Pain Under Kneecap – Causes, Diagnosis, Treatment And More

Pain Under The Kneecap

The knee joint is a weight-bearing structure of the human body and is, therefore, one of the most important yet complex joints.

Knee pain is a common musculoskeletal complaint affecting both children and adults. This article will help you understand more about pain under kneecap, its causes, treatment and also when to see a doctor for pain under the kneecap.


What Causes Pain Under Kneecap?

Pain under knee cap or around the kneecap is also called as Anterior Knee pain or Patello-femoral pain syndrome. Anterior knee pain or pain under kneecap can be divided into two major groups;

Pain under kneecap can occur due to two major causes – focal lesions or conditions that can be distinctly identified either clinically or on the basis of radiological tests such as overuse, trauma, tumors, and dysplasias (abnormal growth or overgrowth of tissues) or Obscure lesions, that is, pain due to conditions that cannot be defined.

Some possible causes for pain under kneecap include;

  1. An unusual or sudden increase in activity such as climbing stairs or prolonged sitting
  2. Poor movement of the hip, knee or the foot
  3. Poor strength or imbalance of muscles of the hip joint or the legs.
  4. Excessive tightness of muscles of the back, hips, and knee
  5. Poor movements especially while lifting heavyweights
  6. Change of footwear
  7. Incorrect or worn-out footwear

Diagnosis For Pain Under Kneecap

Diagnosis of pain under the kneecap or patellofemoral pain syndrome can be done with the help of clinical examination as well as radiological tests.

1. Physical Examination

During a clinical examination, your doctor will enquire about your signs and symptoms, duration, severity, and intensity of pain. Your doctor may lightly press over the kneecap to know the amount of swelling.

A physical examination may also include the following;

  • Position of kneecap and alignment of the lower leg
  • Stability of knee and hip joint
  • Range of movements of the knee and hip joint
  • Attachment of muscles of the thigh to the kneecap
  • Strength, flexibility, and tone of muscles of the hips and thighs
  • The flexibility of the feet

2. Radiological Examination

Otello-femoral pain syndrome can be diagnosed with the help of a physical examination itself. Yet, radiological tests such as an x-ray or a CT or MRI scan may be advised by your doctor to rule out damage to the knee joint, kneecap or to the tissues and ligaments supporting it.


Treatment For Pain Under Kneecap

Treatment of pain under kneecap includes a combination of both medications as well as physical therapy. Treatment for pain under kneecap aims as reducing the pain while addressing the underlying cause for it.

The standard protocol for managing any kind of musculoskeletal pain and swelling is the RICE method. RICE stands for;

1. Rest

Avoid any excess pressure on the affected knee. Restrict activities that may worsen pain


2. Ice

Use ice packs for 15-20 minutes several times a day. Be careful to not apply ice directly on the skin.


3. Compression

Lightly wrap the affected knee in an elastic bandage. Compression prevents additional swelling.


4. Elevation

As often as possible rest with the affected knee above the level of your heart

Some ways to treat pain under kneecap include;


1. Control Of Pain And Swelling

  • Icing the affected joint a few times a day for 10-15 minutes.
  • Avoid activities that put excessive strain on the knees such as squatting, kneeling or over-lifting.
  • Medications like pain killers and non-steroidal anti-inflammatory drugs (NSAIDs) may be helpful in relieving pain. You need to consult your doctor regarding the type of medicines suited to you for pain management.

2. Stretching

Certain stretching exercises help to relieve pain and discomfort. Stretching can be done even if you are not exercising daily. It is however advised to consult a qualified physiotherapist to learn the proper methods of stretching; else you might end up aggravating your complaints.

Stretching exercises for pain under kneecap are;

Hamstring Stretch

  • Lie down and raise the leg straight against a wall. Hold for 2 minutes.
  • Continue to stretch until feeling tingling or numbness.


Quad And Hip Flexor Stretch

  • You will need a towel or a belt to do this stretching exercise.
  • Lie down on your abdomen and fold the knee
  • Use the towel or belt to stretch the knee towards your head.
  • Continue pulling until start feeling a stretch in your hip joint. Hold for 2 minutes and slowly release.

3. Strengthening

Follow strengthening exercises of the hip and knee joint to improve joint stability and also to allow resuming routine activities gradually.

Just like stretching, strengthening exercises must also be learned from a qualified physiotherapist to avoid worsening of pain and discomfort.

Strengthening exercises for pain under kneecap include;


Straight Leg Raises

  • Lie down on your back. Lift up one leg keeping the leg straight at the knee joint.
  • Follow 3 sets of 15 repetitions for each leg.


Outer Hip Raise

  • Lie down on the side.
  • Raise the outer leg keeping it straight at the knee joint.
  • Follow 3 sets of 15 repetitions each.

4. Prevention

Routine work and activities can be resumed gradually as the pain subsides.

Prevent worsening of signs and symptoms, or if the pain has reduced, take measures to prevent re-occurrence of complaints by;

  • Avoid extreme activities such as over-exertion, over lifting
  • Avoid activities which might trigger a knee pain or worsen it
  • Warm-up thoroughly before beginning exercising
  • Use shoe inserts to enhance the stability and alignment of the foot and ankle
  • Change footwear if they are worn out
  • You may also consult your physiotherapist for opinions on wearing suitable footwear
  • Reduce any activities that may worsen pain under the kneecap
  • Maintain a healthy body weight to reduce weight-bearing stress over the knees

When To See A Doctor?

Generally, medicines and exercises are advised by the doctor for a few weeks. If the pain and discomfort of the kneecap do not subside, you need to visit the doctor and the physiotherapist again.

Although it is normal to feel some soreness and fatigue after exercising, you must discontinue exercises if you notice worsening of pain and report to the doctor immediately.

To summarize, you must visit the physician if;

  1. The signs and symptoms do not subside within 2-4 weeks of treatment
  2. Signs and symptoms worsen in spite of medications and physiotherapy
  3. Presence of fever along with complaints; also, fever that does not respond to medications
  4. Increase in swelling and redness of the affected knee joint
  5. Presence of rash along with joint pain and fever
  6. You must also visit the doctor for pain under kneecap if you notice a significant reduction in the range of motion of the joints including the knee joint, hip, and ankle joint

Author:

Dr. Himanshi Purohit

Dr. Himanshi is a Homeopathic consultant currently working as a lecturer in Post-graduate faculty of Homeopathy, Parul University, Vadodara.