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Do you have a knee problem?

Picture 1 Many people are aware of the spectacular footballer's knee injury, the result of an awkward turn, pass or tackle, causing the "torn cartilage" or the more serious ruptured ligaments. But what about the knee that hurts for no apparent reason?

Aching knees (patellofemoral pain) affect 25% of the population at some time in their lives but it is more common in athletes. The sports where patellofemoral pain is typically seen are those in which the bent knee position is required, such as running, breaststroke swimming, tennis, netball, fencing and skiing. Tennis, volleyball, basketball and other jumping sports can produce a related problem which affects the tendons.

Patellofemoral pain is also more common during adolescence, because the long bones are growing faster than the muscles, tendons and ligaments, putting abnormal stresses on the joints.

Are you at risk?

Usually, individuals susceptible to aching knees have chosen the wrong parents, that is, inherited asymmetrical leg alignment. To determine whether you are at risk, stand in front of a mirror with your feet together. In this position, your knees should face the front and the joints should just touch. You may have a problem if:

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  1. when your feet are together, your kneecaps face inwards, your knee joints don't touch when your feet are together, or your knee joints don't remain in the same plane - i.e. one knee ends up in front of the other.
  2. you can't put your feet together because your knees overlap.
  3. you have flat feet.
  4. you can't stand with one knee slightly bent without feeling like the knee is quivering or your body is swaying slightly.
  5. when you stand on one leg and bend your knee slightly, your knee does not stay over the middle of the foot - i.e. your knee goes inwards or it wobbles.
  6. you have very tight hamstring muscles.

The pain may be worse when you go up and down stairs or when you sit for a long time with knees bent. The knee may also give way on stairs, or even on the flat, and may make a grating sound. There may be some swelling.

Why does poor alignment cause aching knees?

The kneecap is kept in position by the interaction of the muscles and ligaments around it, as well as being dependent on the thigh and foot positions. The kneecap is like a tent and all the tissues around it like the guy ropes. If the tension is changed in one of the tissues or the thigh bone moves inwards, the tent (kneecap) does not remain centred. The joint lining has no nerves, so there is no pain until the force distribution is altered beyond a certain point. This may take months or even years.

What can be done?

This problem can usually be treated very well without surgery. You will need to see your local physiotherapist who will examine your knee, determine the diagnosis and plan a treatment program for you. You will be shown how to tape your kneecap into the right position, so that you don't have pain, and you will also be shown how to do specific exercises to dynamically reposition the kneecap.

Management of patellofemoral pain is essentially carried out as a home program but you will need to visit the physiotherapist periodically, for monitoring. Progress will vary from one individual to another, so the number of treatments needed, will also vary. A guide would be how well you manage without tape. If you are still getting pain, then you need to stay taped for longer. Tape is like trainer wheels on a bicycle - only necessary while you re-train the knee joint muscles.

When can you return to sport?

You may return to sport immediately with tape on your knee, provided you are pain-free. If you are not pain-free when the tape is on your knee, then you cannot return to sport. However, your physiotherapist will show you ways to maintain your fitness until you can go back to sport. Time out from sport is kept to a minimum, but it is not advisable to train or play with, or through, pain.

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