Non­sur­gi­cal treat­ments of­ten work to re­lieve knee pain

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - An­thony Ko­maroff Ask Dr. K

I saw my doc­tor be­cause of aching pain in my knee, which some­times buck­les un­ex­pect­edly. He says I have chon­dro­ma­la­cia. What is this, and what can I do to re­lieve the pain?

The joints in your body are cush­ioned by car­ti­lage. This tough, rub­bery tis­sue cov­ers and pro­tects the ends of bones in­side a joint, al­low­ing them to glide smoothly against one an­other as the joint moves.

With chon­dro­ma­la­cia, the car­ti­lage in­side a joint soft­ens and breaks down. The ends of the bones can rub to­gether, caus­ing pain. Chon­dro­ma­la­cia can af­fect any joint, but the most com­mon lo­ca­tion is in­side the knee.

The part of the knee that is af­fected most of­ten is the kneecap (also known as the patella). The kneecap is a lit­tle oval-shaped bone with an un­der­sur­face cov­ered by car­ti­lage.

As chon­dro­ma­la­cia causes more car­ti­lage to soften, it can crack or shred into a mass of fibers. Bits of car­ti­lage can float in­side the joint, ir­ri­tat­ing the cells that line it and pro­vok­ing them to pro­duce fluid. In se­vere cases, the car­ti­lage can wear away com­pletely. That causes pain of the kneecap, in the front of the knee, around the side or even be­hind the knee.

Chon­dro­ma­la­cia of the knee is usu­ally re­lated to in­jury, overuse, and poorly aligned mus­cles and bones around the knee joint. It is es­pe­cially com­mon in run­ners, jog­gers, skiers, soc­cer play­ers, cy­clists and other ath­letes who re­peat­edly stress their knees. Work­ers who spend a lot of time kneel­ing are also more likely to de­velop this prob­lem.

The most com­mon symp­tom is a dull, aching pain in front of the knee, be­hind the kneecap. The con­di­tion also can make your knee joint “catch”: You sud­denly have trou­ble mov­ing it past a cer­tain point, or it may buckle un­ex­pect­edly.

Non­sur­gi­cal treat­ments of­ten re­lieve knee pain within a few months. Your doc­tor may rec­om­mend:

• Ap­ply­ing ice for pain or swelling.

• Tak­ing ac­etaminophen (Tylenol) to re­lieve pain.

• Tak­ing a non­s­teroidal anti-in­flam­ma­tory drug, such as ibupro­fen (Advil, Motrin, oth­ers), to ease pain and swelling.

• Start­ing ex­er­cises to strengthen the mus­cles around your knee. (A phys­i­cal therapist can de­sign an ex­er­cise pro­gram for you.)

• Avoid­ing kneel­ing, squat­ting and high-im­pact ex­er­cises.

• Us­ing knee tape, a brace or a spe­cial sleeve to keep your kneecap aligned prop­erly.

• Wear­ing in­serts called or­thotics in­side your shoes to keep your foot in proper po­si­tion — nei­ther turned in or out too much — when you bear weight on that foot, and the knee above it.

If non­sur­gi­cal treat­ments fail, or if you have se­vere symp­toms, your doc­tor may rec­om­mend arthroscopy. This sur­gi­cal pro­ce­dure uses minia­ture in­stru­ments in­serted through small in­ci­sions to re­pair joint prob­lems. Dam­aged car­ti­lage can be re­moved dur­ing the surgery. If nec­es­sary, your doc­tor can also cor­rect the align­ment of knee struc­tures to help re­duce wear and tear.

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