It is hard to believe it is already summer. Now that the season of the sun is here, many of us are getting outside more as we return to our beaches and the activities that we can enjoy with the warm weather. I hope you are all going to remember to take the proper precautions to be safe as you get out and about.
Being active seems easier in the summer months, doesn’t it? Maybe, it’s just that it seems more inviting. So many of us have that urge to get up and get moving, But the truth is it can be an unpleasant reminder for some of us who have knee pain. It can be more than frustrating. It can be really hard to do the things we want to do when pain can make even the most basic movements difficult. That’s why I’ve invited a special guest to visit with us and talk about one of the causes of knee pain that I am seeing in a growing number of patients.
It is always a pleasure to have Henry Mensack, PA-C, of Premier Orthopaedic Bone & Joint Care visit with us and share his knowledge. Henry has been taking care of many folks in the area for more than 20 years, and so many of you appreciated the information he shared with us in his last visit that I asked him back to talk with us about patellofemoral pain syndrome.
Q. Henry, most people don’t know that the knee is the largest joint in the body and how complicated a structure it is for something that seems so small to look at from the outside. Understanding it seems like a logical place to begin. Can you give us an overview of the kneecap to get us started?
A. The syndrome we are going to talk about in a moment involves the kneecap, which is also known as the patella. It’s pretty well-known that it’s situated in the front of the knee, which is located at the end of the thighbone or femur. The patella is critical to so many movements, so though it may look like a small part of your knee, it’s more like a high horsepower engine.
When you flex your knee, the kneecap moves with it. As it travels up and down on a sort of dedicated track at the end of your thighbone, it’s giving the front muscles in your thighs (the quadriceps), the ability to straighten your leg. The kneecap also tilts and moves from side to side giving you range of movement. The kneecap is also the guardian of the other bones in your knee. It protects them when you do something like fall or bump into something.
Q. What is patellofemoral pain syndrome?
A. Patellofemoral pain syndrome (PFS) is defined as pain involving the patella (kneecap) and femur (thigh bone) at the level of the joint. It can be subdivided into two categories; pain beneath the patella called the retro-patella space, and pain surrounding the patella called peripatella. The symptoms result from pain usually, but not always associated with biomechanical and/or physical changes.
Q. How does it happen and what causes it?
A. PFS occurs when the kneecap’s cartilage abnormally softens. In other words, the cartilage degenerates, but there is no one answer as to what causes this syndrome. Some of the issues that can cause it to occur can include overuse, when the kneecap literally becomes overloaded, it can happen from the misalignment of the kneecap, and it also can result from some health problems and conditions. These are really some of the major factors.
Q. Let’s take this apart a bit, Henry. Would you tell us more about some of the causes?
A. I mentioned overuse. This is something that can happen to people of any age. Young people who play sports that are considered high impact, like football or tennis or even acrobatics, are at risk.
That said, however, people of any age who like to walk or run or jog are at risk. It makes sense when you think about the pounding your knees can take. Now, include some of the uneven surfaces you can encounter on paths and trails, the different surfaces, from hard surfaces to grass, and you can see how these factors can increase the chance of being impacted by PFS.
I also mentioned that some health issues can cause PFS. Certainly, issues like osteoarthritis are logical potential causes. There other issues, too, such as a fracture that has made the structure more vulnerable. Problems such as osteoarthritis, osteoporosis, or unexpected problems such as a fracture or a severe health problem can cause this syndrome to occur. Inactivity, from a health problem or because of choice, can also be a root cause because this syndrome often results from prolonged inactivity.
Q. Are some folks more likely to have this problem than others?
The condition is twice as likely to occur with females as males. These particular patients are usually active. Generally, the more active, the more symptomatic. It is not uncommon for the symptoms to start at a young age, particularly if the patient is involved in athletic activities.
Q. What are some of the most common symptoms or complaints associated with PFS?
A. PFS presents with anterior (front) knee pain, particularly with activities such as stair climbing, kneeling, squatting and exercise. Another common complaint is pain upon standing after sitting for an extended period.
Q. What physical findings do you look for?
A. As you always say, Bob, the first step is to get to your doctor, so that you get a proper diagnosis and a determination of the best course of treatment. Each patient is evaluated by identifying a complimentary history of the type of complaints we were just talking about along with reproducible findings on the clinical exam.
What that means is your doctor is going to try and take you through some movements to bring those symptoms into view. While in the office, we stress the knee gently by overloading the joint which reproduces the symptoms. The evaluation is relatively simple. However, treatment can be challenging.
Q. Once you conduct the physical exam are there any tests you typically perform to get to your diagnosis?
A. The condition is diagnosed with a combination of clinical findings and imaging studies such as X-ray or MRI. On occasion, an arthroscopic evaluation can be helpful. This involves a minimally invasive procedure to get a look at what’s going on inside.
Q. If someone is diagnosed with PFS, are they at risk of getting arthritis of the patella?
A. Yes. However, this is usually a late-stage finding of PFS. This is one of the many reasons why getting to your doctor to get early treatment is so important.
Q. We know that 80 to 90 percent of folks who suffer from PFS recover without surgery, given the proper treatment. So, what potential treatments can people expect?
A. Short-term regular use of anti-inflammatories is a mainstay of treatment. Creams and salves can help, too. Sometimes, cortisone shots can help. But let me be clear that these should be used on limited basis — particularly in younger patients. There are other injectable alternatives that don’t have the side effect profile of steroids.
While surgery is an option for treatment, it is rarely used. Physical therapy, along with activity modification, are the main stay of treatment. Bob, I know that you are better informed on the specific techniques. When doctors refer patients to a physical therapist, the expectation is that the patient will be thoroughly evaluated to create a treatment plan for that patient’s specific needs.
Q. Thanks for giving us all this really helpful information, Henry. I’m going to count on you to come back and visit with us, again, and give us your insight on some other issues.
A. I’d be happy to do that, Bob. Thanks for inviting me. I always enjoy visiting with everyone, and I’m looking forward to next time.