All You Need To Know About Knee Pain – Part 1
Three Common Knee Conditions Discussed

 

Knee pain is one of the most common conditions occurring in all age groups. However, knee pain has always been kept under an umbrella term – Arthritis (Wear and Tear) and reasons given behind it are mostly age and weight.

Now the question comes, how correct are these reasons? Is it the only diagnosis/condition? Does one really has to live with it the entire life? And can it be cured simply by reducing weight?



Let’s find answers to these questions:

First of all, not all knee pain is Arthritis. There are several other conditions that occur in knee such as patella femoral pain syndrome, fat pad impingement, patella tendinopathy, meniscal impingement or tear and many more. So a proper diagnosis is important for one’s recovery in a realistic time frame.

Now by reducing weight can this problem be cured? To answer this question, we first need to know the various contributing factors and symptoms of a condition.

Joint pain, joint stiffness and swelling are the few signs and symptoms of a condition. And the factors which lead to these symptoms are known as contributing factors which can be muscle tightness, poor body mechanics, muscle imbalance, poor posture, weight, poor sporting technique and many more.

Once the condition and the contributing factors have been figured out with help of a physiotherapist or orthopedic, it will be easier to set the SMART (specific, measurable, achievable, realistic and time bound) goals.

Let’s discuss few of the common knee conditions.

Patello femoral knee pain (PFPS) commonly known as runners knee

PFPS is one of the common knee conditions affecting active population of all age groups. It is found more in women because of wider pelvis which changes the direction of forces acting on knee joint.

Patella (knee cap) sits in a groove which is present in the lower part of thigh bone (femur). In a normal knee it glides up and down in the groove smoothly whenever there is knee bending and straightening movement such as in going up and down stairs. However, in an affected knee the patella moves out of the groove causing friction between the two bones which eventually results in pain. Pain can vary from dull ache to sharp pain which might be accompanied by clicking or momentary weakness in knee joint.

knee pic new

                                       Picture 1

 

 

Knee cap is held in position with a good balance between outer and inner structures around the knee cap. Structures which are responsible for movement around the knee are the muscles. The group of muscle present in front of the thigh is known as quadriceps (refer picture 1) as it has four prevailing muscles. Any imbalance between these 4 muscles can cause change in the way the knee cap moves.

 

Contributing factors:

  • Poor lower limb mechanics due to
    • Increased foot pronation (foot  flattening)
    • Decrease lumbopelvic (lowerback and hip area) stability due to weak core (abdominal) and gluteal (hip) muscles
    • Decrease VMO (vastus medialis obliques) activity, the inner most muscle of quadriceps
  • Poor/incorrect footwear
  • Muscle tightness; specially increase in Vastus lateralis (outer most muscle of quadripceps) and Illiotibial band (ITB) tightness/activity. ITB is a connective tissue band present on the outer thigh.
  • Poor sporting technique/ergonomics.
  • Over-training

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors specific to your problem and start working on them
  • Joint mobilization
  • Soft tissue release and stretching exercises specially ITB and quads
  • Getting your footwear checked
  • Gluteal and quadriceps muscle strengthening exercises
  • Running/walking/stairs technique correction
  • Taping

 

Patellar tendinosis  (commonly known as jumper’s knee)

Patella tendon is the continuity of the quadriceps muscle which is present just below your knee cap. Patellar tendinosis is the inflammation of the patellar tendon. Common site of inflammation is just below the knee cap where the patellar tendon originates.

It is commonly seen in population doing high impact activities like basketball, sprinting and volleyball.

knee pic new

 

Causes:

  • Poor sporting technique (like jumping and landing)
  • Increase muscle tightness especially quad, hamstring and calf
  • Lack of cool down and stretching
  • Weak gluteal and quadriceps muscles
  • Stiff ankle joint leading to reduced shock absorption during ground contact

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Soft tissue release
  • Transverse friction massage
  • Correcting sporting techniques
  • Icing
  • Taping
  • Eccentric quads exercises
  • Gluteal strengthening exercises
  • Stretching exercises

 




Fat pad impingement (Hoffa’s Syndrome)

Fat pad is present just below the inferior pole of patella (knee cap) and behind patella tendon (tendon just below your knee cap). In some cases, the fat gets irritated by the inferior pole of knee cap and causes pain and inflammation. It is often confused with inflammation of patella tendon as the location of pain is same.

knee fat pad

        The yellow area in the above picture refers to Fat Pad.

 

It is commonly seen in people who can overextend their knees (known as genu recurvatum). Poor quads control, improper running and sporting techniques or a direct blow can lead to fat pad irritation also.

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Joint mobilization
  • Knee control exercises
  • Icing
  • Taping

 

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Are you over-training?

We have often heard that, “Excess of anything is bad”, this phrase goes with exercise as well. Exercise can only be beneficial if it is done in correct volume. Every individual has different response to training load and rate of adaptation. Considering these individual differences, a training program should be prepared and progressed accordingly.



A good training program features an optimal training load which depends on training volume, intensity and rest periods. Training volume involves duration and frequency whereas training intensity involves force of muscle action and stress on cardio vascular system. A person opting for weight or resistance training has to do high intensity and low volume and vice versa for aerobic or cardio training. Recovery is an essential part of training for which there has to be appropriate rest periods within training programs.

When any of the training factors exceeds to what is required or there is any imbalance between workout and recovery, it can lead to over-training. The individual will start experiencing physiological mal-adaptations and performance decrement which can last weeks, months or even longer. Apart from physiological mal-adaptations, over-training also affects an individual psychologically.

Major physical signs of over-training syndrome include increase in muscle tension and tenderness, increased susceptibility to illness, change in appetite and body loss, elevated resting heart rate and blood pressure and decreased energy levels. Common psychological signs include irritability, restlessness, depression, insecurity, lack of motivation, increased anxiety and fatigue, and decreased vigor and mood states.




Over-training syndrome can not only keep an individual away from sports and physical activity for weeks or months but can also make them quit. Early detection of over-training can save a person from undergoing these physical and psychological issues. Under appropriate supervision and by physiological tests like VO2 max testing these signs can be detected at an early stage. However it is not feasible and practical at individual level. A simpler way to keep track of your training is by keeping a training diary. Recording your training sessions, comments about training, noting your morning resting heart rate, any signs of injury and overall comment for the week regarding mood, sleep etc. These recordings can be tallied at regular intervals to evaluate your rate of adaptation to your training program and notice increment or decrement in performance.



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