 5-7 days per week |
Quadriceps strengthening: straight leg Position yourself as shown above. Hold your right leg straight for 30 seconds and then relax.
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| Technique: | Hold each exercise 5-10 seconds at a gentle stretch. |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
Quadriceps strengthening: straight leg lift. Position yourself as shown above. Raise your right leg several inches, and hold it up for 5 to 10 seconds. Then lower your leg to the floor slowly over a few seconds. Then repeat the exercise
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| Technique: | Hold each exercise 5-10 seconds. |
| Frequency: | 5-10 repetitions/exercise, 5-7 days per week |
Hip adductor strengthening. While sitting, squeeze a rubber ball between your knees. Hold the squeeze for 5 to 10 seconds. (If you don't have a ball, put your hands or fists between your knees and then squeeze.) |
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| Technique: | Hold each exercise for 5-10 seconds |
| Frequency: | 10 repetitions/exercise, 5-7 days per week |
Hip abductor strengthening (left side shown, front and side views) Position yourself as shown above, standing on your left leg with the knee slightly bent. Slowly raise your right foot about 30 degrees, hold for a few seconds, and then slowly lower the foot and straighten both legs. Don't let your pelvis tilt (be crooked), and don't let your knees turn inward during bending. |
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Repeat the exercises below several times with each leg on a daily basis. Over several weeks, increase the resistance by adding ankle weights or by looping purse straps or the handle of a weighted pail over your ankle. Start with one or two pounds, adding one-half pound at a time as you build strength.
Bent-Leg RaisesThis strengthens the inner thigh muscle to balance the pull on the knee joint from the outer thigh, which is often stronger.
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Straight-Leg RaisesThis strengthens the thigh muscles to help support the knee joint.
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Knee pain (Patellofemoral syndrome) in women prevention
Remember that virtually all patellofemoral problems occur at the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point.
Golden rule- Don't ignore the problem, it won't go away
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can be achieved by wearing a good shoe (see our shoe guide) with orthotics (foot beds), knee strengthening and knee support.
1. Check your footwear
Are your running shoes worn and in need of replacing? If so change them. The chances of patellofemoral injury is greatly increased both with the higher impact forces and loss of stability caused by a worn shoe. For more advice on running trainers our running shoe advice page is worth reading. Read more->
Below are a selection of trainers that are ideal for athletes.
Trainers for a neutral or under pronating foot type
Trainers for over pronators
2. rectify Poor biomechanics with orthotics
The way your foot strikes the ground and the forces that are placed on it can have a direct effect on biomechanics causing patellofemoral injury and can also delaying healing times. Check our biomechanics page for detailed information. Read more->
3. Knee strengthening
The single best exercise to improve the strength of the muscles around the knee is eccentric loading. This is usually done none weight bearing, however the use of a wobbleboard is an excellent way to strengthen muscles around the knee, foot and ankle in a controlled gentle manner. Whilst our clinicians have found it a brilliant way to strengthen muscles around the knee, traditionally a wobbleboard was used to help balance (proprioception). Proprioception is the nerve connection from the brain to the foot. This is often damaged/ disrupted after injury and can increase the chances of injury from recurring. It can also significantly delay recovery.
Use of a wobbleboard therefore has a dual benefit in the treatment of patellofemoral injury.
4. Knee support
Consider purchasing a knee brace . This device provides extra stability to the knee when playing sports. The material also causes localised vasodilation (opening of the blood vessels) increasing circulation to the area. This is vital as all ligaments have a notoriously poor blood supply. Increasing circulation to the ligaments can reduce the chance of injury. Extra stability will also reduce the chances of irritation and damage to the knee.
patellofemoral injury prevention checklist summary
returning to sporting activity
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your patellofemoral injury, which could lead to permanent damage. Everyone recovers from patellofemoral syndrome at a different rate. Returning to your activity is determined by how soon your meniscus recovers, not by how many days or weeks it has been since your meniscus injury occurred
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured leg compared to the uninjured leg.
You have full strength of the injured leg compared to the uninjured leg.
You can jog straight ahead without patellofemoral pain.
You can sprint straight ahead without patellofemoral pain.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.
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