Pain and pressure to the front of the knee cap

Patient

Q: Hello I am a 35 year old male who runs 5 days a week, around 4 miles a run. I have been following this routine for a few months now building up my endurance without incident. Unfortunately in the last week I have developed a slight pressure to the front of my right knee cap and with that pressure a little pain but nothing major. The pain seems to subside after the run, but never fully goes away. Just to give you some background, in my youth and to this day I still play football (soccer) and in my early twenties I damaged my right knee ligaments in a tackle. I went to hospital but required no surgery and was walking on it, all be it stiffly the day after and playing again within a month. This injury has never bothered me since then. I have noticed over the years that my right knee grinds when bending and going up stairs but has never given me any pain until now. Another observation I have had is my right knee cap seems to sink slightly to the front, if I compare its position to my left knee cap. One other observation is that I have had no swelling since this has begun, also when I rest from training the pressure and pain seems to subside then disappear. My running means a lot to me, so any help or advice would be greatly appreciated. Thanks Mark

Doctor

A:    Knee pain is the most common presentation of patellofemoral syndrome in young and active people. The pain typically is located behind or at the top or front  of 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 and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory drugs (i.e.: “Aleve”, “Advil”), education to 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 take effect and improve your condition.

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