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Frontal Knee Pain is one of the most commonest conditions I see as an Osteopath here in Edinburgh. This is the pain you feel when you walk up and down stairs and you think it is going to improve but niggles and niggles on. The frontal pain comes from your knee cap constantly moving up and down as you bend your knee and your front muscles of your thigh (the quadriceps) become over strong and tight contract the knee cap into tracking groove of your knee.

Treatment of this prolonged painful condition must include increasing the long term flexibility of the front and back muscles of your legs so that the knee cap or patella is not constantly irritating the boney cartilageous surface of the knee. These muscles can become very tight and need stronger techniques which such as my fleximatic machine to really release those tight muscles and then one needs to stimulate the inflammation to settle with a good effective dose of Ultra Sound. Please read the following article which includes the other combination of treatments which may be needed to resolve frontal knee pain.

This article comes from Wilkepidia and gives you a good back ground education and advice on positive treatment of knee pain.

Patellofemoral pain syndrome (PFPS) is a syndrome characterized by pain or discomfort seemingly originating from the contact of the posterior surface of the patella (back of the kneecap) with the femur (thigh bone). It is the most frequently encountered diagnosis in sports medicine clinics.


1 Mechanism
2 Treatment
2.1 Exercises
2.2 Rest
2.3 Ice and medication
2.4 Taping and braces
2.5 Arch support

The cause of pain and dysfunction often results from either abnormal forces (e.g. increased pull of the lateral quadricep retinaculum with acute or chronic lateral PF subluxation/dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the PF joint. The result is thinning and softening (chondromalacia) of the articular cartilage under the patella and/or on the medial or lateral femoral condyles, synovial irritation and inflammation and subchondral bony changes in the distal femur or patella known as “bone bruises”. Secondary causes of PF Syndrome are fractures, internal knee derangement, OA of the knee and bony tumors in or around the knee.

Specific populations at high risk of primary Patellofemoral Syndrome include runners, basketball players, young athletes and females especially those who have an increased angle of genu valgus (aka “Q-Angle” or commonly referred to as “knock-knees”). Typically patients will complain of localized anterior knee pain which is exacerbated by sports, walking, sitting for a long time, or stair climbing. Descending stairs may be worse than ascending. Unless there is an underlying pathology in the knee, swelling is usually mild to nil. Palpation, as well, is usually unremarkable.

Treatment and Exercises

Quadriceps strengthening is commonly suggested because the quadricep muscles help to stabilize the patella. Proper form is very important. Inflexibility has often been cited as a source of patellofemoral pain syndrome. Stretching of the hip, hamstring, calf, and iliotibial band may help restore proper biomechanics Furthermore, the use of a foam roller may help to add flexibility and relieve pain from sore or stiff muscles in the leg.


Patellofemoral pain syndrome may also result from overuse or overload of the PF joint. For this reason, knee activity should be reduced until the pain is resolved. Those with pain originating from sitting too long should straighten the leg or walk periodically. Those who engage in high impact activity such as running should consider a nonimpact activity such as swimming or aerobics on an elliptical machine.

Ice and medication

To reduce inflammation, ice can be applied to the PF joint after an activity. The ice should be kept in place for 5 minutes only but can be applied at least 5 to 6 times in a day

Taping and braces

In addition to physical therapy, external devices such as braces and tape could be used to stabilize the knee. These devices will not correct the underlying source but may prevent further injury. For this reason, they should be used in conjunction with and not in lieu of physical therapy. The technique of McConnell taping has been helpful in some studies

Arch support

Low arches can cause overpronation or the feet to roll inward too much increasing the Q angle and genu valgus. Poor lower extremity biomechanics may cause stress on the knees and ultimately patellofemoral pain syndrome. Stability or motion control shoes are designed for people with pronation issues. Arch supports and custom orthotics may also help to improve lower extremity biomechanics.

Ultra Sound is beneficial to stimulate the recovery and healing of the  ligaments and other soft tissues

As the Femoral Patella Pain requires 20 minutes of loosening up off your quadriceps and hamstrings then Ultra Sound and checking your foot ware and orthortics I find I need the full hour for this condition and it my normal rate of £35 per hour.

See reviews on Helen in Edinburghonline

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Edinburgh Osteopath Helen How has over twenty-eight years experience of treating patients at the How Osteopathic Clinic (Trinity Edinburgh). Registered Osteopath Helen combines the latest advances in osteopathy with a gentle patient-centred approach to diagnosis and treatment ensuring that osteopathic treatment at the How Clinic is suitable for a wide-range of conditions including; back pain, neck pain, shoulder pain, knee conditions Helen uses Video Clips exercises educational information and outcome which is sent to your computer smartphone or iphone if you wish Treatment at the How Osteopathic Clinic is tailored to the individual and where necessary uses a combination of osteopathic techniques including, Traditional Osteopathy, Cranial Osteopathy, Electrotherapy, Vibrotherapy and Sports Remedial Massage. The holistic approach to osteopathy at the How Osteopathic Clinic, in addition to a full one hour treatment sessions, is designed to alleviate symptoms rapidly and can often significantly reduce the number of osteopathic treatments required. One of the few Osteopaths in Edinburgh and in Britain who uses the unique, gentle fleximatic vibrotherapy or shockwave therapy massage equipment combined with traditional osteopathic techniques in order to to find, feel and palpate those hard fibrotic bands of muscles which accumulate over the years of prolonged sitting, Helen has attended conferences held throughout the country; Helen has been using Shockwave Therapy for over 3 years now for Patella Tendons , Achilles Tendons Plantar Fasciitis and Tendon pain Hips, Upper Proximal Hamstring tendinopathy along with rehabilitation loading Contact Helen How, Registered Osteopath, 14 Craighall Gardens, Edinburgh EH6 4RJ To make an appointment contact Helen on 131 551 1044 or Text /Call 07889304762