Pain below the kneecap, physical therapy, treatment: Focus Fizikal✓

The symptomatology of pain below the kneecap varies depending on the stage of tendon damage and the level of inflammation in the soft tissues surrounding the joint. Patients most commonly describe the pain as a dull sensation that worsens with specific movements, while in complete rest, the symptoms often subside, which can create a false sense of recovery. The clinical picture is typical of overuse syndromes, where the intensity of the discomfort progressively changes with the level of activity.

The most common symptoms accompanying pain below the kneecap include:

• Sharp pain directly on the lower half of the kneecap or the patellar tendon descending to the shinbone.
• Pain that occurs at the beginning of physical activity, then decreases during warm-up, only to intensify after rest.
• Difficulty and painful movement when going down stairs, as well as discomfort when sitting for extended periods with the knee bent, known as the "cinema phenomenon."
• Mild swelling or thickening of the tendon below the kneecap, which may be accompanied by a feeling of warmth in the area.
• A subjective feeling of knee instability or "giving out" when quickly putting weight on the leg due to reflex muscle inhibition caused by pain.

All these symptoms clearly indicate that the patellar tendon is experiencing chronic overload, which requires expert evaluation and a change in activity regimen. Recognizing these early warning signs allows the patient to avoid prolonged breaks and return to daily activities more quickly.

• Knee arthritis
• Ligament injuries
• Excessive knee load
• Patellar subluxation

The causes of pain below the kneecap are most often associated with a sudden increase in the intensity of physical activity or repetitive movements that strain the knee's extensor mechanism. Factors such as hard running surfaces, inadequate footwear, or congenital anatomical variations in the position of the kneecap further contribute to the development of inflammation. Although it is commonly referred to as "jumper's knee," this issue also affects individuals who do not participate in sports, due to weakness in the muscles that should stabilize the joint.

The main causes of pain below the kneecap include:

• Patellar Tendinitis: Inflammation of the tendon due to frequent jumping, running, or sudden changes in movement direction.
• Chondromalacia Patella: Softening and wear of the cartilage on the inner side of the kneecap caused by improper tracking of the patella.
• Osgood-Schlatter Disease: Most commonly seen in adolescents during growth, caused by the strong pull of the tendon at the point of attachment to the bone.
• Muscle Imbalance: Primarily weakness in the quadriceps and tightness in the hamstrings, which alters the direction of forces on the knee.
• Infrapatellar Bursitis: Inflammation of the small fluid-filled sac located beneath the tendon, which helps reduce friction.

Understanding these causes is essential for developing a rehabilitation plan that will address the issue permanently rather than just temporarily alleviating the pain. Each cause requires a specific approach to strengthening and stretching to restore the biomechanics of the knee

Treatment of Pain Below the Patella at the Focus Physiotherapy Center is focused on reducing mechanical stress on the tendon and stimulating the regeneration of damaged fibers. The therapeutic process begins with controlling the inflammatory process, after which exercises are gradually introduced to restore elasticity and strength to the entire lower extremity. Successful rehabilitation is a long-term process that requires patience and consistency from the patient in performing the prescribed exercises.

The modern rehabilitation approach includes the following phases:

• Detailed functional assessment of the biomechanics of the hip, knee, and foot to identify the primary source of overload.
• Application of physical procedures such as shockwave therapy, TECAR therapy, and high-power laser to accelerate tendon healing.
• Manual therapy and patella mobilization to improve the glide of the patella and reduce pressure on the surrounding soft tissues.
• Kinesiotherapy focuses on eccentric exercises to strengthen the quadriceps, which have been clinically proven to be the most effective for tendon problems.
• Use of kinesiology tape and orthotic aids in the transitional phase to relieve the tendon attachment during walking or sports.

Ongoing implementation of preventive exercises after the completion of therapy ensures that the knee remains healthy and resistant to future strain. This comprehensive treatment not only eliminates pain but also significantly improves the overall stability of the leg.