Patient Education

Heel Pain (Plantar Fasciitis)


Knee Pain (Patella-Femoral Syndrome)


Tennis Elbow (Lateral Epicondylitis)


Knee Pain (Patella-Femoral Syndrome)

Overview

The patella-femoral joint (under the kneecap) receives pressure during knee bending activities. This can cause pain due to softening of the cartilage underneath the kneecap or inflammation of the surrounding tendon and tissue. Patella femoral disease is an overuse syndrome and its impact on your mobility will depend on the extent of your damage and success of your rehabilitation exercises.

This pain leads to favoring the knee and causes secondary atrophy of the quadricep muscles. This is the muscle in the front of the thigh that attaches to the kneecap and gives the knee most of the strength.

Exercises

Recommended exercises strengthen the quadricep and need to be done without bending the knee past 30 degrees.

Straight leg lift: Slowly raise the straight leg 6 inches above the ground, hold for 10 seconds and lower. Do 25 repetitions 3 to 4 times daily. As it becomes easier, add 1 to 5 pound ankle weights.

Short arc quad: Place a rolled towel or folded pillow under the knee. Add ankle weight. Straighten knee and keep straight for 10 seconds, relax. Do 25 repetitions 3 to 4 times daily.

Aerobic conditioning: Swimming and using a Nordic Track machine is recommended. Some patients can ride bicycles as long as the seat is raised and the gears are used well. Running is sometimes tolerated, but avoid hills.

Nautilus machines: Nautilus machines can be used to strengthen the quadricep if the exercise arc is limited to full extension (straight) to 30 degress flexion (bend).

Avoid:

  • Deep knee bends
  • Squats
  • Stairmaster
  • High impact aerobics
  • Going up and down stairs
  • Running, especially up and down hills

Pain:

Anti-inflammatory medications, such as ibuprofen (600 mg. 3 times daily) can be taken for pain and swelling. Ice your knee after activity. Please be patient. Often patella-femoral pain takes several months to respond to treatment.

Decrease activity which aggravates the condition

  • Avoid running or jumping
  • Slow walking is better than fast walking
  • Non-impact aerobic exercise is best. Examples include swimming, bicycling, NordicTrack and rowing.

Wear light, impact absorbing shoes

  • Running shoes, walking shoes or dress shoes with crepe soles (Rockport, Easy Spirit, Florsheim, New Balance, etc.)
  • Avoid shoes with thin soles and hard heels that transmit impact to the foot.

Heel cup and arch supports

  • There are several types of heel cups that fit into shoes and redistribute force about the heel.
  • TULI's absorb impact; polypropylene cups mold the heel to spread out pressure.
  • Soft or specially molded arch supports decrease strain along the arch and decrease tension.
  • Over the counter insole replacements can be added to shoes. Be sure to shoes are roomy enough to accommodate an arch support without crowding the foot.

Heat and ice

  • Soak the heel in warm water for 10 to 15 minutes, 2 to 3 times daily.
  • If you have diabetes, water temperature must be less than 95 degrees.
  • Follow the soak with some gentle stretching exercises.
  • Massage the heel and sole with an ice pack or a bag of frozen rice or beans.

Therapeutic exercises

Stretching: Stretch the heel cord (Achilles tendon) for 30 seconds. Rise on the ball of the foot, stretching the toes back. 4 to 5 repetitions 4 to 5 times daily, especially before and after sitting for long periods and before sleeping.

Strengthening: Stand on the ball of the foot at the edge of a stair or footstool. Balance with a hand against the wall or a counter. Rise on the ball of the foot and descend until the heel is below the level of the toes. Repeat on both sides. Do 4 to 5 repetitions 4 to 5 times a day.

Medications

Over the counter non-steriodal anti-inflammatory drugs (NSAIDs) may be taken with meals. Ibuprofen, 2-3 200 mg. tablets, 3 times daily; Naproxen, 2 200 mg. tablets, 2 times daily; or Aspirin, 2 300 mg. tablets, 3-4 times daily are reasonable programs. Avoid dehydration; take the medication after a meal or snack. Read the directions carefully. If there is any history of liver of kidney disease, ulcers, dyspepsia, or you take regular medication for other medical problems, consult your primary care physician before taking NSAIDs. Tylenol, acetaminophen, may be taken with NSAIDs or by itself for relief of pain. If the combination is needed for more than two weeks, consult your physician.