"The Infamous Knee Cap"
Bernard A. Finnerty, M.A., P.T., O.C.S.
Most of us have pain in the knee at one time or another. In the field of Orthopedics and Physical Therapy medicine, the "Knee Cap" has shown itself to be the cause of fifty percent of the knee problems seen in Orthopedic Offices. How does this knee cap pain differ from regular pain?
Usually, the knee pain will manifest itself after different activities. The following are three examples of what could cause possible knee cap pain: 1- After two hours of sitting with the knees bent you experience pain in the front of the knee or on the outside of it for ten minutes to two hours after getting up. 2- If you experience pain after squatting down on your knees for a period of time. 3- If the knee pains exist after climbing and descending stairs.
What causes this pain? The knee cap is designed to ride in a groove in the knee. There are muscles attached to the knee cap to give it proper direction and also to help us extend our knee (see Figure 1). The muscles and the knee cap are finely tuned to work together. Any deviation from riding in the center of the groove can cause pain to the bottom of the knee cap. The possible causes of this pain are repeated falls on the knee cap which will cause the muscles to pull the knee cap up and to the outside. One or two bad falls will also cause scarring to take place under the "Cap" and cause the knee cap to off-track out of the groove or to ride high on the knee. As we get older, if we continue to do a lot of stair climbing, climbing ladders, repeated squatting, or kneeling, this may cause scarring under the knee cap. Naturally, repetitive movement of the knee alone will not cause knee pain. There has to be an underlying problem with the knee cap. Contributing factors can be due to inherited problems such as: flat feet, obesity or as mentioned before, trauma to the knee cap.
Of interest, nearly every person who has knee surgery or who has the knee immobilized will also have problems with the knee cap. This is because the knee cap is no longer in the groove and is riding high. Usually, the patient will be prescribed Physical Therapy after surgery. The Physical Therapist should assess the knee cap as a potential source of pain and limitation by a hands on examination. Manual mobilization, stretching and special taping techniques can correct the malalignment of the knee cap and this in turn will decrease pain and limitations of movement.
When patients are placed on exercise machines soon after surgery, caution must be taken if proper alignment of the knee cap has not been assessed. In the field of Physical Therapy, the therapists are trained to evaluate and treat the Patellofemoral joint (Knee Cap). As usual, like everything in life it is not easy to do this. Often the problem has slowly developed and now the muscles have become tighter and the scarring and inflammation have become fairly entrenched.
If you think that you fall into the category, contact your Physician for an evaluation and if needed a prescription for Physical Therapy.
Bernard A. Finnerty, M.A.,P.T., O.C.S.
Board Certified Orthopedic Physical Therapist