Pain Is Not A Knee Slapper

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The knee joint is a frequent source of pain. The knee is composed of the thighbone, or femur, and the tibia, which is the shinbone, and the fibula, which is the smaller of the two lower leg bones and is behind the tibia. The kneecap is medically known as the patella. The patella tracks up and down over the joint as the knee bends and is held in place by the quadriceps tendon on top, which connects to the anterior thigh muscle, or quadriceps muscle, and the patellar ligament below, which anchors the patella to the tibia. One of the most common knee problems, especially in runners and other athletes, is patellofemoral pain syndrome. Most people with patellofemoral pain describe pain at or under the kneecap that is worse with squatting, running, prolonged sitting, going up and down stairs, or any other activity that involves repeated bending of the knee. The term patellofemoral pain specifically refers to pain that is not caused by a structural problem of the tendons, ligaments, or cartilage around the knee.

Patellofemoral pain is believed to occur when there is a problem with how the patella tracks over the knee, a condition known as maltracking. Maltracking can lead to abnormal contact pressures and mechanics between various parts of the knee. Maltracking can be caused by external or internal factors. External factors include overuse, errors in training (i.e. too much too soon), or improper shoes. Internal factors include imbalances in the strength of muscles around both the knee and hip, an overly mobile or loose kneecap, or a tight iliotibial band (a band of tissue that runs along the outside of the thigh from the hip to the knee). In most cases, patellofemoral pain is caused by a combination of these factors.

Patellofemoral pain, because it is not caused by structural problems, is a clinical diagnosis. Because of this, imaging studies like x-rays and MRIs will be normal. Even the physical examination will usually be normal. The diagnosis is usually made by the patient’s description of the symptoms and movements that cause pain. Imaging studies will only be ordered to eliminate other causes of pain. The mainstay of treatment is rest, which includes modification of activities. Correction of any other underlying causes like improper shoes or errors in training also is helpful. Avoidance of any activity that triggers or worsens the pain is also important. Pain medications like Advil, Aleve, and Tylenol may help with short-term relief but should not be taken long term. Physical therapy is usually prescribed and, in most cases, is helpful. Knee braces, while they may help with symptoms for some people, are not usually recommended. Because patellofemoral pain is not a structural problem but rather a disorder of pain and function, long term consequences like arthritis do not occur.

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