 What
is it?
Knee pain is one of the most common symptoms
experienced by sports participants. Studies have shown
that patellofemoral pain syndrome comprises up to 50% of overuse
injuries. This syndrome is caused by irritation of the
undersurface of the patella (kneecap) which, in its normal
state, is smooth. The irritation can lead to a roughening
of the patella undersurface, a condition called chondromalacia.
The patella is a moving part, gliding up
and down in a groove in the femur (thigh bone). The pain
is caused by pressure between the patella and the groove in
the femur. As you bend your knee, you gradually increase
the pressure and stress between the patella and the femur. The
irritation and roughening of the patella causes an inflammation
which causes the pain. Patellofemoral pain syndrome
and chondromalacia are not arthritis. Children and adolescents
almost always grow out of this problem.
 Predisposing
Factors
-
When the patella is not symmetrical
in the femoral groove, there is an imbalance resulting
in wear and tear. An unsymmetrical kneecap is called "jockey
cap" patella. This condition can be identified
on x-rays.
-
Overuse (especially downhill running)
-
Wide hips
-
Knock knees
-
Increased Q-Angle: Constructed
by drawing a line from the anterior iliac spine (a part
of the pelvis) to the center of the patella, then to
the center of the tibial tubercle (leg bone). Greater
than 21 degrees in females and 18 degrees in males is
abnormal.
-
Tibial torsion (rotation of lower
leg)
-
Flat (pronated) feet
-
Weak inner thigh muscles
-
Previous injury to the knee
Treatment
This is based on two principles: reducing
the inflammation and improving the dynamics of the patella/femoral
relationship.
Rest
When the knee is painful and swollen, you
must rest it. Let pain be your guide. You are aggravating
the condition if you continue activities while experiencing
pain. Mild discomfort or ache is not a problem but definite
pain is cause for concern.
Ice
Apply an ice pack (frozen peas) to your
knee for 15 minutes 2-3 times daily and after any sporting
activities. This reduces inflammation and pain.
Medication
Your doctor may rarely prescribe anti-inflammatory
pills to reduce the inflammation. This can be very important.
Physiotherapy
Various techniques can be used to reduce
the inflammation. Exercises can be used to stretch and
strengthen the thigh muscles. These muscles control
the patella in the groove. When thigh muscles are strong,
the patella will move through the groove with less pressure.
Surgery
In some cases surgery may be indicated. This
is in the form of an arthroscopic examination (a look with
a fiber optic light). In some cases repositioning the
patella is required.
Adjustments
The structure of your foot may
also alter the patella/femoral relationship. Some physicians
may prescribe specific shoes or occasionally orthotics (shoe
inserts) to help your problem. New materials (Sorbothan,
Spenco) have been designed to fit into your shoe to help absorb
the impact as your foot hits the ground.
Sports
There is very little pressure between the
patella and the femur when the leg is straight or only slightly
bent. The best activities are ones that limit the knee
to a range between 135 degrees (1/4 squat) and 180 degrees
(straight).
Good Sports
These sports will be easiest on the knee:
Questionable Sports
These sports can be performed by some,
but could cause problems to others:
Bad Sports
These sports are hard on the knees as they
include deep knee bends. These sports are most likely
to aggravate your condition:
Use your judgment. When your knees
hurt, avoid all but the good sports. Total rest may be
required. When your knees get better after treatment,
you should be able to enjoy all sports.
Exercise
Exercising will build up the muscles that
control your kneecap. Do them daily, as they can definitely
help improve your condition.
Stretches
Always stretch slowly without bouncing
until you feel your muscles stretch. You should not feel
pain.
Single-Quadricep Stretch (A)
Standing with your back straight pull your foot
back until you feel your thigh muscle stretch. Push
down and back with your knee. Hold 15 seconds
and relax. Repeat 3 times. If this
stretch causes pain, stop.
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Hamstring Stretch (B)
Sit on the floor with injured leg straight,
knee locked, and your other leg bent in. With
your back straight, bend from the hips and
reach down over your leg until you feel the
muscles stretch. Hold 10 seconds and
relax. Repeat 3 times.
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Strengthening Exercises
It is important to stay away from exercises
that can aggravate your condition. Here are two that
do not involve bending the knee.
Static
Quads
Sit on the floor with pillows under your
knee. Push your thigh into the floor, raise
your heel, and bend your foot back towards you
and hold 5 seconds. Change legs or do both
at the same time. Repeat 15 times.
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"T" Exercises
(D)
Sit on the floor with a weight on your leg
(2-5 lb kit or handbag). Lock your knee
and raise your leg. Draw a "T" with
your foot. Repeat with your other leg. Do
3 sets of 10. Increase weight weekly as
your strength improves.
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