Pain in the front of the knee between the kneecap and thighbone is commonly seen in adolescents and young adults. The crunching or grating that patients feel and hear in their knees is a result of significant wearing. The kneecap normally glides in a well-aligned groove, and if this does not occur or there is some kind of abnormality in the cartilage, pain may ensue. Patients may feel pain without any direct wearing of the cartilage, or the wearing may progress all the way through the cartilage into the bone. This condition can be quite problematic because as long as you have a kneecap there is potential for irritation.
Patellar-femoral syndrome may be a temporary condition caused by doing an activity one is not used to, for example, riding a bike for an extended time or with the seat too low. Vigorous knee extension exercises on a knee machine may also cause this. Sometimes running is the cause, if there is not good alignment in the foot (overpronation) or there is not good alignment of the knee, whether the patient is bowlegged or knock-kneed. Experts also think some metabolic abnormality in the cartilage can cause pain in this area.
Patients are many times embarrassed because they cannot specifically locate the pain. They point to areas all around the kneecap and deep in the knee. This is because the kneecap is a large round structure in the front of the knee and can circumferentially radiate pain. Pain is usually worse when arising from a sitting position and going down inclines or stairs. That′s because going down actually loads the knee more than going up. Many times patients will complain of the knee′s popping or grating.
Exercises and modifying activity are mainstay treatments for this kneecap-thighbone pain. Initially, ice, rest, and anti-inflammatory drugs calm the irritation. This axiom is applicable to almost any inflammatory process. Then the physician must look at causes: alignment, shoe wear, poor bracing or support (orthotics), and muscle strength. Many times, the patient has either gained weight or been less active and thus started the vicious cycle of weakness and pain. Neoprene supports are helpful. If the patient is a runner, she may be encouraged to continue her activities but to do them in a non-weight-bearing sense, by doing aqua jogging or biking with the seat high. It may be surprising that the stair-stepping kind of exercise seems to be well-tolerated. This is because the leg muscles are strengthened without the shock of running and jumping.