Knee Pain in Recreational Runner

Run Forest Run
A 38 year old male named Forest presents to a podiatrist complaining of knee pain that
has lasted approximately 6 months. Forest is approximately 175 cm tall, weighing 76
kilos.
Forest is a recreational runner who runs approximately 6 days per week. His usual
running regime is to stretch for 5 min, then run approximately 7 kilometres. He has been
doing this routine for around 5 years. He has never had any musculoskeletal problems
before and has reported good general health.
The patient reports with pain in his right knee just below the knee cap. He informs the
podiatrist that the pain is heightened during the 1st 4 kilometres of his run and is
extremely painful for the two hours that follow. During the discussion, the practitioner
learns that the pain is worst when climbing up or down stairs and while performing any
squatting motion or activity. The pain is sharp, followed by a burning sensation.
The patient had 4 sessions with an acupuncturist. This treatment reduced the pain,
although not significantly. Following the cessation of the course of acupuncture and
returning to physical activity, the pain returned.
Forest has attempted to strengthen his thigh muscles, as recommend to him by the local
physiotherapist. These strengthening exercises proved unsuccessful and in fact
increased pain. The application of ice packs on the knee have provided short-term relief.
He has been using cold packs every evening for approximately 2 weeks.
Forests GP suggested anti-inflammatory medication. The general anti-inflammatory
tablets reduced the pain by approximately 50%. The patient was given an X-ray which
reported no significant abnormalities.
After a biomechanical assessment, the podiatrist determined that excessive internal
rotation through the patient’s affected knee and lower leg were most likely causing the
pain. The excessive internal rotation of the knee is most likely due to excessive subtalar
joint pronation.

Answer the following questions (22 marks)
In what anatomical structure is Forest feeling the pain? (1 mark)
Forest is feeling pain on the anterior aspect of his right knee beneath the cap of
the knee.
What type of joint is the knee joint? (1 mark)
Knee joint which is also called the tibiofemoral joint is a double condyloid joint
whose degrees of motion include extension/flexion, abduction/adduction, and
lateral/medial rotation.
What is the function of this structure? (3 marks)
1. Functional lengthening and shortening of the extremity through extension and
flexion.
2. Facilitates the performance of daily activities such as walking, standing, and
climbing stairs and supporting the weight of the body during static and dynamic
activities.
3. Dynamically: supporting and moving the body in squatting and sitting
activities, transferring and supporting weight during locomotion.
What type/classification of tissue is this structure composed of? (ie. Simple
Squamous Epithelial etc) (2 marks)
The knee joint contains a dense and fibrous connective tissue which is useful in
sealing the joint space present between the tibia, femur, and patella bones.
Why do tendons and ligaments heal very slowly? (2 marks)
The ligaments and tendons have fibrous connective tissues which is inelastic and
have insignificant blood circulation for the supply of nutrients and other
resources which are essential in the repair of the injury of damage. As a result,
the process of regeneration occurs slowly at the tendons and ligaments
compared to the process of healing of various connective tissues such as bones.
The process of healing begins from the external soft tissues. Therefore, the
regeneration process tends to be poor due to the availability of little soft tissues
surrounding the knee joint.
Why would cooling the knee down reduce the pain? (2 marks)