Wednesday, August 1, 2012

My Kneecap is On Fire!

Patellofemoral pain syndrome is the most common knee condition affecting athletes and physically active adults.  It affects womenespecially adolescent femalesthree times more often than men.  Pain is caused by unbalanced motion between the patella (kneecap) and its groove on the femur (thigh bone).  The normal patella moves up and down when the knee is bent and straightened (as in running or cycling).  Sometimes, however, the patella moves from side to side too much during this motion or the contact between the patella and the femur is unequalcausing pain.  The condition goes by many names--Runner's knee, patellofemoral stress syndrome, patellalgia, and chondromalacia patella are a few.
The exact cause of this type of knee pain is unknown.  There are no nerve endings in the cartilage on the under surface of the kneecap, so it probably does not come from there.  Some believe that the pain originates from stress on the bone that is attached to the cartilage.
Regardless of the cause of the pain, patellofemoral pain syndrome can limit both athletic and day to day activity.  The pain usually comes on gradually rather than after a single traumatic event.  Early on, it is typically a dull knee stiffness or ache that is present early in activity.  As you get warmed up and moving, the pain may actually improve.  Symptoms may reappear hours later, after resting.  As patellofemoral pain syndrome progresses, the pain may be present throughout activity.  It is often worsened by descending steps, squatting, or standing from a chair.  Sometimes, a crunching or sandpaper sensation called "crepitus" can be felt and heard with movement of the kneecap.  With advanced cases, the knee may start to give out when walking or running.
Diagnosis of patellofemoral pain syndrome can be challenging.  There is no single test that confirms the condition.  In fact, some athletes can have a completely normal physical examination.  Your doctor will take into account the history of symptoms and pain during specific activities.  X-rays and occasionally MRI can be helpful.
Treatment of this painful condition is overwhelmingly non-surgical.   Weakness not only around the knee, but in the hips, lower back, pelvis, lower leg and abdominal muscles must be corrected.  Flexibility exercises are also very important.  Those with flat feet may need orthotic inserts to correct alignment problems that contribute to knee pain.  Braces and taping are also often used to give pain relief while an athlete starts the process of strengthening.  While these external devices may help reduce pain, they do not cure the problem.  Therefore, improvement in strength and flexibility are vital.  Ice, anti-inflammatories and acetaminophen are also used to help with pain.
Patellofemoral pain syndrome is a common problem in active people.  If your knees are aching, call for an appointment and take the first step to getting back on the road.

Written by Brandon Larkin, MD

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