Patellofemoral Pain Syndrome

Knee pain in the front of the knee, around the kneecap (also called the patella), is often called patellofemoral pain syndrome (or runner's knee). This type of pain is more common in people who run or participate in sports that involve a lot of running and jumping.

The pain often gets worse when you run, walk up or down stairs, sit for a long time, or squat. Taking it easy and applying ice are often good first steps. However, if the pain persists, physical therapy may be needed to help strengthen the muscles around the knee and improve its movement.

Knee pain in the front of the knee, often a dull ache, is a common problem called patellofemoral pain syndrome. This type of knee pain can be made worse by activities like:

• Going up or down stairs: The repeated bending and straightening of the knee can trigger or worsen the pain.
• Kneeling or squatting: These positions put extra pressure on the kneecap (patella) and the surrounding tissues, leading to discomfort.
• Sitting with a bent knee for extended periods: This can strain the front of the knee and cause ongoing pain.

If your knee pain doesn't get better after a few days, or if it becomes harder to move your knee, it's important to contact your doctor or other healthcare professional. This is especially true if the pain is severe or accompanied by other symptoms. Early diagnosis and treatment can help prevent the pain from becoming a long-term problem.

Knee pain under the kneecap, also known as patellofemoral pain syndrome, can have several reasons. It's often connected to:

• Doing too much, too soon: Activities like running and jumping repeatedly stress the knee joint. This constant stress can irritate the area under the kneecap, causing pain. It's like overusing a machine until it hurts. Gradually increasing the intensity and duration of these activities can help prevent this.

• Muscle problems: The muscles around the hip and knee help keep the kneecap centered. If these muscles are weak or not working correctly, the kneecap can move out of alignment. This misalignment can lead to pain. For example, if you push your knee inward during a squat, it can put extra pressure on the kneecap and lead to pain. Stronger muscles provide better support and control, reducing the risk of pain.

• A direct injury: A blow to the kneecap, or a situation where the kneecap dislocates or breaks, can cause patellofemoral pain syndrome. These are clear instances of injury that disrupt the normal function of the knee joint.

• Past surgery: Having knee surgery, especially if the anterior cruciate ligament (ACL) is repaired using a tendon from the kneecap, can slightly increase the chance of developing patellofemoral pain. Using a part of your own body in surgery can sometimes lead to extra stress or irritation in the area.

In short, patellofemoral pain syndrome isn't just one thing. It can result from overuse, muscle imbalances, injuries, or even past surgeries. Understanding these possible causes can help people find ways to prevent or manage the pain.

Several things can make you more likely to get knee pain, especially around the kneecap (patellofemoral pain).

• Age: Knee problems are often caused by different things at different ages. Teens and young adults commonly experience patellofemoral pain syndrome, which is often related to the kneecap's tracking and alignment. As people get older, arthritis is a more frequent cause of knee problems.

• Gender: Women are more prone to patellofemoral pain than men. This could be because women typically have wider hips and pelvises. A wider pelvis can affect the angle of the knee joint, putting extra stress on the kneecap.

• Activities: Sports that involve running and jumping put extra strain on your knees. If you increase your training intensity in these activities, the risk of knee pain goes up. For example, a runner who suddenly starts training for a marathon might be more prone to knee problems than a runner who maintains a consistent training schedule.

Knee pain can sometimes just happen, but there are things you can do to help prevent it.

Strengthen your legs and hips: Strong leg and hip muscles are crucial for keeping your knees stable while you move. When you're lifting weights, try to avoid deep squats. Instead, focus on exercises that build strength in your thighs and hips without putting excessive strain on your knees. This includes exercises like lunges, step-ups, and hip bridges. Strengthening your muscles helps support the knee joint, just like a strong support beam helps a building stand tall.

Move properly: A physical therapist can teach you the right way to jump, run, and change direction. This is especially important for strengthening the muscles on the outside of your hips. These muscles help prevent your knee from collapsing inward when you squat, land from a jump, or step down from a higher level. Proper technique can significantly reduce stress on your knees.

Manage your weight: If you're carrying extra weight, your knees have to work harder. Losing even a small amount of weight can make a big difference in reducing the strain on your knees. Losing weight overall is good for your health, and this includes your knees.

Warm up before exercise: Before you run or do any other activity, warm up your muscles for about 5 minutes with light activity, like brisk walking or leg swings. This prepares your muscles and joints for the workout, reducing the risk of injury.

Stretch regularly: Stretching helps improve flexibility and range of motion in your muscles and joints. This can help prevent stiffness and pain. Gentle stretches that target your hamstrings, quadriceps, and calves are beneficial.

Gradually increase your activity: Don't try to do too much too soon. Increase the intensity and duration of your workouts gradually over time. This allows your body to adjust and reduces the risk of injury.

Choose the right shoes: Make sure your shoes fit well and are appropriate for the activity you're doing. Good supportive shoes can significantly reduce stress on your knees, especially during activities like running or jumping. If you're unsure about the right shoes, consult a sports shoe specialist.

Understanding Knee Pain: Imaging Tests

Knee pain can sometimes be diagnosed with imaging tests. These tests use different methods to create pictures of the inside of your knee, helping doctors find the source of the problem. Here are some common types:

• X-rays: X-rays are excellent at showing the bones in your knee. They're very helpful for seeing if there are any fractures, dislocations, or other bone-related problems. However, X-rays aren't as good at showing soft tissues like muscles, tendons, or cartilage.

• CT scans (Computed Tomography): CT scans can show both bones and soft tissues. They create detailed cross-sectional images, offering more detail than plain X-rays. However, CT scans use a higher dose of radiation than X-rays, so they're usually only used when X-rays aren't enough, or when doctors need a more detailed view of soft tissues.

• MRIs (Magnetic Resonance Imaging): MRIs use powerful magnets and radio waves to create very detailed images of soft tissues. This makes them especially useful for seeing things like knee ligaments, cartilage, and tendons. Because MRIs provide such detailed images, they can help pinpoint the source of pain in soft tissues. However, MRIs tend to be more expensive than X-rays, CT scans, or ultrasounds.

• Ultrasound: Ultrasound uses sound waves to create images of the inside of your knee. It's particularly useful for looking at muscles, tendons, and ligaments. Ultrasound is a good choice for many situations, as it's generally less expensive and involves no radiation. It's a quick way to get a picture of soft tissues and can help spot problems like inflammation or tears.

Treating Patellofemoral Pain: Simple Steps First

Patellofemoral pain, discomfort around the kneecap, often starts with straightforward solutions. First, try to minimize activities that aggravate the pain. This means avoiding things like climbing stairs, kneeling, or deep squats.

Pain Relief: If needed, over-the-counter pain relievers can help. These include acetaminophen (like Tylenol), ibuprofen (like Advil or Motrin), and naproxen sodium (like Aleve). However, it's crucial not to take these for longer than 2-3 weeks without consulting a doctor.

Physical Therapy: A physical therapist can recommend exercises to strengthen the muscles around your knee. This is important because strong supporting muscles help keep your knee aligned properly, especially when bending or squatting. The goal is to prevent your knee from collapsing inward during these movements. The therapist might also suggest supportive braces or taping techniques to provide extra support and reduce pain. Applying ice packs after exercise can also help with discomfort.

Footwear and Support: Custom orthotics (shoe inserts) or ready-made ones can help distribute pressure more evenly on your feet and knees. This can be beneficial for managing pain.

Adjusting Activities: During the recovery period, try activities that are gentler on your knees, like cycling or swimming, instead of high-impact sports.

When Simple Treatments Don't Work: If basic treatments don't alleviate the pain, a doctor might suggest more involved options.

• Arthroscopy: This minimally invasive procedure involves a tiny incision and a small camera (arthroscope) to examine the knee joint. This allows the surgeon to see any problems and potentially repair them through small incisions without major surgery.

• Realignment: In more severe cases, surgery might be necessary to adjust the kneecap's position or relieve pressure on the cartilage. This realignment can restore proper function and reduce pain.

Important Note: If you're experiencing patellofemoral pain, it's essential to consult a healthcare professional for a proper diagnosis and personalized treatment plan. They can assess your specific situation and recommend the most suitable course of action.

Further Information: For more details on arthroscopy, please schedule an appointment with your doctor.