Inner Knee Pain: Causes and Treatment Options

Pain at the inner side of both knees, associated with the protrusion of the femoral head connected to the medial patellar retinaculum (medial quadriceps muscle retinaculum)?

Dear Doctor, I experience pain in the inner thighs and at the femoral head protrusion after walking for more than 5 minutes or standing for over 2 minutes.
I have consulted three orthopedic specialists, but the pain has not diminished.
The pain is associated with the quadriceps femoris muscle tendon (medial quadriceps tendon).

1.
Is this patellar tendinitis?
2.
Could it be due to weakness in the vastus medialis and a significant strength discrepancy with the vastus lateralis?
3.
Should I focus on strengthening the quadriceps or is rest more advisable at this stage?
4.
What steps should I take for treatment? Thank you.

Liu Xiansheng, 40~49 year old female. Ask Date: 2015/09/02

Dr. Shi Guozheng reply Orthopedics

Tendinitis is related to overuse, such as running, frequently going up and down stairs, or walking on inclined surfaces, which engages the muscles and tendons in that area.
Currently, treatment options include applying heat, resting, or using medications.
If these methods are ineffective and the pain is localized, corticosteroid injections may be administered locally.

Reply Date: 2015/09/02

More Info

Understanding inner knee pain can be complex, as it may arise from various causes, including muscle imbalances, tendonitis, or structural issues within the knee joint itself. Based on your description of pain in the inner knee, thigh, and the area where the quadriceps muscle connects, here are some insights into potential causes and treatment options.

1. Possible Causes of Inner Knee Pain
Patellar Tendonitis (Jumper's Knee): This condition occurs when the patellar tendon, which connects the kneecap to the shinbone, becomes inflamed. It can cause pain in the front of the knee and may radiate to the inner side, especially if there is associated muscle strain.

Medial Collateral Ligament (MCL) Injury: The MCL is located on the inner side of the knee and provides stability. An injury or strain to this ligament can cause pain on the inner aspect of the knee, especially during activities that involve lateral movements.

Quadriceps Tendonitis: Inflammation of the quadriceps tendon, which connects the quadriceps muscle to the kneecap, can also lead to pain in the knee area, particularly if there is overuse or strain.

Muscle Imbalances: Weakness in the vastus medialis (the inner part of the quadriceps) compared to the vastus lateralis (the outer part) can lead to improper tracking of the kneecap and resultant pain. This imbalance can be exacerbated by activities that require prolonged standing or walking.

2. Treatment Options
Rest and Ice: Initially, it is essential to rest the knee and apply ice to reduce inflammation and pain. Avoid activities that exacerbate the pain, such as prolonged walking or standing.

Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can assess your muscle strength and flexibility, focusing on strengthening the quadriceps, particularly the vastus medialis, while also addressing any tightness in the hamstrings or hip flexors.

Strengthening Exercises: Incorporating exercises that target the quadriceps, hamstrings, and hip muscles can help restore balance. Focus on low-impact exercises such as straight leg raises, wall sits, and step-ups. Gradually increase the intensity as tolerated.

Stretching: Regular stretching of the quadriceps, hamstrings, and hip muscles can improve flexibility and reduce tension around the knee joint.

Orthotics or Knee Braces: If there are alignment issues or if you have flat feet, custom orthotics may help improve your knee mechanics. A knee brace can provide additional support during activities.

Gradual Return to Activity: Once pain decreases, gradually reintroduce activities. Start with low-impact exercises such as swimming or cycling before progressing to running or jumping activities.

3. Monitoring Progress
Keep track of your symptoms and any changes in pain levels as you implement these strategies. If pain persists despite conservative treatment, further evaluation may be necessary, including imaging studies like an MRI to rule out structural issues.

Conclusion
In summary, your inner knee pain could be attributed to various factors, including muscle imbalances and tendonitis. A combination of rest, physical therapy, strengthening exercises, and proper monitoring can help alleviate your symptoms. If pain continues or worsens, it is crucial to consult with a healthcare professional for further evaluation and tailored treatment options. Remember, each individual's response to treatment can vary, so patience and consistency are key in your recovery journey.

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