Patient: I hurt my knee a while ago and suffer from intermittent pain. I may have pain for a couple of days, then the pain will subside for a few days before another random flare up occurs. The pain is located near the lateral side of the head of the tibia close to where the fibula joins. It’s painful when I begin walking, but after a little while, the pain subsides. It tends to flare up again after I spend time sitting idle in a chair as well. I’ve tried icing it and using an ACE bandage to wrap it, but the following day after icing, it seems to be worse, so I’ve stopped doing that. I guess my question is what might the cause and whether or not I need to go to a doctor for an X-ray or MRI. For reference, the initial injury may have occurred this past winter while skiing although I was unaware of it at the time.
Doctor: The intermittent or episodic knee pain is the most common presentation of patellofemoral syndrome in young and active p 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 to stretch and strengthen quads and pain control with TENS, ultrasound, ice packs after the exercises), anti-inflammatory medication (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.