Medical Edge Newspaper Column

Strengthening and Stretching May Help With Kneecap Pain

March 27, 2008
Dear Mayo Clinic:
I have pain across my kneecaps, and I don't know whether I should exercise or stretch more or just take it easy to save wear and tear. Can you advise?

Answer:
Pain in the kneecap (patella) area is a common problem with many possible causes. Whatever the cause, the pain can often be managed with a combination of stretching and strengthening exercises, self-care measures and modified activity.

The patella is one of four bones that make up your knee joint. The others are the large thigh bone (femur) on the top, and the lower leg bones (tibia and fibula) on the bottom. Tough bands of fibrous tissue (ligaments) hold the bones in place. As you bend and straighten your knee, the patella slides back and forth in a groove on the end of your femur. Kneecap pain usually results from the patella not aligning properly in that groove, causing stress between the patella and femur.

A number of conditions can result in malalignment of the patella, including flat feet, weak hip muscles, a difference in the length of your legs, tight muscles in the front and back of your upper leg, weak front thigh muscles (quadriceps), or tightness in the thick fibrous cords that attach your muscles to bones (tendons). Osteoarthritis can also cause kneecap pain.

The first step to relieving the pain is to identify and treat the underlying cause, if possible. If overactivity is causing the problem, temporarily modifying some of your activities may work. In addition, stretching and strengthening exercises for your thigh and hip muscles may rebalance the forces around the knee and relieve your symptoms. A physical therapist can evaluate the situation and formulate an exercise program for you. In some cases, arch supports can reduce kneecap pain caused by flat feet, and a heel lift can decrease pain caused by leg-length differences. If knee osteoarthritis is to blame, various treatments, including exercises and medication, are available to decrease kneecap pain.

You also can decrease the pain by putting ice on your knee for 15 to 20 minutes several times a day and taking an over-the-counter pain reliever, such as acetaminophen or ibuprofen. In some cases, a knee brace or sleeve can also provide helpful support. And, of course, you should try to avoid activities that cause pain.

I encourage you to talk to your doctor or a physical therapist about your pain. Either health care provider can explore the underlying cause, offer specific treatment recommendations, and show you the appropriate stretching or strengthening exercises. Your provider can also prescribe braces, arch supports and heel lifts, as appropriate, and help determine if you should modify your activity.

— Jay Smith, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.