Besides spinal conditions, knee pain is one of the most common ailments of the musculoskeletal system. Problems with the knee are usually associated with either poor mechanics, over use of the joints or a trauma such as with sports, falls or accidents. The knee being a weight bearing joint is also subject to general wear and tear which can result in an eventual arthritic condition.


The majority of people who present to health care practitioners with knee pain usually have not been involved in a trauma and state that the pain just developed over time. By far the most common part of the knee that causes problems is the patella (knee cap).

The patella is a sesamoid bone which is a bone found with in a tendon and used by the body for leverage. There are also sesamoid bones associated with the big toe. The joint that the patella forms with the femur (the thigh bone) is not firmly anchored by ligaments like other joints. Instead the patella sits in a groove in the femur and is attached at its upper end to the quadriceps muscles and the lower end is anchored to the tibia (the leg bone). The quadriceps is the main muscles that extend the lower leg and are used especially with walking, running, jumping and stair climbing. Both the underside of the patella and the groove in which it sits are lined with a smooth cartilage that prevents abrasion of the bones and helps with efficient movement. This cartilage is similar to what is found at the end of chicken bones so it is much softer than bone.

When you are doing activities that require bending of the knee such as walking the patella moves up and down in the grove as the leg bends and straightens. Unfortunately, for various reason this mechanism can develop problems where the patella does not move smoothly or tract properly. This causes irritation to the various tissues in and around the area and especially the cartilage that lines the joint. A common medical term for this is chondromalacia patella or patella femoral syndrome. In many cases the problem is in only one knee but can be in both as well.

The cause can vary but unfortunately women are more predisposed to develop this problem than men. One of the reasons postulated is that there is a greater angle from where the quadriceps originates on the pelvis to where it attaches to the patella due to the fact that women’s pelvises are wider than mans. This adds a slightly more sideways pull on the patella thus leading to additional wear and tear over ones lifetime. Another reason why women might have more trouble is because of the shoes that they wear, i.e., high heels and shoes that offer little foot support.

When wearing heels the body must accommodate and compensate for the postural change. This can affect the patella’s position in the femoral groove as well as the function of the quadriceps and together put additional stress upon all the tissues associated with the patella femoral mechanism.

Of course there are other reasons why people develop patella femoral syndrome and these include, foot problems such as over pronation, anatomical disorders such as bow legs, sacroiliac joint dysfunction (a low back condition), excessive jumping and exercises such as squats and lunges if done incorrectly or with too much weight. Direct pressure on the patella associated with kneeling on hard surfaces can also lead to problems.

The typical symptoms of this disorder are usually associated with walking up or down stairs and with running and jumping. However people often have pain after prolonged sitting with their knees bent for a long time and without being able to straighten such as at the movies. When one has the “movie theater sign” the patella area will be painful after getting up from the chair and walking even on a level surface.

The pain associated with patella femoral conditions can vary from a dull ache to sharp stabbing pains that sometimes can be so severe that people will often avoid stairs. This can be a problem when one lives in a Singapore terrace or semi-D house where there is three or four stories to navigate.

In order to help with the pain one must often look for a combination of solutions. These might include therapy to balance the quadriceps muscles and improve the tracking of the patella, orthotic devices for the feet to improve the gait mechanism, exercises to strengthen and stretch various muscles around the knee. Glucosamine sulfate has been shown in some studies to help improve the joint cartilage in the knee and nonsteroidal anti-inflammatory medication in more severe cases might also be indicated. It is also important to wear good shoes that provide proper support and shock absorption and not to walk bare foot on hard and flat surfaces such as found in the typical Singapore home.

Chiropractors have found that the alignment of the sacroiliac joint can be a factor and will often adjust this joint in addition to some of the other therapy mentioned above.

So if you are suffering from knee pain it is important to go to a qualified health care practitioner who specializes in such problems before there is excessive wear and tear and disability. Joint problems such as this only get worse over time if not properly managed.