Exercise leads to knee pain

Q: I am a 15-year-old girl. I have never had any knee problems until recently.

I exercise regularly, running at least twice a week, and I also have physical education lessons once a week. This means I exercise at least three times a week.

While doing squats and lunges, my knees feel the pressure, instead of my thighs. In addition, after trying out a new pilates routine (from a video) several months ago, my knees hurt when I walked. Slowly, the pain became less prominent, but it still bothers me.

I am running again, but I now find that after doing lunges or squats, my knees will hurt. It is especially noticeable when I twist my leg in a certain way, or sit down cross-legged for a long period of time. My left knee, in particular, will bother me when I walk.

Does this mean that I cannot exercise or do movements that may aggravate the knee pain?

A: From what you have described, it appears that the pain seems to be emanating from the patellofemoral compartment of your knee joint.

This is the contact point between your knee cap and the front part of the lower end of your thigh bone.

Even when carrying out simple physical activities such as walking or climbing stairs, a large amount of pressure pass through this area.

This pressure is much higher when doing exercises such as lunges and deep squats.

Strenuous or excessive activities can cause the articular cartilage that lines the surfaces of the patellofemoral joint to become overloaded and subsequently soften and swell.

If one does not get enough rest in between these activities, they may eventually produce pain that is generally felt at the front of the knee.

This condition is termed medically as chondromalacia patella.

In the early stages, pain is felt only after strenuous activities, such as lunges and squats.

However, as the condition worsens, pain may be felt even when the person is resting.

As the structure of the knee remains largely unchanged by this condition, X-ray scans of the knee will usually appear normal. However, some tilting of the knee cap may occasionally be noted, which is a sign of muscle imbalance.

For most people, the treatment for this condition would not involve surgery.

Treatment consists of cutting down physical activity, undergoing a structured and graduated physical rehabilitation programme for the knee, coupled with the use of analgesics (painkillers) as and when necessary. This approach is successful for most cases.

Occasionally, the symptoms may fail to improve. In such instances, a magnetic resonance imaging scan of the knee can provide more information of any other damage.

For instance, there may be cracks in the cartilage lining or tears in the meniscus (shock absorber of the knee). These conditions, unfortunately, may require keyhole surgery.

DR DARREN TAY

consultant at the department of orthopaedic surgery at Singapore General Hospital

This article was first published on July 3, 2014.
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