Notorious Nagging Knees
Just a fun reminder that this blog is meant for entertainment and educational purposes and does not replace medical advice from anyone’s primary care provider.
The cliché is to say that knee pain is one of the most common issues I see in clinic. However, when you advertise to see more of that kind of issue, you seem to get more. So, it fits for me that I tend to see many knees throughout my practice. At some point every person will develop knee pain. It can happen from Pee Wee league sports to college and professional athletes, as well as the everyday person working around the house, in the garden, or doing their usual exercise routine.
The knee seems like a usual hinged type joint, flexing and extending, however, it is a complex pulley system that must work in concert to perform its function effectively. If one side of the muscles helping it move are overdeveloped, or the counter is underdeveloped, then it can cause issues. The main bones involved are the femur - this is the thigh bone that comes to an end with two bigger knobs on the side with a groove in the middle. In this groove rests the Patella, or knee cap, that acts as the fulcrum for the pulley. The pulley is the quad tendon that the quad muscles all coalesce into to pull on the quad tendon. This has attachment to the patella. The opposite side of the patella is the patellar tendon, the one that gets hit to make a reflex. This tendon then goes down to attach to the tibia, or shin bone. Now there are many other parts to the knee, but in this post, I am only going to focus mainly on these components as these are the more common issues.
Patellofemoral syndrome is a very common ailment of the knee. In essence, this is due to poor tracking of the patella through the femoral groove when the knee flexes and extends (bends and straightens respectively). People in all age groups can suffer from this malady and it can be caused by overuse and muscle imbalances. Pain will occur when the knee is in use and usually after some time has passed. Going up and down stairs, sitting for long periods of time with the knees bent, and attempting to straighten the knee against force can cause the knee to hurt.
Activities such as the Caber toss in the Scottish Highland games can lead to knee pain over time.
The main issues that typically need to be addressed with this syndrome are overdeveloped, or tight, lateral (toward the outside of the leg) quads and underdeveloped, or weak, medial quads (toward the midline of body). Many people will have a very tight IT band that attaches to the lateral patella, along with the quad muscle on the outside of the leg. This adds a force when the quads are activated which pulls the knee cap to the outside of the knee. This will pull the knee cap out of its groove and over the knob of the femur, causing a lot of inflammation and pain under the knee cap. The worst of this normally happens when the knee is just slightly bent and having force placed through it, like going up or down stairs.
The Quadriceps is a collection of four muscles (thus quad). The one over the medial leg and knee (inside toward midline) is not well developed in most people. It typically will look like a teardrop, especially on professional soccer players or football players. This is one of the only muscle that can fend off the onslaught of the outside quads and IT band and their pull of the patella to the outside of the knee. Being weak in most people, this is a losing battle and the patella pays for it. As this inflammation and repetitive pull to the outside occur over and over, the cartilage under the patella gets rubbed and inflamed. If it happens enough, then it can fray like a rope and cause more inflammation and pain. This starts a vicious cycle of pain and inflammation.
https://www.mass4d.com/blogs/clinicians-blog/patellofemoral-pain-syndrome
Luckily, this condition typically doesn’t require surgery unless there is considerable fraying of the cartilage. Focusing more attention to the quad on the medial thigh, stretching the outside quad, and trying to loosen the IT band will normally help most Patellofemoral patients. This can be very difficult so physical therapy or working with the trainer that covers the particular team, if there is one, will be very beneficial. At times an injection may be considered, but any time steroid or lidocaine is injected into a joint it can break down the cartilage and hasten the process of joint breakdown and quicken the onset of arthritis. If this is the treatment option selected, you can only usually get one an injection every 3-4 months, but the hope would be to do it as infrequently as possible.
One of the less sexy things that needs to be a priority for people to avoid developing Patellofemoral Syndrome is to focus on correct form, which may mean backing off the weights. Form breakdown and improper lifting, running, or biking mechanics feed into this syndrome and are the main focus of treatment. Making simple adjustments and focusing on form can possibly help this from developing in the first place, or nip it in the bud if it is just starting, and keep people out of the office and on their particular playing field.
All that being said, if the pain is nagging or if it is acting like what I call the “Crunk Knee” - if it’s popping, locking, and/or dropping - then it’s time to have a physician much like myself evaluate it.
Stay safe, stay in the game, and do your part in this pandemic.
Keep Running and seeing the sites…. Just protect those knees!