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Pain in the Patella

For those who love winter, the only thing worse than bad snow, is a bad knee. Unfortunately, many winter sports put significant stress on the knee and kneecap which can lead to pain and shorter ski or snowboard days. Stress on top of the knee around the kneecap, or patella, is called patellofemoral syndrome or chondromalacia. Chondromalacia is a common condition and can be hard to live with. The kneecap can get aggravated walking up and down hills or stairs, or from sitting for long periods of time. Even certain warm up exercises with deep knee bends, such as low squats or lunges, can cause pain in the knee.
How does this happen? Cartilage behind the kneecap is thick and when the knee bends, the kneecap slides along the end of the femur (thighbone). Normally the friction between the knee and femur is very low, less than two pieces of ice rubbing together. The thick cartilage and minimal friction help protect the patella against everyday stresses. But this stress adds up over time. When walking on a level surface, the pressure on the kneecap is 1.8 times your body weight. Walking upstairs is 3.5 times and downstairs is 5 times your body weight. Pressure on the knees from running or jumping can exceed 10 times your body weight. If you’re over 30 and don’t currently have any knee pain, be sure to say “thank you” to your knees!
The good news is chondromalacia rarely requires surgical management. It can often be resolved with activity modification, anti-inflammatory medication as needed and physical therapy. Activity modification simply means to slow down. Anti-inflammatory medication, such as Ibuprofen or Naproxen, can be helpful for decreasing pain. Physical therapy can range from working one-on-one with a physical therapist several times a week to simply following a home exercise program on your own. Some knee exercises you can try at home to improve strength and decrease pain are available at bartonhealth.org/patellaexercises.

Though you may not need surgery, the longer you aggravate your knee, the longer it will be sore, and the longer you will limit your fun. While chondromalacia is a common cause of anterior knee pain, there are other causes as well. If pain in the knee or kneecap persists or worsens, do not hesitate to consult a physician.

Dr. Jeffrey A. Orr is an orthopedic surgeon at the Barton Center for Orthopedics & Wellness in South Lake Tahoe, CA.