Knee Pain

 which sit on the relatively flat shinbone (tibia). The kneecap is a small,

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 rounded bone that sits in a groove between the thighbone and the knobby ends and gives strength to the joint. As the knee bends and straightens, the kneecap slides up and down in the groove. A tendon attaches the kneecap to the thigh muscles above, and a ligament connects it to the shinbone below. The kneecap acts like a pulley, increasing the power of the muscles attached to it.

The knee flexes and extends, but it has little lateral rotation, says board certified foot surgeon Elliot Michael, D. PM., director of the residency program for Podiatric Medicine at Holladay Park Hospital in Portland, Oregon. The upper and lower leg bones act like long levers on the joint, increasing power and force. A small change in the levers is magnified many times over in the knee, says Michael. This intricate design can cause problems, especially for the kneecap, which accounts for about 20 percent of all knee pain, say knee experts. Proper functioning of the knee and its kneecap doesn’t depend on the alignment of the bones themselves, but on the alignment of the surrounding structures. Think about the kneecap as a puppet controlled by string muscles, tendons and ligaments. As long as all of the strings pull in just the right way, the kneecap moves back and forth smoothly in its track. But if any string pulls too strongly or not hard enough, the kneecap is pulled out of its track and can no longer glide easily against the thighbone, which can cause pain and may even damage the kneecap.

Because women have wider hips, the upper-leg bone of a woman enters the knee at a greater angle, which twists the knee. This makes women more vulnerable to certain types of kneecap injuries, such as chondromalacia, in which the smooth layer of cartilage that undercoats the thighbone becomes roughened or cracked, according to orthopedic surgeon Michael Baskin, M.D., an assistant clinical professor in the department of Orthopedics at Oregon Health Sciences University in Portland. If the large muscles in the thigh (quadriceps) are inflexible due to disuse or lack of stretching before exercise or if these muscles are overused, they can cause inflammation of the knee tendons (patellar tendinitis), sometimes called jumper’s knee. Muscle imbalances, in which one group of muscles is stronger than another and pulls harder, can cause knee problems, too.

While knee problems can result from trauma due to falls, automobile accidents, and athletic injuries or from diseases like arthritis, the vast majority of knee problems are caused from over stressing the knee, according to Michael. When there isn’t an acute injury, most knee pain comes from doing too much too soon or from putting the wrong type of force on the knee, he says. Often, people who start a running program develop knee problems early on. They don’t realize they’re subjecting their knees to four to five times their body weight with every running step. Physical therapist Ellen Nona Hoyven, PT., owner and director of Ortho Sport Physical Therapy Pc. in Clackamas, Oregon, says most of the knee problems she sees are caused by deconditioned muscles. People put a high demand on their knees and their muscles without the proper conditioning, she says. Or they overuse their knees by doing only one type of activity over and over like kneeling, running or climbing. Of course, you can’t always prevent injuries from occurring, and any serious knee injury should be evaluated and treated by a physician. However, if your knee problems are caused from overuse, disuse, or improper training, you can use the following strategies to keep your knees healthy and if you do develop pain, to help ease the hurt and speed healing. michael kors satchel bag

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