Patella pain symptoms, causes and therapy

Pain on the kneecap

Patella pain mainly affects athletic people and people who are kneeling for work. The complaints are primarily when walking downhill, for example, when walking, when climbing and descending stairs, kneeling, standing or sitting long (theater knee, Cinemapain) noticeable. Pain on the kneecap (lat. Patella) is often a result of overloading and goes back after a period of protection of itself.

However, if it is an injury or disease of the patella, e.g. a cartilage damage (Chondromalacia patellae), osteoarthritis-related knee pain or a so-called Patellaluxation in which the kneecap jumps from their leadership, a therapy is required. Depending on the diagnosis, medical, physical and pain therapies can be used. Often also physiotherapy exercises are prescribed. As a rule, surgical interventions are only carried out if the conservative measures do not lead to success.

contents

• Pain on the kneecap
• Illnesses of patellar pain
• symptoms
• Causes of pain on the kneecap
• Patellalateralisation
• Patellaluxation
• Patellaspitzensyndrom
• Patellar pain caused by Plica syndrome
• Chondromalacia patellae
• When is medical help necessary?
• Naturopathy therapies

Illnesses of patellar pain

Retropatellar cartilage damage, patellar dislocation (patellation / dislocation of the patella), patellar lateralization (lateral patellar dislocation), patella crepitus (palpable rubbing behind the patella), patella arthrosis, chondropathia patellae and others.

The pain on the kneecap often occur especially when climbing stairs. (Image: chombosan / fotolia.com)

symptoms

Affected are especially when going downhill and climbing stairs affected by pain in the kneecap. Many people also suffer from pain when kneeling or standing for a long time. The so-called "cinemapain" or "thigh knee" refers to pain that occurs on the kneecap after sitting for a long time.

The pain can occur on, next to and behind the kneecap. Similarly, pain below the kneecap are possible. Often, the complaints of the transitions to bones, ligaments and cartilage occur, which are felt by individuals as punctual and stinging.

Causes of pain on the kneecap

The patella is a flat, disc-shaped, viewed from the front triangular free-running bone that lies in front of the knee joint. It protects the knee joint, reduces the friction of the four-headed thigh muscle and increases its leverage. The patella is connected to the knee joint capsule by tendons, ligaments, and muscles, and slides up and down the femur in a groove when the knee joint is moved.

Due to the high forces in the patellar joint and the lack of a stable bony joint guidance, muscular disorders and defective forms of the plain bearing can lead to severely restricting complaints, which are perceived by those affected as extremely painful. Another cause may be impact injuries and twisting of the knee joint.

The diagnosis of patellar pain is in principle not always easy and often requires examinations that go beyond the knee joint. The function of the kneecap depends, among other things, on the functions of the thigh extensor, the overall stability of the pelvis and the legs, the vascular and nerve supply from the lower back as well as the metabolism in general.

A holistic view of the patient's complaints is therefore particularly important. For example, possible chronic circulatory disorders, back pain, low back pain or buttock pain should be considered in the diagnosis and treatment of the patellar problem. This is the case, for example, in osteopathy.

Patellalateralisation

In a so-called patellar lateralization, the kneecap tends to move laterally due to a slight instability and thus get out of the lane. Frequently, muscle imbalance (dysbalance) is the cause of the displacement tendency, in which the outer muscular components predominate and the kneecap is therefore increasingly pressed to the sides.

By a lateral displacement of the kneecap (Patellalateralisation) it can come to strong pain and rubbing noises. (Image: underdogstudios / fotolia.com)

Patellar lateralization can lead to permanent instability and wear of the articular cartilage (patella arthrosis, Chondropathia patellae) and cause severe pain and audible rubbing noises (crepitations).

In order to prevent permanent damage and signs of wear on the cartilage, especially targeted muscle training and stretching of the shortened muscle groups against the lateral displacement tendency of the kneecap are used. If the purely conservative therapy is insufficient, arthroscopic surgery can be performed to stabilize the movements of the kneecap.

Patellaluxation

As Patellaluxation a dislocation of the kneecap is called. Colloquially, it is also said that "the kneecap jumped out" is. Normally, the first time a petallaluxation occurs as a result of a fall or impact, it is very painful. Bruising in the joint and injury to the internal extensor apparatus (medial retinaculum) may be associated with dislocation of the patella. The cause may also consist of a plant-related flat defect shape of the plain bearing or a ligament and muscle weakness.

Often, children and adolescents are already affected by a patellar dislocation. In order to avoid consequential damage, treatment should be as early as possible. Because similar to a shoulder excursion increases with each further dislocation of the patella, the risk that this occurs again and again. While there is no causal conservative therapy, as with patellar lateralization, proper muscle training and the wearing of certain orthoses can reduce the risk of renewed patellar dislocation.

After a patellar dislocation special bandages and orthoses provide stability, immobilization and guidance of the knee. (Picture: Picture-Factory / fotolia.com)

If these measures are unsuccessful, an operative procedure is often necessary in which a capsule removal or patellar forcing is carried out, so that the path of the patella is specified during movements.

Patellaspitzensyndrom

The so-called patellar tendon syndrome refers to a chronic and degenerative congestive disease of the patellar extensor at the bone-tendon transition of the patella tip. The "jumper's knee" can be very painful, similar to a tennis elbow.

Overuse of the patellar tendon causes hardening and limescale in the tendon insertion on the kneecap. This is caused by repeated strong tensile loads, for example in ball sports and athletics. Those affected complain of pinpoint-like, severe pain, which usually occurs relapsing-like for 15 to 20 minutes.

In order to cure the overload, first of all, protection and a sports austerity are required. Often pain and anti-inflammatory drugs are prescribed and a special bandaging made. Treatment with shockwaves can also be promising. If the degeneration is already advanced and the pain is chronic, an operative intervention is often necessary in which a patellar tendon solution or an excitation of the regeneration process takes place.

Patellar pain caused by Plica syndrome

Patellar pain may indicate the so-called Plica syndrome. These are enlargements and thickenings or folds (plica) of the artificial skin, which swell due to inflammation and lead to painful pinching in the joint.

The wrinkles occur above and below the kneecap, laterally and towards the center of the joint. The consequences are a swollen knee and pain behind the kneecap to overuse and cartilage damage. Those affected report the feeling that the knee is not stable and is sagging or blocked. Cause of wrinkles may be previous injuries, but also overuse of sports such as sports or cycling. Similarly, instability of the knee may be the cause of Plica syndrome.

The therapy consists mainly of protection, physiotherapy and pain-relieving medications. If the knee is swollen, it usually helps to treat it with ice: just put a few ice cubes in a plastic bag and rub the painful area for half a minute. Then heat the area and then repeat the cooling application. The fold can also be removed arthroscopically unless the conservative measures provide relief.

Patella pain as a result of cartilage damage affects mainly adolescents and athletes. (Image: Lars Zahner / fotolia.com)

Chondromalacia patellae

"Chondromalacia patellae" refers to softening and degeneration of the cartilage on the underside of the kneecap. Especially young people and athletes ("Runner's knee") are affected. The pain often occurs on the front of the knee or kneecap. After prolonged sitting or climbing down the stairs, the pain worsens and seems to wander back from the front of the knee.

Among the causes include overuse, trauma, particularly high force on the knee cartilage, dysfunction of the thigh muscles, chronic wear and inflammation of the knee, X-legs, kneecap and ligament weakness.

The treatment of Chondromalacia patellae consists on the one hand of physical therapy and physiotherapeutic exercises. On the other hand, painkillers are administered. Those affected should protect their knee and bend only slightly. Surgical procedures aim to smooth out the frayed cartilage during arthroscopy or to stimulate the formation of replacement cartilage. Depending on the cause of the cartilage damage, other interventions may be necessary, for example in the case of a leg axis error.

When is medical help necessary?

Since kneecap pain can have various causes, sufferers should always consult a doctor to prevent possible subsequent sequelae. The causes of patellar pain listed here are only a selection and do not meet the claim of completeness.

Naturopathy therapies

Naturopathy has long used acupuncture as part of traditional Chinese medicine (TCM) in the treatment of knee and patellar problems. Especially in the treatment of pain, the setting of the fine needles along so-called meridian channels, in which the vital energy (Qi) flows, leads to alleviation of the discomfort. The needles inhibit the pain processing in the spinal cord, so that the actual pain decreases. Often several sessions of acupuncture are necessary until complete pain relief.

In alternative medicine, acupuncture is often used for pain in the area of ​​the knee. (Image: Robin / fotolia.com)

In a knee joint arthrosis, a leech therapy is promising. During the treatment, the leeches remove their saliva (salvia), which contains many health-promoting substances. For example, the enzymes inhibit blood clotting, dilate the blood vessels and counteract inflammation and knee joint pain.

The so-called cupping can relieve knee pain. This is one of the old natural healing methods. The cupping glasses are pulled along the oiled skin along the muscle pathways, which has a lymph-promoting effect. Cupping also affects the painful pathways, so that the pain is breastfed after a few sessions.

Another natural cure for knee pain is Ayurvedic Therapy. It uses ingredients such as lemon, caraway, boxhorn clover and onions. Herbal bags and various warm herbal oils are used in Ayurveda massages to stimulate blood circulation and metabolism. In addition, they release hardening and soften the muscles and tendons.

In addition to the massage treatment, a specific diet is also part of Ayurveda therapy. Another component of what is believed to be the oldest traditional health care system are yoga exercises that teach patients how to strengthen their knee muscles and stimulate their metabolism. Basically, building muscle in most of the symptoms is extremely important to improve joint guidance. (ag, nr, last updated 11.4.2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)