Case Summary  |  chronic knee pain and grinding

I have always been fairly active, running regularly during and after college, and having a job where I am sometimes physically active. I had noticed over the years my knees would sometimes ache after a lot of activity, and grind when I bent them. Finally, after a long summer of being on my feet often in 2004, my knee was in greater pain and was swollen. I finally went to my family doctor, who after a physical exam prescribed me a high dose of naproxen sodium and referred me to an orthopedic doctor. The orthopedic doctor took x-rays and did a physical exam and diagnosed me with chondromalacia. This was due to the muscle on the outside side of my knee being stronger than the one on the inside, so when my knees bent and my kneecap moved, it was pulled toward the outside and rubbed incorrectly aganist cartilage and bone. This caused the grinding and inflammation. The orthopedic doctor prescribed Bextra, a different antiinflammatory, which was more effective, and sent me to physical therapy..

I attended physical therapy for about 3 months. They tried a wide variety of treatments during my therapy. I would usually start with a topical cortisone treatment, but only had a few of these during the first part of my therapy. I would also have ultrasound therapy of the knee, which warms the tissue from the inside out. They would also electrically stimulate the muscles to strengthen them. This was very helpful but somewhat painful if the level of stimulus was very high. I also did exercises at the clinic and was assigned exercises to take home. These included squats, stationary bike riding, and exercises in which a resistance band was tied around my ankle and I would do repetitions pulling the band in each direction, front, back, side to side. These exercises were focused on strengthening the muscle so the kneecap would stay in place better when moving and not be pulled sideways and rub against bone. I was also instructed to ice my knee after exercise. I feel that physical therapy was a great benefit to me, lots of things they did such as the ultrasounds and electrotherapy, I could not have done at home by myself through exercise alone.

After being released from therapy, I have joined a gym. I have lost 20 lbs, which will hopefully lessen the stress on my knees. I also do weight machines at the gym and take aerobics and yoga classes to keep my legs strong and flexible. I continue to wear a knee brace when exercising or walking to keep the patella in place. I have continued to improve some, but do still have some grinding and a small amount of knee pain. Extemely strenuous or high impact activity, such as hiking, is still painful on my knee. On a scale of 1-10, if 1 is not being able to walk and 10 is perfect health, I was probably a 4 at the beginning, a 7 after physical therapy, and an 8 currently. I can do most normal activity, but my knee does still ache occasionally and I must wear the brace when I am being active. I have considered consulting an orthopedic doctor again since it does bother me on occasion, but have decided to ramp up my exercise more first and see if I can improve it on my own, doing some exercises I learned in physical therapy.