LEXINGTON — Knee cap or patellofemoral pain is one of the most common conditions that sports medicine practitioners see. The condition was once thought to predominately affect adolescents.
However, in recent years, it has been recognized as a significant source of pain and disability throughout the life span, curtailing one’s ability to enjoy playing sports, and to perform more basic activities such as going up and down stairs. There is even emerging evidence that having knee cap pain earlier in life may be one risk factor for developing knee osteoarthritis later in life. The pain may or may not be associated with a feeling of instability. Thankfully, recent developments have led to effective treatments for individuals with knee cap pain and instability.
We have learned over the past decade how important the hip is in the development of knee cap pain. It is much like the old adage the knee bone is connected to the hip bone. The knee cap makes contact with the thigh bone. Thus, if the muscles that control the thigh (hip muscles) are not strong enough or lack good control, they can allow the thigh bone to rotate in a way that causes the knee cap to become excessively loaded on one side. With repeated repetitions, this results in pain.
The good news is that with exercises, given under the proper instruction of a licensed physical therapist, an individual’s pain can be significantly reduced if not eliminated. These exercises target not only hip weakness but teach the individual when and how to use the muscles to best reduce stress on the knee cap.
Knee cap instability also has several promising treatments that have developed over the past decade. Much like knee pain, the first step is to work with a physical therapist on similar hip exercises to see if keeping the thigh bone in a better position will reduce the feelings of instability. Other treatments such as bracing and even orthotics may be used to help reduce symptoms, after the initial bout of instability. If conservative interventions are not successful, then a consultation with a board certified orthopedic surgeon with specialized training in the treatment of knee cap instability is warranted.
The orthopedic surgeon would be able to assess whether the knee cap instability is due to a lax or torn ligament called the medial patellofemoral ligament, or if the instability is due to the shape of the portion of the thigh bone that the knee cap makes contact with. This portion of the thigh bone is shaped like a U and if it is too shallow it does not give the patella a good track to follow as you bend and extend your knee. Surgery can help reduce or eliminate the bouts of instability, allowing the individual the ability to more fully engage in activities that they enjoy.
Whether suffering from knee cap pain or instability, it is important to seek treatment from a physical therapist or physician who can guide you through the steps of treatment. We have seen that a wait-and-see approach may cause the perception of pain to grow, even if you decrease the amount of activity you are engaged in.
Brian Noehren, PT, Ph.D., FACSM, is director of the University of Kentucky BioMotion Lab and an assistant professor in the College of Health Sciences Division of Physical Therapy.