No Need for Knee Pain

Do your knees hurt when you walk up and down stairs? Do you hate going to the movies because when you sit for too long your knee becomes so stiff that you think it will break when you get up? Are you afraid to squat because you heard that it aggravates knee problems? If you can identify with these situations, then you may be one of the many women who have a patellofemoral (PF) dysfunction that leads to pain. Women may be predisposed to PF dysfunction if they are overweight, if they have weak or tight musculature, or if they are born with malalignments.

Many theories have been proposed to describe why and how people experience PF pain. The most commonly accepted theory on what causes it is that abnormal patellar tracking (laterally) in the femoral groove increases the stress between the patella and the femur and wears out the cartilage on the underside of the patella. When the cartilage is healthy and the ridges fit into the femur well, the knee is pain-free. However, if the patella and femur do not mesh well together, the cartilage can wear down, predisposing a person to PF pain. Although the cartilage itself has no pain receptors, the bone underneath it does. But the why question of PF dysfunction is an individual issue, and cases differ from person to person. In some cases, a congenital malalignment of the lower body may be the culprit. Tight or weak musculature, lax ligaments, overuse, or trauma may also be to blame. Extra body weight that puts increased stress on the knees can contribute. Whatever the whys and hows may be, the signs and symptoms are generally consistent. They include swelling, loss of range of motion, and a sense of instability (feeling that the knee might give way), as well as pain with prolonged sitting, squatting, and walking up and down stairs.

Previously, treatments of PF dysfunction were based on the hypothesis that the vastus medialis muscle could be individually activated and trained to work with little other involvement of the quadriceps muscle group. This muscle could then pull the patella medially (toward the inside of the thigh), more into the femoral groove. Many studies have now shown, however, that such selective treatment is impossible. When you try to selectively strengthen the vastus medialis, you activate the entire quadriceps muscle group, which is actually the desired outcome for treating PF dysfunction. Strengthening the entire quadriceps group may help change the contact areas between the patella and femur and redistribute the pressures. This alteration in turn can relieve painful areas of worn cartilage.

The first course of action with any inflammatory condition, however, is to treat the symptoms with rest and ice. A medical doctor may also prescribe anti-inflammatory medication. Once the painful symptoms abate, you can tackle treating the cause of the problem. Increasing strength and flexibility of the entire lower extremity from the hip to the foot is crucial. Exercises that are safe and effective to start with include backward walking or running, backward stair climbing, lateral step-downs, and bicycling with the seat high and the resistance low. Leg presses and squats can be beneficial too, but you should keep them in the range of 0 to 30 degrees. Likewise, keeping leg extensions at only 90 to 60 degrees decreases the patellofemoral joint reaction (PFJR) forces. However, the rule of thumb should be to perform all exercises pain-free. Proper bracing or taping by a certified athletic trainer or physical therapist can be effective in decreasing pain so that you can strengthen the joint, and it may improve patellar tracking by better positioning the patella in the femoral groove. Orthotics for the feet may be necessary to correct any malalignments.

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