Patellofemoral Pain (Runner's Knee) Treatment in Doha

What is patellofemoral pain?

The kneecap (patella) glides in a groove at the end of the thigh bone every time the knee bends. This patellofemoral joint carries high loads, several times body weight on stairs and during deep squats. Patellofemoral pain syndrome, often called runner's knee, is pain from this joint and the tissues around it when the load exceeds what they can comfortably tolerate.

In most patients there is no structural damage. X-rays and scans are often normal. The problem is sensitivity of the joint to load, influenced by strength, training habits and movement control, which is why exercise rather than surgery is the main treatment.

Symptoms in patients' own words

• "It hurts around the kneecap, not in one exact spot"
• "Going down stairs is worse than going up"
• "After a film or a long flight my knee aches and I need to straighten it"
• "Squatting, kneeling or getting up from the floor hurts"
• "It aches after running, especially downhill"
• A grinding or crackling feeling under the kneecap, often without harm

Swelling is usually mild or absent. A knee that locks, gives way or swells a lot points to another problem.

Causes and who gets it

Patellofemoral pain is common in teenagers, runners, footballers, padel players and gym users, and is more frequent in women. Typical triggers include a sudden increase in running distance or hill work, new squat or lunge programmes, weakness of the hip and thigh muscles, which lets the knee drift inwards, reduced flexibility, and long periods of sitting. In Qatar, the switch to treadmill running and indoor classes in summer, or a burst of outdoor training when the weather cools, often changes the load on the knee quickly. Floor sitting and repeated kneeling can also provoke symptoms.

Diagnosis

The diagnosis is made from the history and examination, after excluding other causes of front-of-knee pain such as patellar tendinopathy, cartilage injury, kneecap instability, a plica or, in older patients, arthritis behind the kneecap. X-rays are taken when there has been an injury or symptoms persist. An MRI is reserved for cases that do not improve as expected or where the examination suggests a structural problem.

Treatment

• Education: understanding that pain does not mean the knee is being damaged
• Temporary reduction in the activities that flare symptoms, such as hills, deep squats and stairs
• Hip strengthening, particularly the muscles at the side and back of the hip
• Quadriceps strengthening, starting in pain-tolerable ranges and progressing
• A gradual return to running with sensible increases in distance and pace
• Short-term aids such as taping or foot orthoses for some patients

Most people improve over six to twelve weeks of consistent exercise, although some take longer. Anti-inflammatory medication can help in a flare. Injections are rarely needed. Surgery has a very limited role and is considered only when a clear structural cause, such as maltracking with instability or a cartilage defect, is found and rehabilitation has failed.

Living with it in Qatar

Plan runs for early morning or evening, or use indoor tracks, rather than training hard in the midday heat when fatigue changes your running form. Break up long periods of sitting at work or on long flights home by standing and straightening the knees. If floor sitting or sujood is painful during a flare, a low stool or chair is a reasonable short-term adjustment while strength improves.

When to see a knee specialist in Doha

See a specialist if pain has not improved after six to eight weeks of exercise, if it wakes you at night, if the knee swells, locks or gives way, or if you are a teenager with pain that limits sport. Dr. Gelber examines front-of-knee pain at Aman Hospital in Doha, identifies the source and coordinates a targeted physiotherapy programme.