Clicking Knees

Patient

Q: Hi, I'm a 23 year old Female, and i have been playing soccer for 15 years. Recently my knees started clicking - and its really painful. My friend who is a ciropractor advised that it might come from my hips? When i mentioned this to my mom the other day, she told me that i used to wear a frejkas pillow as a child. What do i do to get this sorted?

Doctor

A:    The Frejka pillow is A pillow splint used for abduction (separation) and flexion of the femurs in treating congenital hip dysplasia or dislocation in infants. 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, 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 you 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. On the other hand,the menisci are C-shaped wedges of fibro cartilage located between the tibia and femur, and very close related to knee ligaments and attached also to the joint capsule. They are susceptible to get injured with leg rotation movements or rotational forces applied to them, like playing soccer, and the lesion produced can be partial or complete tear. Also Meniscus injuries are common in young and active people as you, who are involved in sporting or physical activities. Locking or buckling is a common symptom after a meniscus lesion develops. Locking usually occurs at 20-45° of joint extension. If a torn fragment has been trapped within the joint, extension may feel limited against a rubbery resistance. Joint inflammation or capsular involvement also may resemble locking. A more reliable indicator of meniscus lesion is a click or snaps after the joint unlocks, it can be or not associated with pain. A sensation of giving way may occur when the loose fragment becomes lodged for a moment in the knee joint, causing a sense of buckling. Spontaneous healing is common because of the rich blood supply in the meniscal periphery. Successful recovery from a meniscal tear is helped by a gradual resolution of symptoms over 6 weeks with a return to normal activity by 3 months. Many meniscal tears heal spontaneously,  Also, can be treated with casting depending of the severity of the tear. With time the symptoms improve. If there is no significative improvement you should get a clinical (orthopedic surgeon) and Imaging (MRI) evaluation of your knee.
 

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