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Q I am a 20-year-old man and I have been feeling pain slightly off-centre to
the right and below my right knee cap. It has persisted for a month and comes when I am doing physical fitness training. I feel the pain when I do my sprint interval training after broadjump practice.
The pain would occur when a significant force is applied to my right leg when
running, walking down the stairs and at every “push-off” in a run with wide strides. However, my knee has been fine with slow jogs.
A doctor, who said it was a tendon strain, told me to rest for a week and gave me a pain-relief cream. I stopped all lower limb exercises for three weeks and then went back to slow jogs. Pain now occurs only when I sprint with wide strides. My knee also feels awkward and weak, especially after a squat.
What could be the cause? Can I continue with my exercises? How can I reduce the pain and knee weakness?
 A As there are many structures around the knee that can give rise to the symptoms you have described, only a clinical examination can give an accurate diagnosis.
As the pain began during interval and broad jump training and is currently aggravated by similar high impact activities, you may have damaged the meniscus in your knee. This is a C-shaped piece of specialised cartilage that is important for shock absorption as well as the stability of the knee.
If the tear is at the edge of the meniscus, there will be pain on pressure as well as mild swelling. As the menisci are not calcified, they are not visible on X-ray. An MRI (magnetic resonance imaging) scan may be needed to visualise the injury.
If the tear does not heal after four to six weeks of rest, arthroscopy – using small instruments to make a small incision at the joint – may be required for repair.
Impingement of the fat pad, or Hoffa's syndrome, due to repetitive compression of the fat cushion in the knees during the knee extension phase of sprinting, can also cause pain and inflammation.
Some athletes have a band of tissue at the sides of their knees known as a plica. This can also become inflamed during repetitive running and jumping activities.
Patellar tendinosis, which is an injury to the patella tendon (which connects the kneecap to the leg bone) can also cause your symptoms. These conditions will respond to rest, ice treatment and topical or oral anti-inflammatory medication.
A corticosteroid injection is also useful as it relieves inflammation in the fat pad impingement and plica syndrome.
These injections should not be used within the patellar tendon, as they can transiently lower the strength of the tendon and precipitate a rupture. The use of sports tape to reduce load on the tendon during exercise or to protect the inflamed structures will allow the patient to engage in light exercises during the recovery
process.
DR ROGER TIAN
Sports physician and associate consultant at the Singapore Sports Medicine Centre in partnership with Changi Sports Medicine Centre
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