Having previously discussed Osgood Schlatter, let’s stick with this theme and turn to another very common knee problem, patellofemoral syndrome (PS). PS is actually THE most common cause of knee pain from non-acute trauma in adolescents, in either athletes or those not engaged in organized physically competitive endeavors.
The hallmark of PS (sometimes called “chondromalacia of the patella which is actually only one form of PS) is pain in the knee just behind the kneecap (patella). PS is also often called “runner’s” or “jumper’s” knee, because the problem is closely associated with, and exacerbated by, those activities/movements. Kids with PS also commonly complain of worsening pain after sitting still for extended periods. Some PS sufferers will note a popping or crackling sensation in the knee, especially upon climbing stairs.
No one knows the exact cause and in fact it likely has several contributing and compounding issues. The most common factor is wearing/thinning of the cartilage BEHIND the patella (NOT “meniscus”). The soft, smooth cartilage behind the kneecap and covering the lower end of the thighbone(“femur”) is a much more lubricated joint surface for movement than rough, hard bone. When/if that cartilage wears down it causes inflammation and pain.
The condition is usually brought on by some aspect of sub-optimal exercise/training routine: too much training, a sudden increase in training intensity, improper training technique, using improper equipment(or proper equipment improperly) including footwear, bad or sudden change in training surface.
One common factor is quadriceps asymmetry. The quadriceps is the main thigh muscle, responsible for straightening the leg at the knee by pulling the shin (“tibia”) forward at the knee joint. As its name implies, the muscle has 4 parts, and if some sections are stronger/weaker than others the patella is not pulled straight through that cartilage lined groove at the bottom of the bone but rather will shimmy and bounce through it, causing the surface to wear down over time, leading to PS.
Thus a mainstay of treatment for PS is a good quadriceps strengthening program. Also along those lines, I encourage athletes to avoid full “squats” generally and in particular if you have PS. Half squats are usually ok. if they don’t cause pain. If you must do full squats with weights, I encourage flexing the knee < 90 degrees and only use machines/apparatus where the weight is placed past the feet and pushed away from the body as opposed to the weight on the shoulders to be lifted. A period of rest before return to sports is optimal or at least a modified training program limiting running/jumping outside of actual competition(substitute bike, low impact aerobic machines like elliptical trainer, swimming, water running). Heat before, ice after all vigorous activity. Wear a neoprene knee brace open at the patella for support during exercise. Anti-inflammatory medications like ibuprofen are often beneficial but not essential.
Of course, if the pain is more disruptive or persistent then please come on in and let’s take a closer look together. Thanks for following.