Dr. Richard Bachrach - Center for Sports & Osteopathic Medicine knee pain

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We’ve all watched the biggies go down on the football field or the basketball court with knee injuries of catastrophic proportions. The result is often prolonged disability. Surgical intervention ranging from arthroscopic microsurgery to ligament reconstruction is often necessary. This can add up to a tremendous loss for both the athlete and his/her team. Often, it’s the difference between a championship and finishing out of the money. Too frequently it signals the end or at least the abbreviation of a promising career.

Tough nuggies! What really matters to YOU is the pain in the front of YOUR knee when you hit the step machine or the treadmill or the stiffness you feel after sitting in a movie for a couple of hours. That is getting in the way of your fitness training, your running, and your squash or volleyball game. This is really serious.

What’s it all about? The kneecap (patella) under normal conditions glides smoothly and symmetrically in a shallow groove (the trochlea) in the front of the thigh bone (femur) as you bend and straighten your knee. That glide may become irregular, or the patella tilted in the trochlea. Tight muscles in the front of the thigh (quadriceps) may increase the pressure of the patella on the trochlea, eventually eroding the shiny, smooth cartilage of the trochlea and the undersurface of the patella. As an end result, he cartilage becomes roughened, thinned and inflamed … chondromalacia. Eventually, arthritis ensues.

The major factors contributing to patello-femoral malalignment and thus pain, more than one of which is frequently operative in the same individual, are:

Imbalance between the quadriceps muscles on the inner and outer aspect of the thigh. The quadriceps pulls the patella up as the knee is straightened, and frequently the outer thigh muscles are the stronger and tend to pull the patella laterally. This may be enhanced by tightness of the iliotibial band running from the buttock to the outside of the knee. This imbalance is addressed by stretching the iliotibial band, strengthening the medial quadriceps and taping or bracing the patella to reduce its lateral deviation.
Excessively pronated (rolled in) feet may twist the femur medially, relatively laterally displacing the patella and twisting the tendons above and below it. This may contribute to patellofemoral pain and also to tendinitis involving the tendons above or below the patella. Special shoes or orthoses may correct excessive pronation.
Anterior knee pain may be caused simply by tightness of the quadriceps muscle, compressing the patella against the trochlea. Stretching the quads usually manages this problem
If the patella is too small, or rides too high on the femur (patella alta), or the trochlea too shallow, the tendency of the patella to deviate from its course is increased. Taping or the use of a patella restraining brace, along with the appropriate strengthening exercises usually work.
Excessively flared out hips, particularly in the presence of obesity may increase the lateral pull on the patella. Weight reduction, strengthening the medial and stretching the lateral quadriceps may afford some relief.
A small band of tissue, the medial synovial plica, on the inner aspect of the knee may become thickened and inflamed in the presence of abnormal patellar excursion. Correction of foot and knee biomechanics, anti-inflammatory therapy with medication, ice, and physical therapy will address this problem. Surgical intervention, usually arthroscopic, is sometimes needed.

The bottom line in this and other sports medicine problems is accurate, timely diagnosis followed by prompt, appropriate management. The sooner it’s addressed, the more effectively it gets handled. And that’s what we do at the Center for Sports & Osteopathic Medicine. Try us!