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Dear doctorXdentist, I would like to seek some advice from you. I’m a 37 year old, female. Recently has been experiencing some pain on my knee cap. Usually the pain comes when I am in a seating position for an example like a bus ride for 30 minutes or more. When I stand up and walk down the steps from the bus, the pain comes. Other than the problem that I mentioned, sometimes the knee cap area will also feel aching or slight discomfort when the area is cold or windy. Please advise what would be the cause of it and what kind of treatment is best for the problem that I have. Thank you.
Thank you for your question – I fully empathise with you symptoms as it’s a very common. As Dr Ethan and Dr Alan have mentioned, there can be many causes for anterior (at the front) knee pain. Rather than go through the causes again, perhaps I could suggest a few simple things to try out when managing your symptoms.
Firstly, stretching; often, we tend to develop tight muscles in the front of our legs (commonly called quads and hip flexors) – when these are tight, it might be pulling he knee cap more tightly into the thigh bone. So a simple measure might be some stretching and you can find many different videos on YouTube – an example is: https://youtu.be/CZBKSOtyssM
Another option is seeing a physiotherapist who can give you some exercises to do to limit the mal-tracking that Dr Alan mentions. It might be that you have ITB tightness, or weakness in the quads (I know this sounds strange after mentioning about tight quads earlier) or hip muscles.
Finally, perhaps consider some activity modification – if you’re a runner and this brings on pain, offload a little and try other methods of keeping fit. This should only be temporary measure until the underlying problem is resolved.
Good luck with you symptoms and hope it clears up soon.
Dr Dinesh Sirisena
Sport Medicine Consultant
Hi Sharon, there are many common causes of knee pain – you will need to get checked up and examined by a doctor.
Some pertinent questions in your situation – any other joints affected, how long you’ve had the pain for, any prior trauma or injury, whether you have a background as a frequent runner etc, can all sway the according possible diagnoses your doctor will have. He will know which questions to ask you to tease this information out.
The fact that you are female and in your 30s would also make me more inclined to rule out some types of auto immune conditions which affect the joints, such as rheumatoid arthritis/SLE etc; especially if you have more than one joint that’s affected, or a family history of autoimmune medical conditions.
Any of the other structures around your knee can also contribute to the pain – this includes the bone, ligaments, and muscle. Examples of common conditions among people with knee cap area pain include Patellofemoral pain syndrome (I suspect this from your story), Patellar tendinitis, Bursitis, or a sprained ligament. Osteoarthritis is also another common cause of resting knee pain (as you’ve described), but it’s more common after the age of 50s, unless you had an injury to the knee before.
When you see your doctor, he will be able to better advise you on what condition you may have, and perform the correct examinations. If necessary, he may also request for an X-ray or an MRI for your knee.
In the interim, you should rest your knee and ice it where possible. Sparing use of oral anti-inflammatories, such as Ibuprofen, will also help with your knee pain. You could also try applying a topical NSAID (Fastum gel) to your knee for pain relief.
Pain at the front of the knee is often due to problems from the kneecap (i.e. patellofemoral joint). This can be due to a number of causes. In young females, the most common causes are:
- Patellofemoral pain syndrome
- Chondromalacia patella
1. Patellofemoral Pain Syndrome
Patellofemoral pain syndrome occurs when nerves sense pain and inflammation in the soft tissues and bone around the kneecap.
In some cases it can be caused by a sudden change in physical activity, improper sports technique or Changes in footwear or playing surface.
Abnormal tracking of the kneecap due to problems in alignment between the hip and ankle, the shape of the groove that the kneecap sits in (trochlear dysplasia), and muscular imbalance / weakness especially of the quadriceps muscles (at the front of the thigh) may contribute to patellofemoral pain syndrome.
2. Chondromalacia patella
Chondromalacia patella is a softening and degeneration of the articular cartilage of the patellofemoral joint as a result of overuse, injury, or abnormal joint mechanics.It may coexist with patellofemoral pain syndrome.
I recommend that you consult a qualified medical specialist who will examine your knees for the above problems and obtain an X-ray.
Initially your doctor may recommend simple painkillers, and refer you to physiotherapy.
For the previously described conditions, surgery is rarely necessary.
Dr Alan Cheung
Consultant Orthopaedic Surgeon