Kneecap pain causes

What is kneecap pain?

Kneecap pain is any type of pain or discomfort in the kneecap. Pain may range from a dull ache to a sharp or severe pain and may be present all of the time, come and go, or get worse when you do certain activities.

Let’s take a look at what could be causing your kneecap pain, how to treat it yourself at home, and when to see a consultant.

What is the kneecap and how does it work?

The kneecap, or patella, is an oval-shaped bone at the front of the knee that covers the knee joint. It helps to connect the upper leg to the lower leg. The function of the kneecap is to protect the knee joint, support the muscles, ligaments and tendons of the knee, and allow movement of the knee joint.

The kneecap is connected to the quadriceps (thigh) muscle by the quadriceps tendon and to the tibia (shin bone) by the patellar ligament. It rests inside the patellar/trochlear groove, a groove in the thigh bone (femur) that allows the kneecap to glide up and down as the knee moves. The back of the kneecap is lined with a thick layer of cartilage that allows it to withstand the large forces that are often placed on the knee.

What could be causing my kneecap pain?

Kneecap pain may have several causes, including damage to the bone, muscles, tendons, ligaments, or cartilage.

Some common causes of kneecap pain include:

Injury

An injury to the kneecap, such as a blow or fall, is a common cause of kneecap pain. An injury to the kneecap may be minor and involve soft tissue damage and bruising, or may result in a more serious injury, such as a fracture, dislocation, sprain, strain, tendonitis, or damage to the ligaments or cartilage.

Treatment for a knee injury depends on the type of injury.

Overuse

Our knees take a lot of the impact when we perform movements such as walking, running, jumping, squatting, kneeling, and kicking. Repetitive movements that put pressure on the knee over time can cause irritation and knee pain.

Treatment for knee pain from overuse is with RICE therapy and avoiding or limiting the activity that caused the knee pain.

Sprain or strain

A strain occurs when a muscle is stretched or torn. A sprain is when a ligament (a band of connective tissue that connects bone to bone) is stretched or torn. Sprains and strains are common during activities such as sports.

Strains and minor sprains can usually be treated with non-steroidal anti-inflammatory drugs (NSAIDs), RICE therapy, and, in some cases, physiotherapy. Severe sprains may need surgery to repair the damaged or torn ligament.

Patellofemoral pain syndrome (runner’s knee)

Patellofemoral pain syndrome (PFPS) is a condition that causes a dull pain under or around the kneecap. Pain is often worse after activity or sitting for a long time with the knee bent. You may hear a cracking or popping sound in your knee joint when you stand up or climb stairs.

PFPS can affect anyone but is most common in females, young adults, and people who take part in sports that involve a lot of running, jumping, and squatting. Chondromalacia patellae (softening and breakdown of the cartilage in the knee) is sometimes present in patellofemoral pain syndrome.

PFPS can have many causes, including:

• The way your knee is structured
• How you walk and run
• Weak knee muscles
• Overuse of the knee joint
• Not warming up before sports or activities
• Using the wrong technique or equipment during sports or activities
• Playing sports on a hard surface
• Wearing the wrong footwear when taking part in sports or activities
• Injury

PFPS is normally treated by avoiding activities that make it worse, RICE therapy, NSAIDs, physiotherapy and orthotics or shoe inserts.

Chondromalacia patellae

Chondromalacia is a condition where the cartilage that protects the bones, softens, and breaks down. It can affect any joint but is most common in the kneecap. In severe cases, the cartilage can break down completely, leaving the ends of the bones exposed and causing them to rub against each other. Fragments of cartilage can also float inside the joint, causing irritation and a buildup of fluid inside the joint (joint effusion).

Chondromalacia patellae can have several causes, including:

• Overuse of the knee joint
• Trauma such as a knee fracture or dislocation
• Weak muscles around the knee joint
• Bones or muscles that are not properly aligned (in the correct position)
• Osteoarthritis or rheumatoid arthritis
• Injury to the meniscus (a type of cartilage inside the knee joint)
• Infection in the knee joint
• Bleeding in the knee joint

Chondromalacia patellae is normally treated by avoiding any activities that make it worse, RICE therapy, NSAIDs, physiotherapy and, in severe cases, surgery.

Patellar fracture

A fracture or break in the kneecap can occur from a blow or fall directly onto the kneecap. A simple Patellar fracture can be treated by immobilising the knee joint in a cast or splint until the fracture heals, but most kneecap fractures need surgery to repair them.

Symptoms of a patellar fracture include:

• Severe pain to the kneecap
• Swelling
• Bruising
• Inability to straighten the leg
• Inability to stand or walk

Dislocated kneecap

The kneecap normally sits in a groove (the patellar/trochlear groove) in the thighbone. A dislocation is when it moves out of this groove. A dislocated kneecap is normally caused by trauma, such as a collision, fall, or sudden twist of the knee. Treatment for a dislocated kneecap is to put the kneecap back into the correct position, either with a procedure called a closed reduction, or with surgery.

Symptoms of a dislocated kneecap include:

• Hearing a pop when the injury occurs
• Severe pain
• Swelling
• Bruising
• The knee may ‘lock’, and you will be unable to bend or straighten it
• Inability to walk or stand (the knee will buckle when you try to put weight on it)
• The knee may appear deformed

Patellar tendonitis (jumper’s knee)

Tendonitis is inflammation of the tendons, bands of connective tissue that join muscles to bones. In patellar tendonitis, the patellar tendon becomes inflamed due to overuse, such as repeated jumping on hard surfaces. The condition is common among athletes.

Symptoms of patellar tendonitis include:

• Pain, especially when walking, running, jumping, bending, or straightening the leg
• Swelling
• Tenderness behind the lower part of the kneecap

Patellar tendonitis is normally treated with RICE therapy, NSAIDs, and physiotherapy.

Patellofemoral arthritis

Patellofemoral arthritis occurs when cartilage in the groove that the kneecap rests in, wears down, and becomes inflamed. Common causes include overuse, dysplasia (when the patella doesn’t fit properly into the groove) or a previous kneecap fracture or dislocation.

Symptoms of patellofemoral arthritis include:

• Pain
• Stiffness
• Swelling
• Creaking or crackling in the knee joint (crepitus)

Initial treatment for patellofemoral arthritis is normally with NSAIDs, cortisone injections, physiotherapy and sometimes an injection of a substance to increase fluid in the joint. If your patellofemoral arthritis doesn’t improve with these treatments, surgery may be needed to repair or replace the knee joint.

Osgood-Schlatter’s disease

Osgood-Schlatter’s disease is a common condition in growing adolescents that causes inflammation of the growth plate just below the knee. It often occurs during growth spurts (rapid periods of growth) and is most common in girls aged ten to thirteen and boys aged twelve to fourteen. Osgood-Schlatter’s disease usually affects children who participate in a lot of sports, especially those involving running and jumping, though it can also affect less active children.

Symptoms of Osgood-Schlatter’s disease include:

• Knee pain, especially after sports or activity
• Limping after participating in sports
• Tenderness
• Swelling
• Tight thigh muscles

Treatment for Osgood-Schlatter’s disease includes over-the-counter painkillers, NSAIDs, stretching exercises, and applying ice packs to the affected area. Symptoms usually disappear when the child stops having growth spurts (around 14 years of age in girls and 16 in boys).

How can I treat my kneecap pain at home?

Minor knee pain can often be treated at home using the RICE method. This involves:

• Rest — rest the affected muscle or joint until pain and swelling improve
• Ice — apply an ice pack, or a bag of frozen peas wrapped in a cloth to the affected area for around 10 minutes a few times a day. This will help to reduce pain and swelling
• Compression — apply a compression bandage to the affected joint or muscle. The bandage should be tight enough to provide support, but not so tight that it restricts blood flow to your lower leg and feet
• Elevation — keep your leg elevated to, or above, the level of your heart to reduce swelling

Other home treatments for kneecap pain include:

• Over-the-counter painkillers like paracetamol
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Heat packs

When should I see a doctor?

Sometimes kneecap pain needs medical treatment. Make an appointment with a doctor if you have:

• Injured your knee from a forceful impact
• Severe pain, pain that gets worse or doesn’t get better after a few days of home treatments
• Redness, tenderness, and heat around your knee
• Sudden swelling
• Pain when you walk

Go to the hospital immediately if:

• Your knee appears deformed (an unusual shape), and you can’t move it properly
• You heard a pop or snap when you injured your knee
• You can’t bend or straighten your knee
• You can’t stand or walk

Prevention of kneecap pain

Sometimes kneecap pain can’t be avoided, but there are a few things you can do to reduce your risk, including:

• Maintain a healthy weight — losing weight or keeping your weight within healthy limits will reduce pressure on your knees and make knee problems less likely
• Warm up properly before exercise — warming and stretching your muscles before and after exercise can reduce the risk of injury. Stretching the muscles at the front and back of the thighs decreases tension in the tendons, which relieves pressure on the knees
• Wear sensible shoes — wearing shoes that fit properly with a low heel (maximum 1 to 2 inches) helps keep your legs and back in the correct position, helps you balance, and reduces the risk of knee pain
• Choose low-impact exercises — exercises that put less pressure on your knees include swimming, walking, gentle cycling, and aqua aerobics
• Strengthen your leg muscles — strong leg muscles help to support your knee joint and reduce the risk of injury
• Stay active — keeping active is important to keep your knee joint strong and flexible, as well as great for your overall health!
• Increase activity gradually — if you increase or change your exercise routine, do it gradually to give your joints time to adapt

Summary

Our knees support the weight of our upper body and take a lot of pressure and wear and tear as we move. Kneecap pain is a common problem that can prevent you from moving around and impact your quality of life. Fortunately, kneecap pain can be treated in several ways, many of which you can do yourself at home.

If you are worried about your kneecap pain, or it isn’t improving with home treatments, make an appointment to see a physiotherapist or consultant.