Knee Cap pain

[mars76]

Hi All,

I have been playing Tennis for quite some time and plays 5 hours a week on a regular basis.

Few days back i played for couple of hours went to bed and woke up and felt pain in the knee cap.

While walking i feel the pain in my knee and the next day i played for three more hours and while playing i didn't feel any thing.

Wondering what might have gone wrong. Is this normal. I still feel pain when i walk in both my knees..

 

[r2473]

I feel the same thing a few days after failing to pay my bookie (come on Giants.....pleeeeease).

 

[charliefedererer]

It sounds like it could be chondromalacia patella, although there are other possibilities:

Here is what the Mayo Clinic has to say about chondromalicia patella:

"The cartilage under your kneecap (patella) is a natural shock absorber. Overuse, injury or other factors may lead to a condition known as chondromalacia patella — a general term indicating damage to the cartilage under your kneecap. A more accurate term for chondromalacia patella is patellofemoral pain syndrome.

The most common symptom is knee pain that increases when you walk up or down stairs. Simple treatments — such as rest and ice — often help, but sometimes physical therapy or even surgery is needed to ease patellofemoral pain.

Symptoms:

Patellofemoral pain syndrome usually causes a dull, aching pain in the front of your knee. This pain can be aggravated when you:

Walk up or down stairs
Kneel or squat
Sit with a bent knee for long periods of time
You may also experience a grating or grinding sensation when you extend your knee.

Causes

Doctors aren't certain what actually causes patellofemoral pain syndrome, but it's been associated with:

Overuse. Repetitive stress on your knee joint — such as that sustained during running or jumping sports — may result in patellofemoral pain.
Misaligned bones. Patellofemoral pain can occur if the bones in your knee or foot aren't aligned properly.
Injury. Trauma to the kneecap, such as a dislocation or fracture, has been linked to patellofemoral pain syndrome.

Treatments and drugs

Treatment of patellofemoral pain often begins with simple measures. Rest your knee as much as possible. Avoid any activities that increase the pain, such as climbing stairs.

Medications
If needed, take pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory pain relievers, such as aspirin or ibuprofen (Advil, Motrin, others).

Therapy
A physical therapist may suggest:

Rehabilitation exercises. Specific exercises can strengthen the muscles that support your knees and control limb alignment, such as your quadriceps, hamstrings and the muscles around your hips (especially the hip abductors).
Supportive braces. Knee braces or arch supports may help protect your joint and improve the alignment of your kneecap.
Taping. Your physical therapist may show you how to tape your knee to reduce pain and enhance your ability to exercise.
Ice. Icing your knee after exercise may be especially helpful.
Knee-friendly sports. During your recovery, you may want to restrict your activities to more knee-friendly sports — such as bicycling and swimming."
- http://www.mayoclinic.com/health/chondromalacia-patella/DS00777/DSECTION=treatments-and-drugs


From the symptoms, does it seem like this might be what you have?

 

[ATP100]

I would give you some advice that I received almost 40 years ago. But a moderator might call me stupid.

http://tt.tennis-warehouse.com/showthread.php?t=408904

 

[jk816]

Hi All,

I have been playing Tennis for quite some time and plays 5 hours a week on a regular basis.

Few days back i played for couple of hours went to bed and woke up and felt pain in the knee cap.

While walking i feel the pain in my knee and the next day i played for three more hours and while playing i didn't feel any thing.

Wondering what might have gone wrong. Is this normal. I still feel pain when i walk in both my knees..

I love CharlieFederer’s replies (I’m a data hound and love the detail!)

My personal experience, which doesn’t differ widely from yours, also relates to chrondromalacia, but in my case of the trochlear grooves of the femur (mine was diagnosed at grade IV, which is partially exposed bone). I presented with anterior knee pain when going up/ down stairs, getting up from a chair, etc, and subluxation of the patella when going downstairs. The subluxations were pain free (the popping/catching felt ugly but painless). But during activity (tennis, skiing) the pain rarely flared.

After many Ortho visits and numerous PT sessions: VMO work, ART, McConnell taping, etc, I came to realize on my own that the knee pain was directly associated with hamstring tightness. In talking with the PT, he said this could happen if the tightness in the hamstring was compressing the patella into the trochlear groove (cartilage itself was demonstrated not to have a pain response by Dr. Scott Dye’s effective but insane experiment on himself; the bone and synovial lining were however quite pain sensitive!).

In my own observations on myself, whenever I feel patellar pain, I check my hamstring flexibility, and almost always can’t get within 12 inches of my toes. I do some stretches, get my hands almost flat on the floor, and the pain is gone. It also tends to explain why I rarely feel the pain during play (only during the deepest knee flexion and loading- desperate gets!), for when I’m playing I’m usually well loosened up. Note: in observing this I have also noted at different times Achilles or low back pain, all of which can be related to tight hammys—they are all connected.

So check the muscle tightness in the back of your legs (calves too) when you feel your pain, the solution may be simple. My problem is the chronic tightness; I can get loose but cannot stay that way when not being athletic. And chondromalacia is quite possible but need not be the source of pain. I have it bad, but am pain free when loose enough.

Good luck.

 

[charliefedererer]

I would give you some advice that I received almost 40 years ago. But a moderator might call me stupid.

http://tt.tennis-warehouse.com/showthread.php?t=408904

Actually, the "jumper's knee" [patellar tendinitis] that it sounds like you were suffering from is a definitely a condition worth considering.

But it occurs at the bottom of the kneecap where the patellar tendon inserts.
[It seems to be the condition Rafa is troubled with, and is helped by wearing those thin patellar tendon bands or taping.]

So when the OP mentioned that the pain was "in the kneecap" I thought of chondromalacia patella, as the pain comes from the posterior surface of the kneecap.

But mentioning the common "jumper's knee" may cause the OP to reconsider exactly where the pain is occurring, and hopefully bring him some relief.

 

[charliefedererer]

I love CharlieFederer’s replies (I’m a data hound and love the detail!)

My personal experience, which doesn’t differ widely from yours, also relates to chrondromalacia, but in my case of the trochlear grooves of the femur (mine was diagnosed at grade IV, which is partially exposed bone). I presented with anterior knee pain when going up/ down stairs, getting up from a chair, etc, and subluxation of the patella when going downstairs. The subluxations were pain free (the popping/catching felt ugly but painless). But during activity (tennis, skiing) the pain rarely flared.

After many Ortho visits and numerous PT sessions: VMO work, ART, McConnell taping, etc, I came to realize on my own that the knee pain was directly associated with hamstring tightness. In talking with the PT, he said this could happen if the tightness in the hamstring was compressing the patella into the trochlear groove (cartilage itself was demonstrated not to have a pain response by Dr. Scott Dye’s effective but insane experiment on himself; the bone and synovial lining were however quite pain sensitive!).

In my own observations on myself, whenever I feel patellar pain, I check my hamstring flexibility, and almost always can’t get within 12 inches of my toes. I do some stretches, get my hands almost flat on the floor, and the pain is gone. It also tends to explain why I rarely feel the pain during play (only during the deepest knee flexion and loading- desperate gets!), for when I’m playing I’m usually well loosened up. Note: in observing this I have also noted at different times Achilles or low back pain, all of which can be related to tight hammys—they are all connected.

So check the muscle tightness in the back of your legs (calves too) when you feel your pain, the solution may be simple. My problem is the chronic tightness; I can get loose but cannot stay that way when not being athletic. And chondromalacia is quite possible but need not be the source of pain. I have it bad, but am pain free when loose enough.

Good luck.

Thanks for posting, not only as a potential specific cause of the OP's problem, but as a bigger warning to tennis players to try and do some off court conditioning and stretching.

"Like all competitive sports, tennis places uneven demands on the body. You swing with one arm and one side of the body. Certain muscle groups are overworked while others are neglected.
Infamous over-use injuries like tennis elbow and damage to the rotator cuff muscles are less likely to occur in a balanced physique"
- http://www.sport-fitness-advisor.com/tennis-strength-training.html

And from all the split stepping, side stepping and short sprints in tennis, more demands may be placed on some muscle groups in the leg than others.

So an off court conditioning program http://www.sport-fitness-advisor.com/tennis-training.html and stretching program to maintain flexibility http://www.sport-fitness-advisor.com/flexibilitytraining.html
can go a long way to prevent many of the common maladies that players post in this section.

I also realize that many don't have the time/inclination to follow a gym based program like that in Sports Fitness Advisor http://www.sport-fitness-advisor.com/flexibilitytraining.html

For those looking for an at-home-based exercise/stretching regimen with essentially no equipment it's hard to beat Tennis Fitness for the Love of it: A Mindful Approach to Fitness for Injury-free Tennis by Suzanna McGee
http://www.amazon.com/Tennis-Fitnes...9960/ref=sr_1_1?ie=UTF8&qid=1328290593&sr=8-1

 

[rodgerizsik]

My doctor just diagnosed me with chondromalacia patella, said it started developing from tennis, but doing squats and recently starting to workout my legs is what sort of set off the pain associated with it. I have been in physical therapy for 2 weeks and I am also 100%, look to get back onto the courts this coming week. Basically I do some quad, hammy, hip, and foot strengthening exercises to put less stress on the knee. Most of my pain comes when I am sitting when I get up I feel a sharp sudden pain that goes away right away, also a lot of clicking sounds from my knee. If that is what you are experiencing you probably have this too and should get some PT

 

[Chas Tennis]

knee pain references - patellar-femoral pain

Some links with various knee conditions.
http://www.hopkinsortho.org/conditions_diseases.html

Patellofemoral pain
http://www.hopkinsortho.org/patellofemoralpain.html

http://www.aafp.org/afp/2007/0115/p194.html

I guess that most often patellar femoral pain is an arthritic problem from years of use but maybe also a tight rectus femorus - I believe that mine was.

See

http://www.mrtherapy.com/articles/article3.html

WARNING: This stretch involves hip flexors which attach to the lower spine. The stretch could stress or injury the back.

Basically it is a quad stretch, such as the standing quad stretch, where you make sure that you have your hip extended which stretches the rectus femorus (the only quad muscle that attaches above the hip). (I believe that Todd Ellenbecker also mentioned the same hip extension emphasis on Tennis Channel's Fit to Hit.)

I asked for a posture evaluation especially to lessen conditions that might have contributed to my MRI finding:

"PATELLAR CARTILAGE: Multifocal high-grade defects seen along the medial facet and medial ridge with underlying endema."

In my posture evaluation, the Dr (Dixit, author above) said that quad imbalances can lead to poor patella tracking. In researching this point I found the mrtherapy website. I did not stretch my quads for years. From my range of motion I believe that my rectus femorus was tight/short. After 4-5 weeks of stretching my upright standing posture improved and my knee pain was almost gone. My physical therapist also said that many people develope this condition which shows in their posture. Our lifestyle of sitting so much shortens this muscle and active tennis does not help.

Again, take great care considering your back if you consider the stretch.

 

[mars76]

Thanks a lot for such a detailed explanation...

I will use athletic tape next time. I didn't feel any pain after that day. (Again i haven't played tennis all these days)..

 

[r2473]

I feel the same thing a few days after failing to pay my bookie (come on Giants.....pleeeeease).

Knees feeling fine today.......

 

[Lefty5]

its simply a result of your inner quads being weaker than your outer quads and it messed up the track of your kneecap. Your best shot is to strenghten the inside of your quad (VMO). Wall squats at varying angles will quickly take care of it. Do them whenever possible.

 

[danno123]

I have had knee pain in my left knee off and on for almost a year. I finally got off my butt and saw a sports medicine doc. He found the problem in about 15 minutes. He had me sit on a table and flex my quad/lift my leg and I could see that my vmo was firing in my right leg but not firing in my left. I start physical therapy tomorrow and hope that they can sort this out.

 

[Chas Tennis]

reference on VMO problems

I have had knee pain in my left knee off and on for almost a year. I finally got off my butt and saw a sports medicine doc. He found the problem in about 15 minutes. He had me sit on a table and flex my quad/lift my leg and I could see that my vmo was firing in my right leg but not firing in my left. I start physical therapy tomorrow and hope that they can sort this out.

Reference Vastus Medialis Oblique (VMO) misfiring

http://www.sportsinjurybulletin.com/archive/patello-femoral-syndrome.html

Nerve misfiring sounds like one of the more tricky issues. Please let us know how you do.

 

[charliefedererer]

It's interesting to me how so many overuse problems seen in tennis could have been prevented - or can be corrected - with off court conditioning.


Squats fire all of the leg muscles sequentially, training the nerves and muscles.


Many people are scared off from squats because of the body building images of those stacked weight plates.

But the sad fact is that many can not even do a body weight squat.

And it is just a small step up to start doing squats with dumbells, and work the weight up over time:

Many fail to realize the biggest benefit from any off court training program is the initial gain in functionality and prevention of injury.

 

[charliefedererer]

My doctor just diagnosed me with chondromalacia patella, said it started developing from tennis, but doing squats and recently starting to workout my legs is what sort of set off the pain associated with it. I have been in physical therapy for 2 weeks and I am also 100%, look to get back onto the courts this coming week. Basically I do some quad, hammy, hip, and foot strengthening exercises to put less stress on the knee. Most of my pain comes when I am sitting when I get up I feel a sharp sudden pain that goes away right away, also a lot of clicking sounds from my knee. If that is what you are experiencing you probably have this too and should get some PT

Were you doing your squats with your toes pointed out?

If the knees are pointed straight forward there will be more firing of the medial part of your quads as you go down/come up - that will result in the medial part of the quads pulling the kneecap medially - and could have been a contributor to your problem.

Any chance you have flat feet and need arch support? (If your ankles sag in when doing a squat, or running, that will cause the medial quads to do most of the work, and cause abnormal tracking of the patella for the same reason above.)

In retrospect, do you think you pushed your exercise program too quickly? (It takes time for the muscles/tendons/ligaments to adapt to new movements - that's one reason why I like the Sports Fitness Advisor starting relatively slow with a 6 week pretty tame 6 week, only 2-3 set "Foundation Strength" phase.

 

[r2473]

^^ I've found "pistol squats" or one-legged bodyweight squats to compliment tennis better than barbell squats.

It's also nice that you can do them ANYWHERE.

http://www.youtube.com/watch?v=MLBAbqEZIeU

You can even make these easier when you start by hanging on to something for support and assistance. It is also easier if you have your off-leg behind you instead of in front of you.

Progress slowly and you'll be doing the full pistol in no time.

 

[charliefedererer]

I have had knee pain in my left knee off and on for almost a year. I finally got off my butt and saw a sports medicine doc. He found the problem in about 15 minutes. He had me sit on a table and flex my quad/lift my leg and I could see that my vmo was firing in my right leg but not firing in my left. I start physical therapy tomorrow and hope that they can sort this out.

Are you right handed?

Do you load great on your right leg (especially along the medial aspect of your quads) for your forehand?

But don't load up on your left leg nearly as much (or at all) on your backhand?

Could you also let us know if your what your therapist recommends for exercises? (bet it will include some squats.)

Could you let us know what your therapist thinks about seated leg raises as an exercise to strengthen the quads? (bet he'll say he hates them because they set up a situation where the patella is literally dragged across the back of the femur - causing chondromalacia patella http://www.menshealth.com/mhlists/avoid_lifting_injuries/The_Seated_Leg_Extension.php )

 

[charliefedererer]

^^ I've found "pistol squats" or one-legged bodyweight squats to compliment tennis better than barbell squats.

It's also nice that you can do them ANYWHERE.

http://www.youtube.com/watch?v=MLBAbqEZIeU

You can even make these easier when you start by hanging on to something for support and assistance. It is also easier if you have your off-leg behind you instead of in front of you.

Progress slowly and you'll be doing the full pistol in no time.

I am sure you are right that pistol squats are great for tennis players.

After noting that too many can't even do two legged body weight squats, the barbell squats with light barbells were meant only to be a possible progression to the next level in squatting. I was thinking of pistol squats more as a next step after barbell squats, but you are right of course that assisted pistol squats could be natural progression - with the "can do anywhere" advantage inherent in a body weight exercise.