Chronic knee pain brought on by overuse

Patient

Q: My Mother is 57, and has been riding a stationary exercise bike and been doing floor exercises to stay fit for 30 years. 5 weeks ago she spent a couple of hours squatting outside pulling weeds and that's when she noticed pain in one knee. The next morning the pain was bad enough where she wasn't sure if she could stand on it. She stopped her normal exercising and stayed off of it for about two weeks and it improved, so she tried to start riding her exercise bike again, and the pain immediately returned to as bad as it was originally. She says the pain is worst in the morning, and that it can hurt equally bad whether she's standing, sitting, or lying down. Since then she's been staying off it as much as she can, and using an ace bandage and icy hot menthol rub to get some marginal relief, however we're both fairly certain unless she stays off it entirely except for trips to the bathroom she will keep aggravating it and it will not heal. My Dad passed about a year and a half ago, and now she has a very large medical insurance deductible and a small income. I'm hoping for some advice on how to proceed. We don't want to go down the road of x-rays and possible surgeries unless it's absolutely necessary or other options have been exhausted first. Thanks for your advice.

Doctor

A:    Knee pain is the most common presentation of patellofemoral syndrome 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, bicycle, 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 medication (i.e.: “Aleve”, “Advil”), education  so  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 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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