Resources - Injuries

 

 

 

Kneecap Pain

By Jake Kennedy, RPT

You may call it kneecap pain or soreness. Others may call it "runner's knee," "Chondromalcia" or "subluxing patella." In reality, the most acceptable term is patellofemoral pain syndrome. In most cases, this will not become a major problem. Your job is to become educated and control the problem so 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. When the knee is straightened and bent, the kneecap slides up and down the groove at the end of your thigh bone. It is this joint, or the junction between the kneecap and the thigh bone, where trouble lies. Problems with this joint are generally nagging, aggravating injuries. This is not like the more troublesome torn ligaments and torn cartilage that occur in our larger knee joint.

Bone can be very sensitive and painful. A kick in your shin will quickly prove this. 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 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 injuries 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. The muscle is like a rope and wants to pull your shin bone forward, as if you were 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 like the tree branch. By having your quadriceps go over the kneecap before it pulls up, the leg becomes stronger and can lift, squat, run, 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 because 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 faster. It will not happen right away, but eventually a problem will arise. So if your kneecap likes to slide slightly out of the groove every time you do certain movements, parts of the kneecap may eventually wear down.

When the kneecap is partially worn down, we are at risk for pain. If enough force is built up under the kneecap, it may get 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, or it may cause some swelling and hurt for longer periods of time. Swelling is a buildup of fluid and cells that gather around any injured part of the body. When enough swelling is present, it will always cause pain.

An aggravated knee may hurt during squatting, going up and 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 may hurt constantly and limit daily activities. Mild kneecap pain may just disappear in a day or a week.

So kneecap pain, or patellofemoral pain syndrome, is a problem that arises when the cushioning under your kneecap is 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. 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 determine what led to your kneecap pain and quickly modify your activities.

In order to decrease the aggravation of your injury:

ICE

  • Elevate your leg and put an ice bag right over the top of your knee for 15 minutes every night and after any activity that aggravates the knee.
  • A three to five minute ice massage one to five times a day may be helpful. This may be done by rubbing an ice cube over the bottom half of your kneecap (ice should be applied directly to 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 may need to avoid heavy lifting for a period of time.
  • Avoid activities that repeatedly bend your knees with your weight on them, such as stair climbing, step aerobics, and heavy resistance biking.
  • Avoid excessive pounding 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.
  • Warmup before undertaking exercise. For example, ride the bike easily before sports, walk around the tennis court for five minutes, or make your first mile the very slowest in your run.

CROSS TRAIN

  • Substitute less stressful activities like low resistance biking, using the Stairmaster without deep stepping, walking or running in the pool, or using a 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 and tennis shoes are also good. If you "over pronate," which is excessively flattening your arch when walking and running, you put more stress on your kneecap. Nothing is better than a running shoe to control pronation. Wear your 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 muscles flexible. Tight muscles can lead to problems with the kneecap tracking improperly. Be sure to stretch the quadriceps, hamstrings, calf and ITB.
  • If improper tracking is the problem, you need to stretch the structures around the kneecap as well.