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by Carol Pietromonaco PT. - Physical Therapy Plus

Q. I play softball and am having pain in my knee when I run. I also have pain when I squat or bend my knee all the way back. I would really like to finish playing this season. What should I do?

The patella, or “knee cap", and its tendon transmit power from the quadriceps to the lower leg. The knee joint itself is called a hinge joint, because it acts very similar to a door hinge, in that it only allows motion in one plane. (As opposed to the ball-and-socket shoulder which allows motion in all three planes.) When your lower leg moves, the kneecap slides over this hinge. Normally, as the knee bends the patella slides smoothly along a groove in the lower part of your thighbone. 

Sometimes the kneecap may become maligned and slide incorrectly in the groove. This will cause pain, inflammation, and rapid wear and tear on your knee joint, and could lead to early-onset arthritis. During softball, short bursts of speed irritate the knee joint when your kneecap does not glide like it should. Also, when the knee is fully flexed, you will feel the full extent of inflammation.

This is referred to as Patellofemoral Syndrome (PFS). You may be familiar with the older term, Chondromalacia Patella. PFS is one of the most common causes of knee pain in runners. The pain is usually located in the front part of the knee, but may be on the inside, outside, or vaguely located. The pain can feel either sharp or dull, and is often made worse by squatting or walking down stairs. Walking down stairs loads the knee joint more than walking up stairs, that’s why it hurts more. You may also notice grinding or clicking. 

You may be prone to PFS because of:
• Excessive training while running 
• Biomechanical abnormalities such as being bow-legged (genu varus) or knock kneed (genu valgus)
• Quad muscle weakness, specifically your VMO (lower, inner thigh). 
• Muscle tightness, as runners often don't stretch their hamstrings and iliotibial band (lateral thigh) often enough

In order to finish the season I would suggest resting it before and after games, accompanied by ice. Anti-inflammatory medications, such as Motrin or Advil might help also, but just check with your doctor before you take any medicine about which you are unsure. It is important to continue stretching and strengthening exercises re-balance the patella. Soft tissue therapy and stretching help loosen tight structures. Once the pain has resolved, strengthening exercises can be started to prevent the condition from returning. Focus your attention on your quadriceps and inner thigh, but don’t forget your hamstrings, hips, and calves. You don’t want to overload one muscle group and create imbalance.

Common strengthening exercises include performing a straight leg raise with knee straight and foot turned outward. You may use weight cuffs to increase intensity. This will strengthen the VMO muscle. You may also perform step lowering by placing the affected leg on the step and slowly lowering opposite leg to the floor. Consult your physician if condition persists.

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