July 2007

My knee has suddenly started hurting, but I didn't do anything to injure it. Will this go away in time, or would therapy help?

It sounds like you may be suffering from what is called patellofemoral pain syndrome (PFPS). This is the number one complaint for athletes and nonathletes alike presenting to physicians or physical therapists that care for knee problems. The symptom that generally presents with PFPS is anterior knee pain, often surrounding the patella, which can be present in one or often both legs. This may come on with the navigation of a flight of stairs, or sitting for a prolonged period of time, and is often worsened by activity including squatting or kneeling. Symptoms may be a dull ache, or even a sharp-burning pain, and sometimes can even result in the knee giving way. There are many predisposing factors which can lead to PFPS. In normal knee extension/flexion, the patella glides through a groove in the distal femur. When the bones in the lower leg are not lined up, it can cause the gliding between the patella and femur to become abnormal. This malalignment can lead to overloading of the articulation generally on the outside of the knee. This abnormal lateral tracking can be very painful and may lead to accelerated wear between the surfaces of the bone. Several anatomic and congenital factors may lead to predisposition toward PFPS including: tightness of the quadriceps, hamstrings, Iliotibial band (IT Band), and relative weakness of the quadriceps (VMO). Other factors may include: excessive rotation of the hips, or lower legs, genu valgum (knock knees), knee hyperextension, and excessive pronation (flat feet). Treatment for PFPS involves a combination of activity modification, anti-inflammatory/pain related modalities, and a comprehensive stretching and strengthening program. Symptoms may go away on their own with rest and ice, but the process can often be accelerated with the help of a physical therapist who will get you set on an individualized program catered to your needs. If you are having knee pain, physical therapy can help.

Jessica King