Knee pain can be a slow and frustrating condition to heal. But most people with patella-related knee pain gain relief with a few months of nonsurgical treatment. Generally, the longer you have had a patellar tracking disorder, the longer you can expect to be in treatment.

Unless your knee is swollen, dislocated, giving way, or causing you severe pain, try the measures described in the Home Treatment section for a week or two before deciding whether to see your doctor. With rest from aggravating activity, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs), you can expect your pain to decrease. Do not give aspirin to anyone younger than 20 because of the risk of Reye’s syndrome, a rare but serious disease.

As your pain starts to subside, begin stretching and strengthening exercises to loosen tight connective tissue that can pull the patella off track, and to help stabilize the patella in the femoral groove as you bend and straighten your knee.

Medical treatment

If home treatment isn’t enough to reduce your knee problems, or if your knee is swollen, dislocated, giving way, or causing you severe pain, see your doctor for evaluation. Knee problems are often difficult to distinguish from one another, so a thorough exam and accurate diagnosis are essential for you to receive proper treatment.

After confirming that you have a patellar problem, your doctor will review your home treatment measures and make further recommendations. You may be advised to have physical therapy, use a custom brace or shoe inserts (orthotics), stabilize your knee with tape or a neoprene brace, or lose excess weight.

Surgery is not commonly done for patellar tracking disorders. But surgery is recommended in cases of repeated patellar dislocation, displaced or damaged cartilage following a dislocation, loose bodies (such as small pieces of bone or cartilage) in the knee following a dislocation, repeated subluxations caused by a structural deformity, or failed nonsurgical therapy.

What To Think About

Nonsurgical treatment—including stretching and strengthening exercises, temporary use of nonsteroidal anti-inflammatory drugs, and sometimes bracing or orthotics—usually eases the pain of a patellar tracking disorder and makes surgery unnecessary. Keeping your knee strong and flexible will help to prevent further problems. Staying at a healthy weight to decrease stress around your knees may also help.

If you have achy knee pain on or around your kneecap and have not yet been diagnosed with a patellar tracking disorder, first use the following home treatment measures:

• Take a break from activities that cause knee pain, particularly squatting, kneeling, running, and jumping. Swimming and cycling are good aerobic alternatives.
• Ice your knee regularly, particularly before and after activity.
• Use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling.

You may also want to try:

• Wearing a neoprene brace with a patellar cutout, if you feel that your kneecap is shifting enough to need stabilizing.
• Using supportive shoe inserts (orthotics). You can buy good-quality inserts from a shoe store or drugstore.

As your knee pain starts to subside, begin stretching and strengthening your leg. Stretching can loosen tight muscle and connective tissue that have been pulling the patella off track. Strengthening your thigh muscles can help stabilize the patella in the femoral groove as you bend and straighten your knee.

• Stretch your thigh muscles (quadriceps), hamstrings, iliotibial (IT) band, and Achilles tendon daily, particularly before and after activity.
• Begin thigh strengthening with isometric exercise and straight leg raises only. Progress to exercises such as quarter squats and leg presses, in which your feet are pushing against something (closed-chain exercises). Avoid knee-extension exercises in which you are raising and lowering your foot, which may further damage your unstable knee.