Email
PrintWhat a Pain in the...Knee
“Steve” was going to Disney World no matter what. He’d had knee pain for weeks, tried to wait it out, but it was now crunch time; they were leaving with their two young daughters in a day. He asked me to take a look at him before he left, I guess because he just wanted to know if he’d be curled up in a ball stranded on some ride like Dumbo.
The things we do for our kids.
We took our three boys to Disney World at that age, and recently, while we were reminiscing, they admitted they couldn’t remember much.
What???
Lemme tell you kids, Dad remembers it. Dragging your keisters all over the Magic Kingdom in 95 degree weather, paying six bucks for a drink, jockeying for a place in line with the other sweaty parents, having a heat stroke while that insane song, “It’s a small small world” wouldn’t stop running through my head…..
Ok, stop. Deep breath.
I knew what Steve was in for, limping and dragging his knee all over the park.
Fortunately, he had what was the most common cause of knee pain that physicians see. It’s called Patellofemoral Syndrome, otherwise known as Chondromalacia Patella.
He’d fallen on the knee, landing on the kneecap, and the knee had swelled up for several days. It initially hurt to bend or straighten, and then he had a hard time putting weight on it. Then it got better over the next two weeks, which is why he waited, but he still had pain with kneeling, getting up from sitting and prolonged walking, especially inclines.
Most people are worried about tearing a ligament or fracturing something inside the knee, but fortunately, most of the time the problem is inflammation of the cartilage underneath the kneecap.
The kneecap, called the patella, is attached to the upper, frontal leg muscles called the quadriceps at one end and the knobby part of the lower bone of the leg at the other end. It glides in a groove as the knee bends, to keep that whole pulley system aligned.
There is cartilage underneath the kneecap, which helps cushion it as it glides up and down in that groove as we bend and straighten the knee.
In Steve’s case, he whacked his kneecap going down; his body responded by creating painful joint fluid to separate the injured kneecap’s cartilage from the bone under it.
(The whack from his wife for not going to Disney World and disappointing his daughters would have been a lot more painful.) Hence the swelling – the body doesn’t like bone against bone, or any friction, so in our inflamed joints, we tend to get swelling as the distance between our bones narrows with age.
But now that the kneecap had fluid underneath it, it was floating out of its groove, creating misalignment – kind of like when your sliding screen door comes off the tracks.
The same thing can happen if the quads are weak, causing the kneecap to not be “in the groove.” This is the major cause of knee pain, more than any other by far; some estimate as high as 80 to 90%.
The warning signs of it being something else would be:
Unable to put weight on it at all (fracture)
Constantly “giving out” (torn ACL or other ligament)
Something inside “catching” so the knee can’t bend or straighten (torn meniscus)
A good thorough knee exam would be able to diagnose this common diagnosis, while X-rays are probably not as useful as a good solid history from the patient of the injury and symptoms.
In fact, we didn’t do any Xrays on Steve. So, how did we “fix” him? Patellofemoral syndrome gets better without a whole lot of invasive therapy, but needs a lot of just paying attention from the patient. In other words, no easy fix, but it’ll improve if you let it.
Still, I was the one who was going to get whacked next if we didn’t figure out a way to get him moving while at Disney World, but we had a solution.
He wore a knee brace with the hole in the center, which aligned and centered the kneecap. He walked peg-legged like a pirate, keeping the knee from bending. He avoided kneeling and squatting and hill climbing, which would have forced the kneecap against the leg bone underneath it. He could ice it down and take ibuprofen if it got too painful (but I told him to make sure he didn’t get the ice while in the park; I remember telling the kids each ice cube in that $6 cup was worth a quarter, but I digress….)
They came back and had a great time; he’s still limping but improving, and wearing his brace.
The things we do for our kids. Just hope they remember it someday!
