Knee Pain Part I: The Anterior (Front) Knee

Posted by on Oct 2, 2012 in Acupuncture, Blog, Injuries

Knee pain can be a real pain, especially if you’re super active and depend on your knees to stay in shape and have fun.  Before you get panicky and start worrying about surgery or continue to exercise on a knee that could be damaged by further activity it’s a good idea to get a proper assessment.  This post will cover the most common and treatable injuries of the anterior (front) part of the knee to be followed by later posts covering the lateral, medial, and posterior portions.

Begin by identifying the exact area of the pain and the activity associated with aggravation of the injured area.   It should be noted that knee injuries can be either acute and inflammatory, degenerative and ischemic (lack of oxygen flow which is very common in tendon issues), or a combination of both wherein the joint will suffer from pain, damage to the tendon, and swelling in the local area.

Anterior Knee Pain: Patello-femoral joint dysfunction
Location: Pain is felt directly under or around the kneecap.
Signs/Symptoms: Often felt when walking up or down stairs, squatting, kneeling or rising from a seated position.  Clicking or

Incorrect tracking of the Patella

popping (crepitus) may be heard.  The knee may also feel unstable or loose.  Pain can even radiate to the backside of the knee.
Details: A repetitive stress injury characterized by inflammation and irritation of the underside of the patella which results in faulty tracking along the patello-femoral groove.  Chondromalacia (softening of the patella), or anterior compartment arthritis may occur in advanced cases.  Overuse from running or cycling are often precipitating factors.
Differentiation: It is important  to differentiate anterior knee pain as there can be a number of other causes including ligament or meniscus injury, osteoarthritis, bursitis, tendonitis, or ACL, PCL sprain or injury.  Seek professional advice to insure you are treating the correct issue.
Treatment: Anti-inflammatory medications (I recommend Circumin with Bioperine internally and Traumeel externally-See below), temporary decrease in activity, physical therapy/training to address muscle imbalances, acupuncture (usually twice a week for three weeks depending on severity), and hyaluronic acid (Synvisc) injections if healing seems to have hit a plateau.  If all else fails, knee replacement surgery may be necessary.

Anterior Knee Pain: Patellar Tendonitis (Jumpers Knee)
Location: Pain may be felt anywhere along the anterior knee line from the inferior border of the patella to it’s attachment on

the anterior knee

the tibia.
Signs/Symptoms: Pain during rapid acceleration or deceleration, downhill running, jumping, and landing.
Details: A repetitive stress injury where inflammation and irritation of the patellar tendon occurs.  Pain may also be felt with acute trauma.  This injury is often seen in people performing in high intensity sports such as basketball, football, volleyball, trail running or any sports with high impact.
Differentiation: Several other conditions can look similar to patellar tendonitis.  Differentiation from patellar bursitis (inflammation of one of the several bursae of the patella), Osgood-Schlatters which mainly occurs in adolescence where rapid growth causes the tendon avulse (pull away) from the bone at the tuberosity, osteoarthritis, ACL and PCL injury, chondromalacia, and stress fractures can be determined by careful palpation and medical imaging if necessary.
Treatment: Anti-inflammatory medication (see below for recommendations), running in water, biomechanical adjustments, physical therapy and acupuncture twice per week for three weeks in acute situations and once weekly thereafter in chronic conditions.  

Products I recommend for inflammation:
Circumin with Piperine (take 3-5 tablets per day with meals)
Traumeel Topical Anti-Inflammatory (rub on painful area 3-9 times per day)

Remember that there are a myriad of causes for knee pain.  Always work to decrease inflammation through diet, activity modification, supplements, and professional assistance if necessary.  If you have or have had a knee condition please leave a comment below and tell me how you injured your knee and what helped you and what didn’t in your recovery.

References  
Reaves, Whitfield., with Chad Bong. The Acupuncture Handbook of Sports Injuries and Pain., July 2009, Boulder, CO.

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