Recurring Knee Pain

[nickwsmith]

I'm a 20 year old male and a former high school offensive lineman. During my senior season I hurt my knee during practice twice in a day first by falling and landing directly on it and then by twisting it. What resulted was an intense pain on the inside of my right knee that usually came after climbing stairs or having to keep my knees in the same position for an extended period of time (e.g. at a movie, or during a car ride). Eventually I went to a doctor who referred me to a physical therapist. The physical therapist claimed it was some form of tendinitis and had me do an assortment of exercises over several months and eventually the pain went away.

Fast forward to now, about two years after the initial pain subsided I have started up a work out program that includes 45 minutes to an hour of daily recumbent bicycle cardio. All was well for a few weeks but all of a sudden I got this knee pain. It started out as just a light pain but has gradually gotten worse over the last week (with continued exercise).

The pain is on the inside or the left side of my right knee. It seems to run along the edge of the knee cap. At first the pain was only when I walked up and down stairs and had to put all my weight on one knee but now I can hardly extend my knee without getting sharp pains on the inside of the knee. Also, not sure if this is relevant, but there is a painless bruise on the middle of my knee right below my knee cap and I have no idea where it came from.

Any ideas?

[Michael L Gross, MD]

Your original injury sounds more like an injury to the patellofemoral joint rather than tendonitis. The combination of a direct blow to the patella (kneecap) and the symptoms of stair pain and pain when sitting for long periods of time are classic.  This is sometimes called "dashboard knee", it occurs in motor vehicle accidents when the knee hits against the dashboard.  
It's unclear whether this is related to your current problems, even though the symptoms are the same.  However, you certainly may have an injury to the articular cartilage of the patellofemoral joint that has now been aggravated by your new cycling program or it could simply be the cycling itself.  Improper seat position is a common cause of patella problems.  Be sure that your far leg is almost fully extended, about 5 degrees bent at the knee.  Icing after riding can also be helpful. In addition, the use of a patella stabilizing brace for riding may be useful.  If the pain persists, see an orthopedist.

[nickwsmith]

Thanks a lot for the help, it was very informative. The idea of dashboard knees actually makes a whole lot of sense, after some thought I realized that during cycling I've nailed my bad knee on the cup holder a few times and the pain started after that. The pain had been getting worse almost daily so I think I'm going to set an appointment with an orthopedist.

Thanks for the help!