• The knee is a hinge joint as it hinges, the kneecap slides in a groove along the front. The powerful thigh muscles transition into the patellar tendon at the bottom of the kneecap. This important tendon extends a couple of inches to the top of the leg bone, where it attaches at the tibial tuberosity – a bump on the bone in the front. Where there is friction you’ll find a layer of protective cartilage. The irritation and damaging of the cartilage produces a form of arthritis.
• The meniscus is another tissue in the knee that can become injured. This is a wedge, shaped like a half moon that fits between the thigh bone (femur) and the leg bone (tibia). There are 2 of them in each knee. They provide cushion and hold the bones in perfect position minimizing friction when the knee hinges. They are composed of a type of cartilage called fibrocartilage. When the knee is twisted into an unstable and inefficient position, or if one of the bones moves excessively, the meniscus can be pinched or torn, which is painful. Damaged meniscus may cause the normal cartilage near the meniscus to gradually wear down.
• The top of the kneecap is commonly injured when there is too much pulling stress at the thigh muscle connection. This is an area that can adapt to increasing load. But too much downhill yoga, mileage increases, sudden unexpected stress from weight training (especially when lifting too much weight), jumping, landing in the wrong position, etc. are all causes.
• Pain at the kneecap itself is also load-related. If the cartilage between the kneecap and femur is not adequately adapted, it can become irritated. The cartilage will become thicker and stronger if the adaptation is gradual. There is a wide variability among individuals as to the amount of time needed. If the irritation continues, it can result in arthritis of the cartilage surface and be permanently susceptible to pain. If the surfaces do not match closely, if the knee is inflamed and the fluid inside the knee is changed from normal because of inflammation, or if the cartilage surface is damaged, you may hear clicking, popping and crunching. Sometimes this goes away as the knee heals, but if it persists, or is new and significant, see a doctor. Some people experience this from a young age and accept it as normal. Many people have shallow patellar grooves at the back of the kneecap, or an irregularly shaped knee cap which can produce more friction as the knee cap slides. If a person has bowed legs or knock knees, the knee cap can also slide a bit sideways when the knee bends, which exerts more pressure on the area. Excessive foot pronation or supination causes the knee to turn in or out and stresses the knee.
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• Pain along the lateral edges of the kneecap is usually an irritation of the connective tissue that holds the kneecap aligned in its groove. When the forces applied to the kneecap pull it sideways, the connective tissue becomes irritated. Anatomical variations mentioned earlier are causes, but excessive pronation and supination are also often causes.
• Pain in the patellar tendon is related to excessive load, so gradual adaptation will help. The individual anatomical shape of the knee affects the direction of pull at the patellar tendon. Pulling at an angle results in more stress to the tendon. Excessive pronation and sometimes supination is related, and often overlooked as a cause. If the tendon is significantly injured or pain is ignored for a long period of time, the tendon can become permanently damaged.
• Pain at the tendon insertion, on the tibial tuberosity, is caused by the same factors that produce patellar tendon pain. Pronation and supination are less of a cause, though. Young people, especially boys up to about 16 years old, have a growth center in this area that can become irritated.