Knee pain
February 26, 2012 | 20,00 EUR | answered by Dr. med. Mario Werner
Hello,
I am 60 years old and have been experiencing pain on the inside of my right knee for a long time. I had an MRI done (results are attached). After the MRI, I received a hyaluronic acid injection and have been taking glucosamine supplements for the past 5 months. I also did machine training at the gym several times a week. The pain completely went away – I could do everything again!
However, for the past 3 weeks, I have been experiencing pain when kneeling, once again in my right knee but this time below the kneecap. The pain is getting worse, even without kneeling, and even Voltaren gel is not helping. I have a feeling that the source of the pain is below the knee – could there be a bursa or something similar there?
I was actually happy that my knee was doing well again. What could this be?
Dieter
Dear Dieter,
The complaints you describe fit into a condition known as patellar tendonitis. The tendon of the patella, which attaches at the bottom of the kneecap, can lead to such complaints and to a condition known as "insertional tendinosis." This is a kind of inflammatory irritation of the tendon, possibly due to incorrect muscle loading at the gym. Also, a misalignment of the pelvis and the resulting muscular tension in the thigh muscles, or postural abnormalities originating in the lumbar spine, can lead to such symptoms.
In this case, physiotherapists can perform cross-frictions on the patella tip, along with extensive stretching, back exercises, and manual therapy.
It is important to differentiate this from the cartilage damage described in the MRI scan just below the kneecap. If the pain is more located here, it might be due to using equipment at the gym that increases pressure on the kneecap and thigh, leading to increased cartilage abrasion and subsequent irritation of the joint lining. Exercises such as bringing the shins into extension against resistance should be avoided at all costs.
Highly recommended is training on the stationary bike with moderate resistance.
We often inject a series of 5 hyaluronic acid preparations to achieve long-term success, so you might consider this option.
I hope this information has been helpful to you and wish you a speedy recovery.
Dr. M. Werner
