Dealing with long term knee pain- What works best ?

March 31, 2021

Research update on Patello-femoral syndrome

If you are like me you probably have recurring  knee pain in least of your ” punching bags of the lower limb”. In fact it’s so common that one of my recycled jokes is ” Remember when you were young enough to call your knees left and right instead of good and bad”.

Knee pain is only 2nd to low back pain in it’s commonality. According to a great meta-analysis of 22 published trials with over 1472 participants the most common cuase of knee pain is known as Patello-femoral syndrome ( PFP) ( 1)

This basically translates as pain in around the kneecap that gets worth exercises such as stair climbing or jogging. It differs from some other knee complaints in that it’s not related to a tear of your internal ligaments or cartilage disc, but rather comes from irritation of ligaments and muscles around the patella.

Nearly 40% of those with PFP continue to experience symptoms after 2 years, which is associated with frequent use of pain killers, lowering of physical activity levels and low quality of life.

So what works ?

Well we know what doesn’t work.

Doing nothing.

Just ignoring knee pain and hope that it’s gets better is the poorest outcome. The wait and see approach has the poorest outcome from the all interventions mentioned and my personal experience is once knee pain has set in for months to years it’s probably going to hang around for the long term unless you take an active approach.

There has been a trend to ” patient education ” and a lot of more passive modalities recently in the industry but this study fails to find that these are any better than exercise.

Given that you get a whole lot more benefits from exercise plus the pain the reduction the position of Niseko Chiropractic is that a knee specific gym training exercise under the management of well qualified personal trainer is still the best option. I was I could say that just seeing a chiro for chronic knee pain would get you sorted but honestly in this area exercise seems to trump physical therapy.

Some of my favourites that help me manage my dodgy left knee are this article here

What exercises are best to prepare for a Niseko ski trip ?



  1. Winters MHolden SLura CB, et al
    Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis


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