Knee pain - difficulties faced by patient

These difficulties (symptoms) of knee in the initial stages are due to the involvement of the knee cap (patellofemoral) joint. The knee cap joint is where the knee related problem begins (3rd-4th decade of life) which then extends to the tibio-femoral joint (classical knee joint) in due course (2-4 decades). All patients with tibio-femoral joint will have symptoms of the patello-femoral joint and in addition will have varying degree of difficulty in walking.

What are the difficulties experienced by the patient that are typically attributed to the knee cap joint?
  

• Need to straighten (extend) of the knee: this is one of the earliest symptoms for the patient to experience. This happens when the patient is sitting cross-legged and after some time he or she feels the need to straighten the same to feel better. The patient may experience discomfort, pain, stiffness or sometimes numbness while sitting with leg crossed and will find relief on straightening the same. With this symptom once the patient tries to rise after prolonged sitting he or she may experience an initial hesitancy to walk which would completely disappear after some steps and once he or she starts walking they will have no pain or discomfort. This symptom is so subtle that they usually attribute to increasing age or weight. In the younger population if it is a regular feature then it can be a presenting complaint.
• Pain while sitting: This is an unnerving symptom classically attributed to knee. This usually happens when the person encounters situation where he or she are sitting for prolonged duration which may be the case while sitting at work, driving (especially when there is too much traffic and if the clutch needs to be repeatedly used), watching movies, or sitting in yoga asanas (sukhasan, vrajrasan). They will be having varying degree of pain ranging from dull ache to throbbing type which will make them limp for a few steps and once walking the symptom will subside completely.
• Pain/Discomfort while rising after prolonged sitting (chair, travel, movie, floor): This is a very characteristic feature of pain originating from knee. The patient can complain of knee as a source of pain and it can be a compensatory overload of any other body part (commonly heel and buttock) who have similar history. Knee is the only joint, rather the knee cap (patellofemoral joint), which characteristically will have maximum symptoms following rest and once the person is active, the symptoms will reduce and sometimes the patient will even forget about the same. For pain originating from any other joint in the lower limb (tibio-femoral, hip, ankle, feet), the pain has to increase on walking due to the mechanical overload happening. Only pain originating from the patello-femoral joint will reduce or be absent once the person is walking briskly or running. This pain becomes so discomforting that patients overload the other body parts (wrists, shoulders, feet, heel, buttock) and make them vulnerable to injury and pain.
• Pain while negotiating stairs/slopes: This is also one of the earliest features evident especially in young. They usually go for a picnic where they need to indulge in a trek or slopes and the problem becomes evident. Otherwise it remains subtle as stair negotiation has reduced drastically in the affluent class. It is still prevalent in homes of super affluent (duplex flats) and those homes where there is a need to negotiate stairs more frequently. The stairs in question are influenced by the height of the patient and height of the stair. The higher the mismatch between the user and the step height more the difficulty. On the other hand, even a simple step can be difficult to negotiate in a person with advanced problem in the knee. Such patients have difficulty in climbing in a bus, train, crossing the dividers on the road, climbing the footpath and require to take some support and they always prefer to load the less painful knee.

Any one suffering from any one of the above mentioned difficulties must accept that they are having an issue with their knee. They cannot attribute it to age, weight, menopause, deficiencies, rheumatism. The patient with the classical rheumatoid arthritis will have more severe form of the problem, will always have associated swelling and the handicap will be more pronounced. If identified early, treated appropriately with the taping treatment (along with soft tissue stretching) and the weight kept under control, then there are fair chances of keeping the problem under reasonable control.