Pain in both knees when sitting on feet at yoga practice

Patient

Q: Experiencing pain (moderate to severe) and swelling (mild) in both knees; cannot bend either knee without pain and sitting on feet for yoga practice is excruciating. Have never had this problem before, usually very flexible and pain free. Did have a medical issue in February 2012, DVT left leg and PE, but clot in leg has fully resolved with thrombolysis,angioplasty, stent. Still taking coumadin for PE but no other meds. Otherwise have been healthy with no issues other than periodic lower back pain for the past 10 years. Can you help?

Doctor

A:   Most likely the knee pain that you described correspond to a patellofemoral syndrome or Chondromalacia Patella, in which the Knee pain is the most common presentation  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, yoga, gardening, 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 medication (i.e.: “Aleve”, “Advil”), wearing a soft knee brace with patella stabilizer (the one with a patella window), braces that are tightly applied directly over the patella should be avoided, because they actually increase patellofemoral pressures and may exacerbate the condition,  education so  you 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  physical therapist should educate you about a home exercise program. Allow time for these conservative measures (ei: exercise program) to have an effect , usually 4-6 weeks is adequate for some resolution of symptoms.

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