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Tag Archive: physiotherapy

  1. What is causing pain at the front of my knee?


    Many athletes and recreational sports people suffer from on-going knee pain and soreness. Today Physiotherapist Sarah Marshall looks in more detail at one aspect.

    One of the most common types is Anterior Knee Pain (AKP). It describes pain at the front of the knee and can affect up to 40% of the population. It is especially common amongst athletes, yet not disrupt their sporting function or ability.

    What are the causes of AKP?

    There are many causes of AKP and I have listed the most common below. Symptoms will often present without specific injury. Any persistent pain must be assessed by an appropriate medical professional in order to make an accurate diagnosis who will then advise on the correct treatment plan.

    Patello-Femoral Joint Pain (PFJP) is by far the most common cause of AKP. Athletes will describe pain in and around the patella. I would not expect to see any significant swelling around the knee joint.

    Symptoms are usually aggravated by stairs, kneeling, squatting, lunging and running. PFJP can also cause pain at rest, especially when sitting for long periods (movie goer’s knee).

    A Patella Tendonopathy, Fat Pad Irritation / Impingement, Bursitis and Patella Instability with also produce AKP.

    What causes PFJP

    There are many contributing factors to the development of PFJP

    •  Local muscle weakness (especially quadriceps)
    •  Poor neuromuscular control
    •  Muscle tightness (especially quadriceps and hamstrings)
    •  Poor hip / pelvic control / stability
    •  Poor foot posture / mechanics

    All of the above will increase the functional loading of the Patello-Femoral Joint which is likely to cause inflammation and pain with repeated use. PFJP is also a very common complaint following any knee joint surgery and must not be missed as referred pain from an old Posterior Cruciate Ligament injury.

    Management of PFJP

    knee pain

    Get your knee assessed by a Chartered Physiotherapist

    Always seek professional advice if you can before embarking on a rehabilitation programme. Initially, pain levels need to be managed and controlled before early rehabilitation can be progressed.

    Pain Management

    •  Activity modification i.e. avoid aggravating factors
    •  Taping techniques
    •   Acupuncture
    •  Soft tissue massage


    •  Stretching programme (hamstrings, quadriceps, gastrocnemius, anterior hip structures)
    •  A graded strengthening programme with initial emphasis on quadriceps
    •  Hip and pelvis stability exercises ( transversus abdominus, gluteus medius)

    (Post rehab, there are 3 keys to maintaining Knee Health)

    There are limited surgical options for this problem with relatively poor outcomes.

    A biomechanical assessment of the foot can help determine whether shoes orthotics are indicated. Commitment to rehabilitation must be adhered to for many months in order to achieve individual goals.

    Unfortunately, without the appropriate management, PFJP often develops into a chronic problem.

    If you want an individual assessment on your knee pain, then please book in to see me.

     Sarah Marshall 

  2. How to manage “Growing pains”


    A guide to common growing pains in athletes

    Osgood-SchlattersChildren and adolescents endure many of the same injuries and mechanical dysfunctions as adults. However, in the maturing skeleton there are some specific conditions that are only seen in the young.

    Here is an overview of the common conditions, their causes and how to manage them.

    Osgood -Schlatters, Sinding-Larsen-Johansson and Severs lesions

    These are non-articular types of osteochondrosis or ‘traction apophysitis’. These specific conditions affect the growth plates, where muscle tendons attach to bone.

    They are normally seen in the more active and sporty adolescents during or after a growth spurt. Either one or both limbs can be affected. All three of these conditions are self- limiting and in some cases the symptoms can continue for years.

    Recovery rates will vary between each child. Investigations such as x-ray and diagnostic ultrasound are not normally indicated to make a diagnosis.

    • Osgood-Schlatters

    A common cause of anterior knee pain in the young athlete. Pain, swelling and local tenderness will be present at the tibial tuberosity, where the patella tendon attaches below the knee joint. In some cases a boney lump can be seen. Affects boys more than girls.

    • Sinding-Larson-JohanssonSinding-Larsen-Johansson

    A less common cause of anterior knee pain in the young athlete. Pain, swelling and local tenderness will be present at the inferior pole of the patella, at the superior end of the patella tendon (at the bottom of the knee cap).

    • Severs

    A common cause of heel pain in young athletes. Pain, swelling and local tenderness will be present where the Achilles tendon attaches onto the heel.

    What are the causes of Growing Pains?

    • Growth spurt (during this period bone will lengthen before muscle. This will put increased pressure on tendon attachment during exercise)   Increased intensity of training
    • Adaptation to a new sport, especially those which involve running and jumping.
    • Reduced muscle length, especially during or after a growth spurt.
    • Reduced muscle strength.
    • Poor control / stability at the spine and pelvis.
    • Poor foot mechanics.

    How to manage the condition

    • growing painsMonitor and keep a record of the child’s growth. This can help to adapt training needs specifically .e.g. during a growth spurt an increased emphasis on stretching is required and maybe some reduced activity.
    • Reassurance to the child that his/her condition is relatively short term and that by continuing with their sport is not doing any harm.
    • Activity modification (this should be guided by pain levels. There is no evidence to suggest that prolonged and complete rest is beneficial)
    • Regular stretching of the surrounding muscle groups
    • Strengthening of the surrounding muscle groups. This should be focused on during periods of reduced symptoms and limited growth.
    • Spinal and pelvic stability / control work.
    • Assessment of foot mechanics Maybe a need to change footwear or use of orthotics. Small heel raises or gel cushions can be useful to control the symptoms of severs.
    • Use of ice locally
    • Use of massage to surrounding muscles
    • Seek medical advice regarding use of analgesics and anti-inflammatories.  


    Growing Pains could be considered a normal part of growing up. A sound training plan and recognition of sudden changes in growth can help guide the young athlete through the problem.

    Any young athlete who is complaining of pain needs to be assessed by a medical professional.  You can book in at my Physiotherapy clinic in Willand, Cullompton, Devon.


    1. ‘A heel cup improves the function of the heel pad in Severs injury : effects on heel pad thickness, peak pressure and pain.’ Perhamre et al. Scandinavian Journal of Medicine and Science. August 2012.vol 22.4.p516.
    2.  ‘Childhood lower-limb apophyseal  syndromes : “what is the egg on my leg?.”’ Stickland. SportEX Medicine. Jan 2011.47.p22.
    3. ‘Adolescent anterior knee pain’ Gerbino et al.Operative techniques in Sports Medicine. July 2006.vol 14.3.p203.
    4. Clinical Sports Medicine. Bruckner et Al. Third edition 2006.Mcgraw-Hill Australia Pty Ltd.

    Sarah Marshall Chartered Physiotherapist.

  3. Scheduling Training- Andy Larmour

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    tokeleyOne significant issue affecting young athletes more and more as they become increasingly successful is scheduling.

    This is a multi-sport issue.

    As young athletes achieve greater success their talent is required more and more.

    Before they realise it they can be required to represent their school, their club, their county, their region and possibly their country, often at more than one age group. It’s exhausting just thinking about it.

    It can be incredibly difficult for young athletes to learn how and when to say “no”.

    It is highly likely that this may be the first time that the athlete and their parents have been in this situation.

    This is when the athlete’s ‘team’ may need to step in to take on this responsibility for the young athlete. The athlete needs to build a team of experienced Professionals they trust to advice them on the Physical, Technical and Psychological aspects of their sport.

    Young athletes I meet are often trying to please everyone, and competing in every event possible. This has inevitable consequences on performance, health and motivation.

    Learning that less really is more, and that performing in the right events, at the right time, in the optimum physical condition, may be best for their long term future is a tough but important lesson to learn.

    This is where we Professionals may be able to help, especially if we have experience of this.

    You can’t please all the people all the time and the most important person is always the athlete, we must never forget this.

    Andy Larmour Joint Owner of Ocean Physio