Knee pain after Sitting: Patellofemoral Syndrome


Q: I am a 28 year old male, fairly active ( in that I run usually twice a week). About 3 years ago I started getting very bad pains in my shins up to my knees when I was running, so had to stop for some time. I visited a chiropractor who prescribed orthotics to me, and these have been working fine. However, over the last few weeks, I have been getting pains in my right knee after sitting down for any period of time. I have no issues with it whn I am moving or running, but after I keep it bent it takes about ten mimutes of walking to loosen it up again. The pain is specifically at the back of the knee. Does this sound like ligament damage? Should IO be going to see a doctor? A physio? Is there any chance ther has been adverse effects form the orthotics?


A:   Knee pain is the most common presentation of patellofemoral syndrome in young and active people. The pain typically is located behind 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 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. The patient's physical therapist should educate the patient about a home exercise program Allow time for these conservative measures (ei: exercise program) to have an effect in patients with patellofemoral syndrome, usually 4-6 weeks is adequate for some resolution of symptoms.

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