Knees Pain, Clicking and Grinding

Patient

Q: Since I was around 11 years old, I have always suffered with my knees. I had to stop trampolining when I was about 17 or 18 because they were getting worse. I have been to the doctors, to a specialist and have had physiotherapy. I have always been told that the pains are growing pains but I am now 24 and this cannot be the case anymore. I can't sit in one position for more than 5 or 10 minutes, they sometimes give way (there have been times when I have fallen to the floor and felt sick afterwards), the clicking and grinding is so loud and feels horrible, and I get cramp after exercise or wearing high heels which can sometimes be quite severe.

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 (e.g, 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." Also “grinding” and “clicking” may be present. 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”), educate you about 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. Please, allow time for these conservative measures (e.g: exercise program) to have an effect, usually 4-6 weeks is adequate for some resolution of symptoms.

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