Oh My Aching Knees!

In an earlier post I wrote about pain on the outside of the hip and I entitled the blog My Aching Hip. I thought I would follow that popular post with My Aching Knees. The knee pain I am referring to is located on the front of the joint and is made worse with squatting, ascending and descending stairs and prolonged sitting. Repetitive activities like running and cycling can also aggravate the problem. Pain on the front of the knee is usually from the patellofemoral joint or the articulation between the knee cap and the thigh bone or femur. When you go to a movie or a restaurant are you the one that wants the aisle seat so you can keep your knee straightened out? If you this sounds like you then you might have patellofemoral pain.

Patellofemoral 1

A. Patellofemoral joint

patellofemoral 2

B. Sunrise view showing the patellofemoral joint between the patella and femur

The 3rd International Patellofemoral Pain Research Retreat was held in Vancouver in September 2013. The group of knee experts reviewed the worlds medical literature on this condition and published a consensus statement. Some of their more interesting conclusion are as follows:

  1. Patellofemoral pain is more common in adolescent girls than boys but as adults are concerned not enough research has been done to determine a gender difference.
  2. Osteoarthritis can develop in this joint and can be just as common as arthritis in the rest of the knee joint.
  3. There is new evidence that abnormal structure or alignment of the patellofemoral joint can lead to cartilage damage
  4. In the past it was thought that a structure that helps hold the knee cap in place called the retinaculum was a pain generator, however, recent research suggests otherwise.
  5. Some people with knee cap pain have weak hip muscles especially the ones that bring the leg back and to the outside. However, it is not know which comes first the pain or the weakness.
  6. Exercises to help increase strength in these muscles- Gluteus Maximus and Medius can help reduce the pain, however, it might be more effective for women than men.
  7. A physical therapy program that includes therapeutic exercises, foot orthotics and taping can help in the short term (less than 1 year) but at 1 year 40% of people are still experiencing pain
  8. Use of physical modalities in therapy has not been shown to have any benefit whatsoever.

So, what does all this mean for the person whose knees hurt? It is important to exercise maintain good leg muscle flexibility and strength as well as cardiovascular endurance. As far as orthotics and knee bracing are concerned they can be very helpful for the right person. My best advice is to have your knees evaluated by a qualified orthopedic or physical medicine and rehabilitation doctor.

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