The diagnosis
Primarily, the doctor first examines the knee clinically to see what structure is probably the cause of the pain and to check when the pain is at its worst. As a further step, an ultrasound examination is often added to this to check whether there has been a thickening or inflammation of a tendon. Inflammation often causes an effusion of fluid in the knee joint, which can be detected by ultrasound.In some cases, an X-ray or even an MRI examination must be consulted for diagnosis, for example, in order to draw conclusions about cartilage damage or ligament injuries. For example, cartilage damage, which often leads to pain behind the patella, is more likely to be suspected if there is audible rubbing of the patella during the clinical examination, as in this case there is more bone rubbing against bone and the two are not separated by protective cartilage. Calcifications, e.g. in the case of chronic tendonitis, can also be detected with the help of an X-ray.
The Therapy
The therapy for pain behind the kneecap usually consists of a conservative, non-surgical therapy. There is a choice of several therapeutic procedures, which are often used in parallel. On the one hand, anti-inflammatory and pain-relieving drugs can be used if the pain is otherwise unbearable.
Analgesic ointments such as Voltaren® are also frequently used for this purpose. Local injections of painkillers play a major role, especially in cases of inflammation of the tendon attachment, and usually provide immediate relief. Furthermore, cold in the form of ice wraps can improve the symptoms.
In order to alleviate the symptoms not only in the short term, exercises for targeted muscle training can be used during physiotherapy to relieve the knee joint itself so that the muscles can absorb the force acting on them. During muscle training, the muscles of the thigh are trained in particular, as they are best able to stabilize the knee. In addition to physiotherapy, the orthopedist can also prescribe treatments such as ultrasound, electrotherapy or manual therapy.
Many athletes also like to wear knee joint bandages during the phase of illness, as these stabilize the joint and also relieve pain. In addition, they are advised to immobilize the knee for a certain period of time or to significantly reduce the workload so that regeneration can take place. Frequently, the rest should take place over a period of eight weeks.
If complete immobilization is not required, sports such as swimming or cycling are a good alternative. In the case of a patellar dislocation, immobilization with a bandage or orthosis is often indicated. However, this is followed by a muscle-building therapy.
If you have problems with knee problems, you should avoid high shoes and hard soles. Overweight is also a risk factor, so that weight reduction should be considered. If the orthopedic surgeon determines that there is damage to the cartilage, this can be remedied by a minimally invasive procedure (knee arthroscopy = knee arthroscopy), for example by smoothing the cartilage.
If cartilage is detached, it can also be removed from the joint during arthroscopy. If a patient suffers from repeated dislocations of the kneecap, the loosened retaining ligament of the kneecap can be surgically replaced with the aid of the patient’s own tendon, thus stabilizing the knee again. The exercises, which can be performed independently at home, are primarily aimed at strengthening the thigh muscles.
A further effect is that the knee is supplied with more blood and consequently the cartilage, which itself has no blood vessels of its own but is supplied with nutrients by diffusion, is better supplied with blood. An exercise that serves the cartilage above all is the execution of knee bends. The arms should be stretched out in front and the knees should not extend beyond the tips of the feet.
However, it is important, and this applies to all exercises, that the knee is not overloaded by the exercises. Cycling is also good for the knee. The knee is moved, but is not exposed to too much pressure.
Other exercises that can be done well at home are: letting the knee swing while sitting. This promotes above all the formation of synovial fluid. Extending the knee in a sitting position and holding it for a while also has a beneficial effect on the thigh muscle, which can relieve the pressure on the knee.
In addition, to strengthen the thigh muscle (quadriceps), a leg can be placed in a sling (for example, a towel) at the ankle and slowly pulled up backwards by the arms. This exercise stretches the quadriceps and permanently stabilizes the knee joint. It is also beneficial to perform a lunge.
This position is then held for some time while small rocking movements are performed at the same time.Knee bandages are often recommended for pain behind the kneecap or general pain in the knee area. These bandages are intended to provide additional stability and pain relief within the knee joint. This can prevent muscular imbalances and instability within the knee joint. In addition, it supports the kneecap so that it can usually no longer dislocate. In addition to the bandages, physiotherapy is always recommended to strengthen the muscles in the thigh and knee area.
