The knee has limited mobility compared to other joints. It moves forward and backward like a hinge, and can only tolerate a limited amount of twisting motions or side-to-side movements. It is especially prone to injury since it is used heavily during activities such as running, jumping, sprinting, and more.
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The knee functions to allow movement of the leg and is critical to normal walking. The knee flexes normally to about a maximum of 135 degrees and extends to 0 degrees. The bursae serve as gliding surfaces for the tendons to reduce the force of friction as these tendons move. The knee is a weight-bearing joint. Each meniscus serves to evenly load the surface during weight bearing and also aids in disbursing joint fluid for joint lubrication. Posture can contribute to knee pain, especially if the individual is engaged in vigorous activities like running or dancing. Knee pain is rarely an isolated problem; it routinely involves dysfunction in other parts of the lower extremities such as increased tensile stress on the soft tissues known as fascia. As fascia encompasses all muscle groups and all lower extremities pass over or attach at the knee. Overuse of anyone of the muscle groups can cause muscle imbalances or fascial tension and result in knee pain. Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones forming the joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.
Knee injuries are one of the most common athletic injuries. The knee has less mobility than many other joints. Simple moves forward and backward like a hinge, but can tolerate only a very limited amount of side–to–side or twisting motion. Knee sprains are among the most complicated and difficult injuries to rehabilitate. They happen most often in skiers, but can occur during any type of contact sport. Ligaments around the knee can be injured by many things.
- Anterior cruciate ligament (ACL) – Often accompanied by a popping sound, occur when the knee joint rotates violently while the foot is in a flat and fixed position on the ground. ACL is the most frequently injured. Third degree sprains are more common than second or first degree, and some estimates suggest that as many as 85% of ACL sprains involve a complete rupture. The majority of ACL injuries result from sporting activities, particularly those that involve deceleration, twisting, rapidly changing direction or jumping. ACL injuries rarely happen alone. Instead, they coincide with damage to other ligaments such as the MCL or PCL. It is common to have ACL injury in addition to meniscal damage.
- Posterior cruciate and capsular ligament (PCL) – Result when the knee is hyperextended, or forced backward. Most knee injuries and sprains need at least six weeks of recovery time.
- Medial collateral ligament (MCL) – Occurs when the knee is forced inward, for example when someone kicks the outside of the knee.
- Lateral collateral ligament (LCL) – Result when the knee is forced outward over the little toe.
Pain in front of the knee is often associated with activities emphasizing knee flexion and extension, such as running, jumping, climbing or descending stairs, hiking, and squatting. Activities that engage more resistance are likely to create more pain. Especially with sudden changes in activity level, holding the knee in a flexed position for long periods, such as sitting in a movie theater, tends to aggravate symptoms. The knee pain subsides when extended or the person begins to move around again. Other times the knee pain feels like it’s coming from under the kneecap (retropatellar), but is unable to identify a specific site. The tissues under the patella are not necessarily the cause of pain as other tissues could refer pain to the region. Pain is customary in the midst of activity, but can develop with delayed onset—coming on even a full day after activity. Grinding or grating sensations during knee extension might be reported.
IT-Band Friction Syndrome
IT- Band Friction Syndrome is an “overuse” condition caused by the occurrence of an excessive amount of friction between the IT-Band itself and the outside of the knee. Excessive heel and foot pronation (walking like a duck) or bow legged and tightness in IT-band (no stretching program) is major contributors to IT-Band problems and knee pain. Symptoms may include one or more of the following – lateral knee pain, pain can radiate toward the proximal tibia, pain worsens during running, and rest usually relieves the discomfort.
With Chondromalacia Patellae, one may report knee pain, but not necessarily. The condition might have developed in childhood or be an acquired condition, such as one resulting from over pronation. Conditions that could be related to the problem, sometimes results from compressive stress patterns on the ends of the femur and tibia. Activities such as running or jumping indicate repetitive use of the quadriceps group, may indicate knee pain in the front of the knee associated with these activities. Chondromalacia literally means softening of the cartilage and the term is sometimes used to refer to front of the knee pain. But because there is little innervation in the cartilage, it is unlikely that cartilage degeneration is producing the knee pain. The term chondromalacia is best reserved for degenerative conditions in the cartilage and not for Patellofemoral tracking disorder pain.
Patellofemoral Pain Syndrome (PFPS)
Patellofemoral Pain Syndrome (PFPS) is knee pain in front of the knee of variable origin primarily caused by a patellar tracking disorder. While the knee pain of the syndrome is widespread and recognizable, an adequate understanding of the cause has yet to be developed. The condition is moderately frequent, particularly in the athletic population. PFPS is generally considered an early warning sign of chondromalacia patellae, which may develop if the dysfunctional biomechanics of PFPS are not corrected.