Knee Pain Getting You Down?
by David Oster, M.D.
Knee pain is a frequent problem and increases with age. One of the most common complaints is anterior knee pain. This pain usually is a pain around the kneecap that worsens with stairs, kneeling, squatting, running and sitting in one position. On exam tenderness is noted around the kneecap and crepitus (crunching) is evident when squatting.
The cause of this pain can be from wear of the cartilage surface that covers the bone. This surface is smooth but over time can thin and crack. Once the surface is damaged its mechanical properties change and pain may occur.
Treatment for this problem usually is non-operative. Typically
analgesic (reduce pain) medications such as acetaminophen
(Tylenol) or anti-inflammatories (reduces pain and inflammation)
medications such as ibuprofen (Motrin) may be used. It is
also important to modify activities. Deep squats, leg extensions,
lunges and high impact activities should be avoided because
these activities place high loads on the kneecap. Kneecap
friendly exercises include low impact exercises (bike, elliptical,
swimming), mini-squats, and leg presses and hamstring curls.
Weight loss is also important; every pound that is lost equals
4 pounds in the knee. Good cushioned shoes or inserts take
up some of the impact with activities and may reduce the forces
on the kneecap. Other medical treatments include steroid injections.
These injections are frequently used when acute pain and swelling
occur that cannot be managed by oral medications. Lubricants
(hyaluronans) are another option and involve an injection
every week (3 to 5 weeks) and symptoms can improve for 6 to
12 months. If all other options fail then surgery can be considered.
This article originally appeared in the September edition of the "Living Well in Lowry" newsletter.