Knee pain, though common, can signal several ailments

Q: Is pain directly under my kneecap anything to be concerned about?

A: Knee pain is fairly common and can affect people of all ages. Your pain could be the result of an injury or could be a more serious medical condition.

Runner's knee: Pain directly under the kneecap can be attributed to one of several conditions. Among the most common is chondromalacia, also known as runner's knee. It usually happens to people who participate in high-impact exercise, such as running, or sports that require a lot of stopping and starting. Chondromalacia is a softening or thinning of the cartilage under the kneecap. Often, people with chondromalacia may feel a crunching sensation when placing their hand over the kneecap and bending the knee or when climbing down stairs.

Osteoarthritis: A similar crunching sensation may be felt with osteoarthritis of the knee, which typically affects patients over age 50. Osteoarthritis often affects the entire knee rather than just the kneecap area. With osteoarthritis, the cartilage, which serves as a shock absorber, is progressively worn away, exposing bare bone and causing pain.

Jumper's knee: Another common condition is patellar tendinitis, an injury that affects the tendon connecting the kneecap (patella) to the shinbone. Also known as jumper's knee, it is most common in athletes who jump frequently, such as basketball, soccer and volleyball players. Soreness is usually felt just below the kneecap.

Maltracking: If your knee seems to slide out of place, you may have some maltracking or patellar instability. Maltracking occurs when the knee doesn't track in its groove and moves to one side instead. In patellar instability, the kneecap actually pops out of joint.

Treatment: If you have difficulty walking, instability, frequent persistent swelling, or pain that wakes you from sleep, see your family doctor. You may be referred to a doctor specializing in rehabilitation (physiatrist or sports medicine specialist) or joint surgery (orthopedic surgeon).

The mainstay of treatment for most knee pain is nonsurgical. For patients with chondromalacia or patellar tendinitis, surgery is not typically recommended. Instead, patients are usually told to temporarily cease high-impact sports while beginning a physical therapy program.

Physical therapy exercises will help strengthen the muscles around your hip and core, as well as around the knee to make it more stable. Ice and compression should be used to control any swelling. Orthotics and bracing are sometimes helpful, particularly if instability is an issue. Your doctor may also recommend cortisone or hyaluronic acid injections.

Keeping knees healthy

To prevent knee pain from occurring in the first place, maintain a healthy weight, strengthen your hip and core muscles, and listen to your body. Many people ignore pain until it becomes unbearable. Take it easy when pain flares up.

Diane Dahm, M.D., is an orthopedic surgeon at the Mayo Clinic in Rochester, Minn.

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