Knee Cap Pain

You may call it kneecap pain or soreness. In reality the most accurate term is patellofemoral pain syndrome. In the large majority of cases, this will not become a major problem. Your job is to become educated and control the problem so that you can stay active and pain free.

Patella means kneecap and femoral means relating to the femur, which is the thigh bone. The knee joint is the large joint where the thigh bone meets the shin bone. Sitting in the front of this bone is a small, round bone called the kneecap. As the knee is straightened and bent, the kneecap slides up and down the groove at the end of the thighbone. It is this joint, or the junction between the kneecap and the thighbone, where your trouble lies. Problems with this joint are generally nagging, aggravating injuries. This in NOT like the more troublesome torn ligaments and torn cartilages that occur in the larger knee joint.

Bone can be very sensitive and painful. A kick in your shin will quickly prove it. Luckily, when two bones come together in a joint, the ends of the bones are covered with cartilage. Cartilage is a nice cushion and acts as a shock absorber to prevent our bones from hurting and wearing down. Look at the end of a chicken bone and you see a shiny white surface. This is what the cartilage coating looks like.

The good news about cartilage is that it can absorb force without hurting. The bad news is that cartilage does not know how to repair itself and slowly wears away. We hope that our cartilage lasts until we are 150 years old, however, we wear our joints down more quickly due to injuries, inactive lifestyles, or excessive and improper exercise and activities. Major injuries to the cartilage means major problems, but minor problems usually only mean nagging problems.

Your large front thigh muscle is the quadriceps. It comes down from your hip, narrows, and runs over the kneecap to attach to your shin. The kneecap acts as a pulley for the muscle. It’s like the muscle is a rope and wants you to pull your shinbone forward, as in kicking. If you had a rope and swung it over a tree branch, then tied it to a weight, you could easily pull up the weight. The kneecap is the tree branch. By having your quadriceps go over the kneecap before it pulls up, the leg becomes stronger, and can lift, squat, jump, and walk better. However, if you tried to pull up with too much weight, the tree branch might break. So if we do too much with our leg, the kneecap might wear down.

A second function of the quadriceps muscle is to guide the kneecap up and down in its groove. It needs to stay in the groove as this is where the cartilage is. Many of us have kneecaps that like to ride partially out of the groove. This is like a car riding down the highway half on the road and half on the shoulder. The tires that are off the road will wear out at a faster rate. It will not happen right away, but eventually a problem arises. So if your kneecap likes to slide slightly out of the groove every time you do certain movements, part of the kneecap may eventually wear down.

When we have a kneecap that is partially worn down, we are at risk for pain. If we get enough force built up under our kneecap, the force may go right through the poorly cushioned area. If enough force gets through to the bone, the kneecap will start to hurt. It may start to hurt only when we rub against this area, as in a quick twinge, or it may cause some swelling and hurt for longer periods of time. Swelling is a build up of fluid and cells that gather around any injured part of your body. When enough swelling is present, it will always cause pain.

An aggravated knee may hurt during squatting, going up or down stairs or similar activities. When the kneecap’s cartilage gets inflamed, it can hurt when sitting or driving with your knee bent, or even at rest after stressful activities. If certain steps are not taken, the kneecap pain may be constant, and limit daily activities. In cases of mild kneecap pain, it may disappear in one day or one week.

So kneecap pain, or patellofemoral pain syndrome, is a problem that arises when the cushioning under your kneecap in unable to absorb the forces you give it. It is usually due to a worn down kneecap that has been riding partially out of its groove, however, it can also happen to a normal kneecap that is used excessively. So this is what you have… now what do you do?

The first thing is to figure our what led to it and quickly modify your activities. This can be easy, as in these examples.

** You have been running for 20 years on the streets, always using that same brand of sneakers. All of a sudden you try at new brand of sneakers and start running on a rocky trail. If you get a kneecap pain, you should go back to your original brand of sneaker and stay off the trail. Gradually work them into the routine.

**You want to lose 20 pounds, so you stop using the elevators and take the stairs all the time. If you get kneecap pain, go back to mostly elevators, and find a safer way to burn calories, like increased walking, biking, swimming, etc.

So lets attack your problems.

In order to decrease the aggravation: ICE:
-Elevate your leg and put an ice bag over the top of your knee for 15 minutes every night and after any activity that aggravates the knee.

-A 3-5 minute ice massage 1 to 5 times per day may be helpful. This may be done by rubbing an ice cube over the bottom half of your kneecap (ice is directly on the skin)

MODIFY ACTIVITIES:
-Avoid all squatting (if you must work low, sit on the ground). Since lifting without squatting is bad for your back, you need to avoid heavy lifting for a period of time.

-Avoid activities that repeatedly bend your knee with your weight on them, such as stair climbing, step aerobics, and heavy resistance biking.

-Avoid excessive poundings to the knees, like overdoing running, running downhill, and hopping activities.

-increase the rest period between exercise and stressful knee activities. Take a day or two off in between.

-warm up before undertaking exercise. For example, ride the bike easily before sports, walk around the tennis court for 5 minutes, or make your first mile the very slowest in your run.

TRAIN:
-substitute less stressful activities like low resistance biking, Stair Master without deep step, walking or running in the pool, or Nordic Track for more stressful activities like aerobics and running.

USE PROPER FOOTWEAR:
-proper footwear protects the kneecap by absorbing more shock. Running shoes are the best, but cross trainers walking shoes and tennis shoes are also good. If you over pronate, which is excessively flattening your arch with walking and running, you put more stress into your kneecap. So get a shoe that is made to limit pronation. Wear these running shoes through the day, not just during sports.

Build strength of the quadriceps so it will intercept forces heading for the knee, and also keep the kneecap in the groove.

Keep the leg muscle flexible. Tight muscles can lead to problems with the tracking. Hamstring, calf and ITB flexibility is especially important (see sheet for stretches).If improper tracking is the problem, you need to stretch the structures around the kneecap as well.