Experiencing pain in front of the knee or around the knee cap while going up and down the stairs, pain in the knee cap after sitting for a long time in a car or in the movie hall, and unable to bend down to a squatting position, all these symptoms points toward a number of medical condition that causes pain around the front of the knee. These conditions include anterior knee pain syndrome, patellofemoral mal-alignment, and chondromalacia patella. One of the common knee disorders that contribute to 1 in every 4 knee pain is patellofemoral pain syndrome (PFPS), which will be dealt in detail in the following sections.
About patellofemoral pain syndrome
The knee cap, in technical term, is called as patella, which is a small, flat, triangular sheet of bone that is placed in front of the knee. The patella moves over and with the knee when the knee bends. The moment of knee is a coupled motion of the tibiofemoral (tibia + femur/thigh bone) and patellofemoral (patella + femur bone) articulations. The patella glides up and down along the end of the thigh bone and supports the front thigh muscles for straightening the leg. The patella acts as a protective shield to other inner bones and tissues. Patellofemoral pain syndrome is a very common knee pain that causes pain under and around the knee cap. The pain can be felt in one or both the knee. Pain increases or worsens with activity or sitting for a long time. Around 2.5 million Americans experience such symptoms and the condition is diagnosed as Patellofemoral pain syndrome.
Causes
What exactly causes PFPS is yet to be unwrapped. It is suspected that the pain has to do something with the movement of the patella over the thigh bone, femur. Patella does not move smoothly and correctly when the knee bends or straightens. This incorrect movement can damage the underlying and surrounding tissue or cartilage that causes pain. PFPS is very common in people who are active and do a lot of sports. Some factors that lead to development of PFPS include increased pressure between the patella and the thigh bone (femur) due to overloading and bending the knee. Sports like running, jumping etc increases the pressure on the knee. Having flat feet also increases biomechanical stress on the knee joint affecting the alignment of the patella during movement. Having larger femoral angle (Q-angle) can force the patella outside the knee thereby increasing the pressure on the knee and results in pain due to damage of the underlying structure. Women are mostly affected with PFPS as they have a larger Q-angle due to a broader pelvis. Other factors include excessive training or over use of the knee, mal-alignment of the knee cap, and tight, weak or imbalanced thigh muscles.
Symptoms
Patients with PFPS may experience pain or dull ache underneath the knee cap while walking, climbing up or down the stairs, getting up or while sitting for a long time. Sometimes, while trying to get up the knee may catch and give a harsh creaking sensation. The pain in the knee increases or worsens with intense activity. PFPS may also be noticed while starting a new activity or while increasing the intensity of any activities. Tenderness might be noticed in the inner side of the knee; swelling may occur, in the knee, after physical activity but swelling is not a major feature of PFPS.
Diagnosis
On approaching a doctor he/she would like to know the details about when the pain started, how it feels during pain, did the patient encounter any major injury to the knee in the recent past, about other health conditions like diabetes and allergies and also about any medication that the patient is currently taking. This questionnaire session is followed by physical examination and imaging tests. During physical examination the knee cap will be felt by touching it as it is easily accessible. The doctor will then test for pain and tenderness by moving the knee cap and checking how well it responds to the flexes and other movement of the leg. Physical examination is sufficient to confirm PFPS but in few cases if the doctor couldn’t come to a conclusion and wants to have a closer look then he may suggest few imaging tests. Imaging tests like X-ray will show if the knee cap is out f track. Magnetic resonance imaging (MRI) scanning helps to detect whether the pain is due to damage to the bone, cartilage, and muscle around the knee. Arthroscopy is helpful in having a detailed look at the inner kneecap region by inserting a small camera into the knee.
Treatment
The treatment options for PFPS include physical therapy and exercise medications, surgery and other options. Treatment exercises for PFPS are based on the muscular cause of the pain. Usually exercises that help strengthening the quadriceps (largest extensor muscle in legs) are recommended as they play an important part in patella movement. Other additional exercises depend on accurate physical examination. A 20 minutes duration of exercise everyday is sufficient for good results. Prescribing anti-inflammatory drugs for PFPS doesn’t prove effective as their side-effects overshadows their benefits. The best anti-inflammatory medicine is placing ice over the knee for 20 -30 minutes after physical activity. As one of the causes of PFPS is over use of the knee, it is better that the person reduces the intensity of knee activity. In addition, tapping the kneecap in a perfect position will help reduce friction and pain. Using, walking or athletic foot wear has been very effective in curing PFPS in many patients. In very rare case, surgery is preferred to smooth the undersurface of patella.
Exercises to help knee pain
Any treatment for PFPS cannot bring an overnight change; it might take atleast 6 weeks or longer for the patient to get better. PFPS is less likely to come back if physical therapy is followed regularly. Few exercises that help to relieve PFPS pain are
Straight leg raises: The patient has to lie on his/her back and bend the unaffected knee and keep the affected knee straight. Now the affected knee should be raised up in the air and held there for few seconds. This is done as 3 sets of 15 repetitions
Hip adduction: Lie down on the side so that the affected leg is at the bottom; now bring the unaffected leg over the affected leg or keep it at the back of the affected leg. Now raise the affected leg and hold it in position for few seconds and repeat it again. This is done as 3 sets of 15 repetitions
Hip abduction: Lie on your side so that the affected leg is on top; now fold the unaffected leg. Keeping the affected leg straight lift it towards the ceiling and hold it for few seconds. Take care that the hip is not lifted or the body do not roll over the stomach during exercising. This is done as 3 sets of 15 repetitions
Hip flexion: Sit straight on the edge of a chair or table, hang the knees down. Now in the same bent position lift the affected knee towards the ceiling, hold it in position for few seconds and then repeat it again. This is done as 3 sets of 15 repetitions
Hamstring: This is done to stretch the posterior thigh muscles. For this the patient has to sit straight with his legs stretched out. Now try to touch the toe with the finger but remember to keep the back straight and flat. Hold the position for 30 seconds and repeat this 5 time
Quadriceps: To strengthen the anterior thigh muscle the patient has to stand straight, now bend the leg backwards by holding the ankle with the hand and now try to touch the buttocks with the foot. Hold for 30 seconds. The person can balance by holding to wall or chair. Repeat this stretch for 5 times
Gastrocnemius/soleus: The patient need to support or lean against a wall with both the hands. Hold the position for 30 seconds. This will help to stretch the calves, now from this position bend the knee to help stretch the soleus muscle
Iliotibial band: The iliotibial band runs from the hip to knee and to the outside of the legs. To stretch this band sit straight with both legs stretched, now cross one leg over the other and place the crossed-over foot flat on the ground. The crossed leg can be gripped with the opposite hand and pull the body across so that the opposite shoulder touches the knee of the crossed leg
Practicing these simple exercising will help to get relieved from knee pain.
Outlook
Knee pain is a very common problem that is faced by many around the globe. Many people are in the wrong conception that arthritis is the only cause for knee problem and straight away start with treatment for arthritis. People should be aware that there are many other medical conditions that cause pain in the knee. Knowing the proper cause of pain will help the physician to direct his treatment towards curing the cause and its symptoms.
