Knee pain is getting worse after few months of a fall

Patient

Q: So I was watching a 200 plus lb great dane and one day I went out to go play with him. Well I turned around just as he jumped on me, luckily I didn't fall backwards, but I fell onto my left knee on a cement landing that had been worn down from repeated use. I did get a small scratch nothing big and it hurt a lot, but not enough to warrent any attention. The thing is that since then it has kept on hurting from either walking around a lot to driving for extended periods of time in a day. Lately though its gotten so bad that there are mornings that I don't want to get out of bed cause it hurts so much. I've tried pain killers, light exercise, staying off of it. I also got an xray done yet there is no signs of anything wrong.

Doctor

A:    The knee pain after a fall may be caused by damage to one or more of the soft tissue structures that stabilize and cushion the knee joint (including the ligaments, muscles, tendons, and menisci). One of the most common causes of acute knee pain are sprains after injury or a fall, and these involve the stretching or tearing of non contractile structures, such as the ligaments or the joint capsule itself, also a strain refers to stretching or severing along the course of muscles or tendons. In your case, the injury that you sustained could cause an unbalanced muscle pull that produced excessive pressure or leverage forces on the patellofemoral joint surfaces. The difficulty in flexing the knee along with the pain that you described are a common presentation of the Patellofemoral Syndrome, which is produced by an impairment affecting the patella and femur joint.The suggested strategy should be: strengthening and stretching the main muscle of the thigh: quadriceps, to restore the muscle balance around the knee joint, for this is indicated physical therapy for 6 to 8 weeks, using ice packs at the end of the exercise routine to decrease pain and swelling. The use of soft knee braces helps to control patella position and restrict full knee flexion which is good to ease the pain. Also, and very important, the activities or sports that require frequent squatting must be avoided until the pain is under control. If there is a limited response to the treatment and locking or instability of the affected knee is noticed, then an orthopedic surgeon evaluation must be considered.

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