Knee Pain and Stiffness

Patient

Q: Hello doctor, im a 19 year old active male. when i was 15 i had to have have an operation on my knee(patella stabilisation) as i was suffering patella subluxation. I had the operation and built back sufficient muscle around the knee. However i still feel pain in the knee and at times does get very stiff. I also noticed that if i was sitting in a room which was very cold, the knee would become quite painful or if i had to stand for long periods of time. I went back to my physio and he says the knee is structurally okay but the pain persists. I was wondering why this is and how i can stop the pain?

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 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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