Physiotherapists explore knee pain; benefits of laser therapy

Does the pain at the front of your knee get worse with walking, running, squatting, stairs and prolonged sitting?

Do you have pain in the front of your knee under your knee cap? Does it get worse with walking, running, squatting, stairs and prolonged sitting?

If so, you may have a condition called patellofemoral pain syndrome.

Your patella (knee cap) is a small bone embedded in the quadriceps (at the front of your thigh).

Your patella sits above your femur (thigh bone) and together they make up the patellofemoral joint. Normally, the patella will glide along a groove in the femur when you bend and straighten your knee.

Abnormal tracking of the patella which is often caused by a muscle imbalance, lack of flexibility or poor biomechanics can increase the compression forces at the patellofemoral joint which may result in wearing of the cartilage on the undersurface of the patella.

The quadriceps is actually a group of muscles that pull on the patella in slightly different directions.

One muscle of the quadriceps that tends to be weaker is the vastus medialis oblique (VMO) which is responsible for pulling the patella inwards.

The VMO will often need to be strengthened, since it becomes inhibited when you have knee pain and swelling.

Weakness around the hip muscles is often another area that needs to be addressed with a strengthening program to improve the alignment at the knee.

Tight muscles are another possible cause that can contribute to abnormal tracking of the patella.

It is important to warm up properly prior to exercise and stretch tight structures around the knee which may include the IT band, hamstrings and calf muscles.

Just as it is important to strengthen the muscles around your hips if they are weak, it is important to look at the structure of the foot.

Flat feet may also contribute to patellofemoral pain. It is important to wear a good quality supportive shoe that is appropriate for your foot.

Arch supports or custom orthotics may also help improve the biomechanics of the foot and can help to prevent overpronation and alleviate pain at the knee.

Since the causes of patellofemoral pain syndrome are often multi-factorial, it may be beneficial to see a physiotherapist to determine a specific treatment plan that is right for you.

This may include education about appropriate footwear, strengthening exercises, stretching exercises, manual therapy and taping.

—submitted by Krista Smith, a registered physiotherapist and associate at Sun City Physiotherapy. She can be contacted at the downtown, St. Paul Street location or email



As part of the toolkit of treatment methods used by physiotherapists there are various modalities that, when used as part of a comprehensive treatment program, can be effective in optimizing healing and accelerating recovery.

One such modality is low level laser therapy.

Low level laser therapy utilizes a cold laser to produce a therapeutic effect—the laser does not cause a detectable temperature rise in the tissue being treated.

This differs from the high-intensity type of laser that is used in surgery such as laser eye surgery.

The therapeutic effect of low level laser therapy is termed photobioactivation—‘photo’ meaning light, and ‘bio’ meaning biological, so essentially it is the activation of biological processes within the tissues by the laser light.

The laser used in low level laser therapy is delivered using a hand-held device that is held over the area being treated for a set time at a specific energy intensity.

The laser penetrates the skin and is absorbed by the damaged tissue beneath the skin that is being targeted.

The absorption of the laser initiates a series of events within the damaged tissue that helps to reduce pain and inflammation, and promote healing.

This therapy has been shown to be useful at relieving pain by reducing inflammation and by affecting the nerve conduction.

It has beneficial effects in the treatment of soft tissue injuries such as tendinosis, inflammatory joint conditions such as osteoarthritis and rheumatoid arthritis, neck pain, and wound healing.

Once a specific diagnosis has been made, laser can be effective when used alongside other methods of physiotherapy treatment such as manual therapy and exercise, to optimize tissue healing and maximize recovery.

—submitted by Niall McGregor, a registered physiotherapist and associate at Sun City Physiotherapy. He can be contacted at our downtown, St. Paul street clinic or email


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