The kneecap (patella) moves up and down, tilts, and rotates. Patellofemoral pain syndrome is pain under and around the kneecap from changes in the patellofemoral joint. One or both knees can have it. High-impact sports such as football, basketball, soccer, tennis, and running can worsen kneecap problems. Running on uneven surfaces (hills or trails) or playing on different surfaces (grass and hard tennis courts) may also lead to this syndrome. Even sitting for long periods can hurt (moviegoer’s knee).
The causes include weak quadriceps muscles (front of the thigh), tight hamstrings (back of the thigh) or calf muscles, and weak or tight hip muscles. It’s an overuse syndrome and can affect active people such as runners. It’s also an overload syndrome because it affects inactive people (who are overweight).
Dull, aching kneecap pain occurs with activity and often worsens when going down steps or hills or when sitting. The knee can catch when bending. A painful grating or creaking feeling can occur.
The health care provider will make a diagnosis from the medical history and physical examination. X-rays of the knees, magnetic resonance imaging (MRI), and arthroscopy may be done when diagnosis is unclear. In arthroscopy, the health care provider puts a tiny camera into the knee to see inside.
First treatments are rest, quadriceps strengthening exercises, and icing (especially after exercise, used for 10 to 20 minutes). If possible, change to nonimpact aerobic activities, such as swimming or elliptical exercise machines. Hip, hamstring, calf, and iliotibial band stretching exercises may also help. It’s important to wear the right footwear, such as running shoes with extra cushioning and arch supports. Most runners, for example, change shoes every 300 to 500 miles. Orthotics, knee sleeves, and braces may be of benefit. Surgery is the last resort. Recovery can take up to 6 weeks.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, help inflammation (swelling, redness) and pain. These drugs can cause stomach problems and should be taken with meals. People who have ulcers or bleeding ulcers should check with the health care provider before using these drugs.
Kneecap pain can often be managed with physical therapy to strengthen quadriceps muscles and stretch hamstring and calf muscles.
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