Patient: Hey Docs, I am training to be a free runner however my knees, make a grinding noise when i straighten them from a sitting position. Also, they hurt sometimes hurt while walking and feel like they are going to give out. Jumping also hurts. I visited a clinic and they said it was “just a sprain”. He gave me naproxen and it temporarily worked. If it is “just a sprain” it still hurts after about 2 months. It really hurts on my tendons but the grinding noise sound like my bones. I’m really confused as to what the problem is. What do you suggest I do?
Doctor: Knee pain is the most common presentation of patellofemoral syndrome. The pain typically is located behind the kneecap with or without “grinding” and often shows during activities that require knee flexion and forceful contraction of the quadriceps (during squats, bicycle, ascending/descending stairs, jogging 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. On the other hand, the feeling of “giving out” might correspond to an associated ligament injury, which is relatively frequent in young and active people, maybe you should go to an Orthopedic Surgeon to get an evaluation in order to rule out a ligament or meniscus associated lesion. 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”), education so you understand 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 (exercise program) to have an effect, usually 4-6 weeks is adequate for some resolution of symptoms.