The Curbsiders Internal Medicine Podcast #406 Kneedful Things: Knee Pain 201 with Dr. Ted Parks
Jul 31, 2023
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Extensor Mechanism Is Central To Anterior Knee Pain
- The extensor mechanism (quadriceps → quadriceps tendon → patella → patellar tendon → tibia) is the main driver of knee extension and bears most load against gravity.
- Problems anywhere in this chain can present as anterior knee pain and require targeted evaluation.
Start With History, X‑ray, Then PT
- For anterior knee pain prioritize history (location, worse with weighted flexion like squatting/stairs) and consider a sunrise/Merchant view x-ray to assess patellofemoral joint.
- Begin conservative treatment with stretching and PT focused on quadriceps flexibility and medial quadriceps strengthening (stationary bike).
Stretch And Bike Before Considering Surgery
- Use quadriceps/whole extensor stretches (heel-to-buttock) and a stationary bike to preferentially strengthen the medial quadriceps and improve patellar tracking.
- Emphasize restoring elasticity over immediate surgical fixes for patellofemoral pain.