Knee Tightness: Causes and Treatment Options

The knees of both legs feel tight?

Hello, Doctor.
Today I would like to consult about my knee.
In mid-October, I traveled to Taipei and wore a pair of leather shoes while walking, which made the soles of my feet uncomfortable.
I changed my shoes the next day, but I started to experience pain on the "inner edge of the anterior aspect of my left knee." My right knee showed no issues at all.
After returning home, I began to apply hot compresses to my left knee, and after about a week, the pain subsided.
I then resumed my usual activities, such as playing basketball, but it was not intense; I was just shooting hoops.
Towards the end of my session, the pain in the "inner edge of the anterior aspect of my left knee" returned.
To be cautious, I decided to see an orthopedic doctor.
I described my symptoms to him, and after a brief examination, he diagnosed me with "chondromalacia" and advised me to avoid strenuous activities while following a rehabilitation program he prescribed (electrotherapy and hot compresses).
I complied, and the treatments targeted the "anterior aspects of both knees." However, during the rehabilitation process, I noticed that my previously normal right knee also began to feel tight.
I underwent a total of 12 rehabilitation sessions at his clinic (about two weeks) and took the anti-inflammatory pain medication he prescribed, but the tightness in the anterior aspect of my knee did not improve.
Last week, I decided to consult a traditional Chinese medicine doctor.
He listened to my symptoms and asked me to stand and squat for him.
I did not feel pain while walking or climbing stairs, but I was slower to squat because I could clearly feel the tightness in my knee.
The Chinese medicine doctor also prescribed anti-inflammatory pain medication, which slightly alleviated the tightness.
However, I feel that the recovery is not progressing quickly.
Both doctors mentioned that the inflammatory symptoms would take time to heal (6-8 weeks).
The information I found online has been quite distressing, such as patellar chondromalacia and the need to strengthen the quadriceps.
Therefore, I would like to ask the doctor to review my symptoms and provide recommendations for treatment and precautions.

Hu Tongxue, 20~29 year old female. Ask Date: 2014/11/25

Dr. Shi Guozheng reply Orthopedics

Based on your age, it is unlikely that you have osteoarthritis.
Typically, such pain is caused by improper use or overuse, leading to tendonitis.
Resting more or taking some pain relievers can help alleviate the discomfort, and extensive treatment is not necessary as you mentioned.
The pain you described is located at the attachment point of the hamstring tendons on the inner side of the knee joint.
Activities such as going down stairs or running engage this area, and if done too vigorously, it can lead to inflammation.
This type of symptom usually recovers gradually, but complete healing may take about six weeks.
Therefore, just because the pain subsides after one or two weeks does not mean it has fully healed; adequate time is still needed for complete recovery.

Reply Date: 2014/11/25

More Info

Knee tightness and discomfort can stem from various underlying issues, especially after a recent increase in physical activity or changes in footwear, as you described. Your symptoms, particularly the pain localized to the inner front of the left knee, suggest a potential issue with the patellar region or surrounding soft tissues. Here’s a comprehensive overview of possible causes, treatment options, and recommendations based on your situation.

Possible Causes
1. Patellar Tendonitis: Often referred to as "jumper's knee," this condition occurs due to overuse of the patellar tendon, which connects the kneecap to the shinbone. It can result from activities that involve repetitive jumping or running, leading to inflammation and pain.

2. Chondromalacia Patellae: This condition involves the softening and breakdown of the cartilage on the underside of the kneecap. It can cause pain during activities that put pressure on the knee, such as squatting or climbing stairs.

3. Iliotibial Band Syndrome: This occurs when the iliotibial band, a ligament that runs along the outside of the thigh, becomes tight or inflamed, leading to pain on the outer side of the knee.

4. Meniscus Injury: Although you mentioned that your pain is localized to the front of the knee, it's worth noting that meniscal tears can also cause pain and tightness, particularly if there is associated swelling or mechanical symptoms like locking or catching.

5. Patellar Bursitis: Inflammation of the bursa located in front of the kneecap can lead to pain and swelling, especially after activities that involve kneeling or squatting.

Treatment Options
1. Rest and Activity Modification: It’s crucial to allow your knee to rest, especially if you’ve recently increased your activity level. Avoid high-impact activities like running or jumping until the pain subsides.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and restore function. Focus on exercises that strengthen the quadriceps, hamstrings, and hip muscles, as these can provide better support to the knee joint.

3. Ice and Heat Therapy: Applying ice to the affected area can help reduce inflammation and pain, especially after activity. Heat therapy can be beneficial for muscle relaxation and improving blood flow before engaging in exercises.

4. Anti-inflammatory Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation. However, since you mentioned allergies to NSAIDs, consult with your healthcare provider for alternative pain relief options.

5. Orthotics and Footwear: Since you experienced discomfort from wearing dress shoes, consider using supportive footwear or orthotic inserts that provide better arch support and cushioning.

6. Gradual Return to Activity: Once your symptoms improve, gradually reintroduce activities. Start with low-impact exercises like swimming or cycling before returning to high-impact sports.

Recommendations
- Monitor Symptoms: Keep track of your symptoms and any changes in pain levels. If the tightness persists or worsens, further evaluation may be necessary.

- Consult a Specialist: If your symptoms do not improve with conservative management, consider seeing an orthopedic specialist for a more detailed assessment, which may include imaging studies like an MRI to rule out any significant injuries.

- Patellar Tracking Exercises: Incorporate exercises that promote proper patellar tracking, such as straight leg raises and wall slides, to help alleviate tightness and improve knee function.

Conclusion
Knee tightness can be a frustrating issue, especially when it interferes with daily activities and sports. It’s essential to approach treatment holistically, focusing on rest, rehabilitation, and gradual reintroduction of activities. If symptoms persist, don’t hesitate to seek further medical advice to ensure a proper diagnosis and treatment plan tailored to your needs. Remember, recovery can take time, and patience is key in the healing process.

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