Why does my knee hurt?

runners knee

Patellofemoral pain syndrome is a very common cause of visits to the physician. It is more frequent in women, especially in teenage and young adult women, and is reflected by pain in the knee.


Most patients locate that pain behind the knee cap, inside the knee, and it worsens when walking up and down stairs or when sitting for long periods of time. When patients begin to feel the pain, they often feel compelled to change posture.

Other frequent symptoms are that patients feel like their knees cannot support their weight or cracking and clicking noises in their knees, especially when getting up from a chair. It can also cause pain when driving a car.

Causes

Pain in the back of the knee might have several causes. In most cases, patients do not have any prior problems with their knees, but they subject them to stress due to their job or by practicing sport-related activities such as spinning. Other causes might be from climbing up and down stairs, or squatting repeatedly. When the inflammation is treated by means of drugs, ceasing the activity which causes the problem, and rehabilitation treatment, the pain usually goes away.

However, when patients suffer from a displaced knee cap, if they “punish” their knee repeatedly the pain will persist and it won’t cease even after taking medication or following other treatments. In these cases, patients should visit a rheumatologist to diagnose the state of their knees through imaging techniques.

In general, a patient who does not react well to a rehabilitation program and has pain, limited mobility and/or poor quality of life has such a degree of structural damage that their knee cannot be restored to its previous condition.

Clinical Assessment

It is important to remember that back knee pain is associated with noticeable anomalies in knee cap alignment or to individual anatomic variations.

There are patients who present alterations in their knee extensor apparatus, but that do not experience pain; whereas other cases that have the same structural changes have to endure significant pain and limited mobility.

We should be able to recognize those factors that can predispose us to having back knee pain: high knee cap, quadricipital muscle atrophy, and acute tissue lassitude.

As we have commented previously, patients talk about the pain they feel when sitting. They need to change posture and stretch their knees because by doing so they alleviate their pain. Very often, they cannot easily tolerate long car trips; at the cinema, they have to sit in an aisle seat so that they can stretch their legs.

When climbing stairs up and/or down they experience pain, or cannot do it altogether. When we ask patients to point out where it hurts, they often “grab” their knees. When we displace their knee cap, they experience pain, mostly in the external side of the knee cap. It is important to assess the quadriceps’ muscular tone; that muscle’ atrophy would predispose a patient to the above mentioned disorder, thereby causing knee cap displacement and subsequent increase of pain.

Very often, this disorder begins after trauma or surgery which required mandatory rest – which causes the quadriceps to become atrophied.

The first test to be carried out would be an Rx scan to determine the exact position of the knee cap in the knee. It might be in the correct place or displaced, usually outwards.

TAC-TAGT is also useful because it allows us to check the motion of the knee cap within the knee. During TAC-TAGT sessions, patients are asked to contract and relax the musculature of their thigh. TAC-TAGT is also useful to plan possible future interventions.

Knee NMR is a very useful test as it allows us to determine precisely if there are knee cap cartilage injuries, as well as the tilting degree of the knee cap.

Conservative treatment

– Oral drugs. We recommend the intake of drugs to strengthen and boost joint cartilage. The most commonly used drugs are glucosamine sulphate and chondroitin sulphate. The treatment usually lasts one year as they are slow-action drugs, so patients will not notice immediate improvement.

-Rehabilitation treatment. Highly useful to reduce inflammation, boost muscle tone and strengthen our legs. If we choose this method we should be highly perseverant as they involve long processes that sometimes can be discouraging because it is difficult to notice improvement in the short-term. Using an electrostimulator it is also highly recommended.

-Hyaluronic acid infiltration. It consists of adding to the joint a component they had lost – hyaluronic acid. The lack of hyaluronic acid in the knee causes increased pain and accelerated aging of the joint between the knee cap and the femur.

Open and closed kinetic chain exercises. A number of scientific papers recommend these exercises, as they have been proved to alleviate pain and improve knee position within the knee.

Surgical treatment

Knee arthroscopy. It is a highly useful, less invasive technique that allows one to assess the true situation of the knee joint. One of the most common experiences in patients suffering from anterior pain is the liberation of the external patellar aileron. When this occurs, patients try to balance and re-center their knee cap, thus easing the pressure exerted on the external side.

Knee cap realignment. Should be carried out when symptoms become acute and preliminary exploration shows major displacement. We realign the extensor apparatus be means of mini-approach surgery. It should be noted that it is not necessary to perform incisions in the knee. We move towards the knee’s medial compartment, the bony part of the joint, and re-attach it with two screws. Patients can begin to bear weight on their knee within 24 hours of surgery. Immobilization of the knee is not necessary.

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