KNEE PAIN
BY G. STEPHEN CLEVES, MD


There are many causes of knee pain ranging from simple bruises to arthritis to torn ligaments. Any knee pain which is associated with giving out of or locking of the knee should be seen by a physician. Knee pain that is more chronic in nature and associated with activities such as running or jumping may be associated with one of the following conditions.

Patellofemoral syndrome, formerly known as chondromalacia or runner's knee, is the result of abnormal movement of the kneecap resulting in pain and inflammation. As this inflammation increases, the underside of the kneecap becomes rough causing increasing discomfort. The main cause is the abnormal movement of the patella or kneecap along the groove of the thighbone or the femur. In normal activity the patella should move smoothly through a groove in the end of the femur. If the patella shifts and does not ride smoothly up and down inside this groove, it will rub along the lateral edges of the femur resulting in pain and stiffness. Often times a patient with chondromalacia will both hear and feel the creaking of the knees as it bumps along in the femur groove.
This abnormal tracking of the patella can be the result of weak thigh muscles, excessive pronation (outward rolling of the foot which then changes the angle of the lower leg to the knee) or improper shoes. Frequently this pain is worse with jumping or going down steps.
The initial pain and discomfort of chrondromalacia usually responds to typical treatment with ice and an anti-inflammatory medication. However, to prevent recurrence of this pain certain steps must be taken. The mainstay of treating and preventing chondromalacia is to strengthen the anterior thigh or quadriceps. Exercises such as squats and deep knee bends should be done while keeping in mind the fact that the knee should not bend beyond 45 degrees. The use of a knee sleeve with an open hole for the kneecap will assist in maintaining minimal tracking of the patella. The use of such a sleeve will often times alleviate the pain of chondromalacia. If some of this pain is thought to be secondary to running then the use of a motion control running shoe or a shoe insert will often assist in preventing over pronation.

Iliotibial band syndrome. The iliotibial band is a ligament which runs along the outside of the thigh. In iliotibial band syndrome, this thigh ligament rubs against the large leg bone, the femur, resulting in pain and inflammation on the outside of the knee. This results in a dull ache, associated with activities such as running. This pain will frequently stop after the activity, but in severe cases can leave the outside of the knee tender and swollen.
While ice and anti-inflammatory medications may be helpful in iliotibial band syndrome, the most important treatment for this is stretching. To perform the proper stretch of the iliotibial band, stand with the right leg crossed in back of the left, and extend the left arm against a wall. Lean against the wall while pushing the right hip in the opposite direction. Make sure that the right foot stays anchored while allowing the left knee to flex. This should stretch the iliotibial band in the right hip and down the outside of the right leg. If these stretching exercises do not prove effective, then it may be necessary to try a motion control running shoe, a shoe insert, or a cortisone injection to alleviate the discomfort.

Patellar tendentious. The patellar tendon connects the lower part of the kneecap (patella) to the shinbone. Repeated activities such as running, jumping or biking can lead to inflammation of this tendon. Poor alignment of the knee resulting from an inward rolling of the ankle (pronation) can also be a cause. Symptoms are pain, tenderness and swelling at the lower half of the kneecap with activity. R.I.C.E. treatment (see Sports Injuries) is very helpful. You should rest for several days or until pain and swelling has disappeared. Ice can be applied for 15-20 minutes several times a day. A knee strap worn across the patellar tendon at the bottom of the kneecap can help prevent some of the inflammation. Over the counter anti-inflammatory medications are also helpful. Strengthening the thigh muscles with squats and leg presses can prevent and treat this problem.