Knee Pain@25

When was the last time you suffered with pain in the knee while walking or maybe using the stairs? Not too long ago I guess and all you did was neglect it. Knee pain or rather any pain should never be neglected. Pains’ always occurs because of some under lying pathology and the more quickly it is diagnosed, better are the results.

Normally we associate pain with old age but it is not so. There are numerous causes for knee pain at different age groups. The patient's age and the anatomic site of the pain are two factors that can be important in achieving an accurate diagnosis.

Common Causes of Knee Pain by Age Group

Children and adolescents

• Patellar subluxation
• Tibial apophysitis (Osgood-Schlatter lesion)
• Jumper's knee (patellar tendonitis)
• Osteochondritis dissecans

Adults

• Patellofemoral pain syndrome (chondromalacia patellae)
• Medial plica syndrome
• Pes anserine bursitis
• Trauma: ligamentous sprains (anterior cruciate, medial collateral, lateral collateral), meniscal tear
• Inflammatory arthropathy: rheumatoid arthritis, Reiter's syndrome

Older adults

• Osteoarthritis
• Crystal-induced inflammatory arthropathy: gout, pseudogout
• Popliteal cyst (Baker's cyst)

KNEE PAIN @ 25

Case Study A patient presented at my clinic with bilateral anterior knee pain since 3 months. He had taken treatment from various doctors and clinics but got no result. Medicines made him temporarily better. Finally an orthopaedic surgeon referred him to us for physiotherapy. The patient was 24 years old, a little overweight and he presented with pain on stair climbing and on walking after prolonged sitting. He gave a history of performing squatting exercises at the gym. On examination of the knee, there was mild effusion (swelling) and pain on palpating the anterior aspect of patella. Crepitus (Grinding sound) was present in both the knees. The patella was slightly shifted laterally and quadriceps was weaker.

On doing a detailed assessment of the patient we observed that the lateral structures of the thigh were tight (esp. the iliotibial band) and also the patient had flat foot. The foot was also in over pronation. Assessing these bits made our treatment with him more comprehensive and permanent. Exercises were done to strengthen the Quadriceps femoris and gradually putting stress on the Vastus Medialis Oblique. Patellar Mobilisation and stretching of the tight structures around the hip and knee joint were also done. To correct the flat foot, intrinsic of the foot were strengthened and the patient given a medial arch support. Within 2 months, and having alternate day sessions, the patient had full recovery. The pain was gone and 3 months follow up was done. The patient was following the home exercise program and was on the road to recovery.

Chondromalacia patella is the softening and breakdown of the tissue (cartilage) that lines the underside of the kneecap (patella) and it is a common cause of anterior knee pain in young adults.

The patella is the bone that connects the most important muscle of the hip and thigh to its attachment at the tibia. When we bend the knee the patella traverses around a patellar groove on the femur or thigh bone. Anterior Knee pain starts when the patella is at an abnormal position due to biomechanical changes of muscle weakness and muscle tightness.

The cause of pain and dysfunction often results from either abnormal forces (e.g. increased pull of the lateral quadricep retinaculum with acute or chronic lateral PF subluxation/dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the PF joint.

The disease starts with mild pain at the anterior aspect of the knee

Symptoms

· grating or grinding sound

· pain on stair climbing

· pain on walking after prolong sitting

· mild knee swelling

· lateral patellar tracking (J Sign)

Physical Therapy Treatment

Rest

Patellofemoral pain syndrome may also result from overuse or overload of the PF joint thus individuals should rest the knee and engage in activities like swimming rather than jogging.

Strengthening

o Quadriceps esp. VMO

o Adductors of the hip

o Intrinsics of the foot

o Gastronemius Soleus & Tibialis Posterior Strengthening to correct flat foot and Over pronation

Stretching

o Lateral Retinaculam and Iliotibial Band

o Hamstring

o Quadriceps

o Gastroc-Soleus Complex

Orthoses

Flat foot leads to over pronation and thus increasing the Q angle and genu valgus. Poor lower extremity biomechanics may cause stress on the knees and ultimately patellofemoral pain syndrome. Arch supports and custom orthotics may also help to improve lower extremity biomechanics.

Taping

Taping the patella medially helps in better congruence of the patella to its groove thus decreasing the pain considerably and also improving biomechanics.