Knee Cap Pain and Crunching; Part 1








I feel compelled to write about knee cap pain again. Many of you have already read my earlier blog on this subject; “Do Not Do Squats.”  Today I saw 6 women in my office with knee cap pain and crunching. All but one had been participating in supervised exercise routines which utilized squats, deep knee bends and lunges as the backbone of the program.

Women have a physical predisposition to having pain under and around their knee caps. It has to do with the shape of our legs. We were put together pretty well for having babies but not so much for running stairs and doing squats. And in the natural world we just didn’t have to get in and out of chairs all day, or go up and down stairs all day, or do squats deep knee bends and lunges with weights in our hands, three times a week. And remember…in the natural world we didn’t live much past 25 years.

When I see a woman with pain around her knee caps, 8 out of 10 times I can get some kind of history of excessive stair climbing or participation in an exercise class involving lunges and squats! Now trainers get very upset when I write about this and often send comments impugning my knowledge. I’m an orthopedic surgeon.  I’ve been doing this for 29 years. And I have this condition. I feel very strongly about this because I see a lot of women, and this is a big problem, especially since the exercise industry is invested in the squat, the lunge and the deep knee bend.

Trainers would really be doing their female patients a service if they took this information into consideration, and sought out versatile strengthening programs like the McLernon Method ( Or better yet, try to eliminate the squat and modify the lunge.

But most importantly, just pay attention to clients while they’re doing these exercises. Watch for clients who are “cheating” or making grimaces while squatting. Turn off the music and listen for crunching knee caps. Most of the time the clients just quit, so trainers don’t hear about the problems. Women are embarrassed to complain because often the trainers will treat them like they’re just being lazy. Feel their knee caps while they’re doing the exercises. You’ll be able to feel, and sometimes even hear the crunching and grinding! That’s your sign that they shouldn’t be doing this exercise. That symptom often precedes the pain. Let clients know that they should watch for pain, crunching and grinding around their knee caps while on a program of squats, deep knee bends or lunges. And keep in mind that it doesn’t always occur while they’re doing the exercises. Sometimes it starts hurting that night, or even the next day. Sometimes it takes a month for the symptoms to show up!

Next time; get started on taking care of this problem yourself. Maybe you won’t have to come see me.

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2 Responses to Knee Cap Pain and Crunching; Part 1

  1. ken May 4, 2015 at 9:37 am #

    Any comments on Makoplasty and/or Regenokine procedures as opposed to total knee replacements?

    • Barbara May 4, 2015 at 10:10 am #

      While it’s always good to seek out alternative and legitimate treatment alternatives to conventional treatments, I can’t say that there are many which at this time beats a traditional total knee replacement, when the time is right. Makoplasty is basically a computer guided system for a partial knee replacement. While partial knee replacements definitely have a place among currently accepted modalities for treatment of degenerative joint disease (DJD) of the knee, they are not for everyone. If you have DJD involving any more than one compartment of your knee, you are not a candidate for partial knee arthroplasty. There is no consensus on the benefits of computer assisted arthroplasty over traditional arthroplasty. In my group I have partners using it and others who continue to do it the old fashioned way…which still BTW, is the gold standard. But first you have to be a candidate for partial knee arthroplasty. Then if you believe Makoplasty is what you want and need, you must find a doc who does it. As with all technical systems, the more familiar the surgeon is with the process, the better he/she is at getting it done. All that being said, I never recommend having important operations which are commonly done by good surgeons in your community, done out of town.
      I know nothing about Regenokine, but it sounds like a nutritional program, supplementing some kind of injection (platelet rich plasma?). Proper nutrition, maintaining a healthy weight and good sleep, while important for overall health, will have little effect on improving the knee pain related to arthritis or slowing the process down, to a degree which will diminish your need for TKA, should your disease be progressed to that point. Many of these programs are fancy marketing schemes for already accepted treatment modalities like viscosupplementation. It sounds like it might be some form of stem cell or PRP treatment, which while not prohibited in the U.S., is certainly not currently accepted as a standard treatment for DJD of the knee. I know of no double-blind, prospective studies which indicate that this treatment is beneficial or disease altering. There are anecdotal reports at best. That means someone gets an injection and they report they feel better. That’s the lowest level of evidence. These programs cost thousands of dollars. And there’s usually no guarantee. Hey, but it’s a free country, and as long as it doesn’t “hurt” you, I would say you can do what you want.
      I’ve had a number of patients go to Europe to get these treatments, at a cost of over $10G, and that’s in addition to just getting there. Most of them have come back for hyaluronic acid injections, saying the program didn’t work. Then they eventually get their total knee replacements…which really takes care of it!

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