Question :

Pain when walking up and down stairs and with leg extension when seated on chair

Dear Ask The Doctor:
I hurt my knee about 5 years ago in a baseball. I was standing on a base as someone came slid in for the plate. They hit my left knee, I heard no pop or crack, but my knee swelled to twice the normal size. I felt no pain thus elevated my knees when ever seated or laying and avoided long standing on it as much as possible. After a week my knee was back to normal. In recent years I noticed that weight lifting exercise caused me pain in my left knee. Thus I avoid exercise that I know would cause pain. Recently I played a soccer game and felt slight pain in my left knee. After the game that pain increased with walking, but the pain is worst going up and down stairs. The next morning walking on the knee was ok, but at times while standing a worling the knee would over extend causing a sharp pain below the knee cap on my upper tibia. I wrap the knee which lessen the pain. Now it is two days later I removed the wrap and is able to walk on the knee. I still have pain walking up the stairs. It also hurts when I am in a seated position and try to extend my leg. Is this a serious condition that needs to be looked at?


Answer :

Dear Patient: 
 Knee pain is the most common presentation of patellofemoral syndrome in young and active people. The pain typically is located behind or at the top of the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (ei, during squats, ascending/descending stairs or pendants). Pain may be worsen by sitting with the knee flexed for a long period of time, such as while you are playing as a catcher, watching a movie, hence leading to the terms "theatre sign" and "movie-goer's knee." The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint. The suggested strategy for conservative treatment should be as follows: Physical therapy program (exercises and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory drugs (i.e.: “Aleve”, “Advil”), education of the patient so  he/she understands which activities avoid because those can aggravate patellofemoral syndrome. Also, and very important, remark the need for extended adherence to the exercise regimen. Your physical therapist should educate you about a home exercise program. Allow time for these conservative measures make any effect and improve your condition.


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