Baseball catcher's knee pain: Patello Femoral Syndrome

Patient

Q: I have been a basball catcher for nearly twenty years now. Now that I am almost thirty years old, my knees are feeling it much more than they used to but it is to be expected. I am writing because of some worse than usual knee pain I have had in my right knee for the past few months. It is exceptionally painful when I straighten my knee out after keeping it bent for awhile or when bending my knee after keeping it straight for a while such as after working on my feet all day. Specifically, it hurts on the back of my knee and the outside- near the rear of my knee. It hurts soemtimes worse than others, but it is consistently sore regardless of what activity I am doing. This pain first started after a game in April. In this game I rounded third base and upon trying to stop quickly my feet came out from under me and i twisted my knee a little. At the time, it hurt a little but I hurt my knees all the time being a catcher so I wasn't too worried. However, my knee has yet to recover, and if anything has gotten worse, and its been nearly 4 months. Is this just a normal sprain or strain that just needs time to recover? or could it be something more serious that I should see a doctor about?

Doctor

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 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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