Kneecap pain

Kneecap pain is often caused by roughness under the patella.

The patella is a common subject of complaint at the chiropractic coalface. The bone slides up and down in a groove in the femur as you walk; the underside is layered with the thickest hyaline cartilage in the body which acts as a sort of shock absorber.

Degenerative wear and tear, or traumatic shock, may cause a painful hole to develop in the cartilage; it used to be called chondromalacia patella but is now just known as PFPS. 

It occurs often after a fall directly on the kneecap, on the street or in the garden, for example; in sportsmen and women, it's usually associated with a weak quadriceps muscle or an improperly formed groove in the femur.

PFPS is strongly associated with a magnesium deficiency causing chronic arthritis and a condition called chondrocalcinosis.

The good news is that patello femoral pain syndrome in all its forms responds well to chiropractic management; well, having said that, a recent congress on the subject suggests that satisfactory outcomes of all forms of care is only in 40 percent of cases.

Chondrocalcinosis

Chondrocalcinosis, as the name suggests, is the deposit of calcium crystals in the cartilage of joints; along with poor tracking of the kneecap it is a not uncommon cause of kneecap pain.

Richette et al did a literature search on chondrocalcinosis and concluded:

  1. It presents at the coalface as an acute inflammation in synovial joints; it is sometimes called pseudo gout.  
  2. A form of chronic arthritis.

It is not uncommon, affecting about 10 percent of people aged 60.

In those younger than 60 a metabolic disorder should be considered.

Chronic magnesium depletion from drugs or a poor diet is strongly associated with chondrocalcinosis.

Most of the joints in the body are synovial; meaning the bones are lined with hyaline cartilage and the space between the bones is filled with a very slippery fluid that acts as a lubricant.

Ten percent of folk over sixty is a lot of people, and it may well be much higher in patients over 70.

Most of the magnesium in your body is tied up with the calcium in the bones. Many drugs including those for anti-hypertensives, contraceptive pills and corticosteroids all leach the body of minerals; blood thinning medications and diuretics have been fingered too.

If you are taking any of these drugs long term, then you are in the high risk group of suffering from chondrocalcinosis and chronic arthritis. Patello-femoral pain syndrome is just one of many diseases affected by a magnesium deficiency.

When severely depleted painful cramps in the muscles will begin; think in the first instance of magesium, but it could be another mineral.  

Foods rich in magnesium include

  • the dark green vegetables such as spinach which contains 79mg per 100g and broccoli at 21mg; but beware because 30 percent is lost in the water used to boil them. See lower down for links to how to grow them in the garden.  
  • chickpeas contain 48mg per 100g, 
  • pumpkin, sesame and sunflower seeds and
  • beans.

These fresh spinach salad recipes with added homemade hummus or pesto are amongst my favourites; the condiments make them more palatable, but the chickpeas and sweet basil add more magnesium too for your arthritic joints; and your heart too.

Kneecap pain

Kneecap pain responds well to chiropractic care.

  • COLD HOT THERAPY is the first step in the management of all pain and swelling. Making an ice-cup is simple: fill a paper cup with water, place it in the deep freeze, and tear away a slither leaving the ice standing proud.
Ice cold therapy can be applied using a paper or polystyrene cup.
  • Mobilising the patella is a vital part of the management of kneecap. This can cause some discomfort but it is temporary and rarely a problem. The crystals of calcium are gently ground down.
  • Quadriceps exercises are important. PFPS is often associated with a weak Vastus medialis or lateralis, which allows the patella to track to the side. Strengthening the weak muscle, using quad-setting exercises is vital in the long term.

Clarke's test

Clarke's test can be extremely painful when strongly positive; it makes the definitive diagnosis of patello femoral pain syndrome.

Mrs P is a typical case. Only 51, she has pain stretching through her whole back, wrists, hips and knees for as long as she can remember.

She has had operations on her wrists and knee. She presented first for treatment of her right kneecap some four months ago, having had moderately successful chiropractic treatment for her back and neck from a colleague who does not specialise in extremity conditions.

Walking upstairs was particularly painful in her knee. The x-ray above confirmed the diagnosis: Mrs P has Patello Femoral Pain Syndrome but the underlying cause is chondrocalcinosis; calcium deposits in the cartilage

She takes no chronic medication, nor has a history of any metabolic diseases. But she does have chronic arthritis pain throughout her body; she admits to an aversion to her greens as she calls them.

Clarke's test is the definitive test for PFPS; it was strongly positive, particularly when the kneecap was pressed against the medial condyle.

The chiropractic help for kneecap pain is simple, non invasive and effective; nevertheless convincing scientific evidence of the value of any treatment, manipulative or medical, that is proven, is conspicuously absent in the literature. Strengthening of the vastus lateralis muscle was seen as an important long term part of the care.

She responded remarkably quickly. I gave her the option of magnesium tablets, or a diet high in green leafy vegetables, especially spinach, hummus, sunflower seeds and dried beans. I am glad she chose the latter. There are many other benefits from eating these foods, as Popeye well knew. 

In the future she may also have to take the mineral supplement depending on how she responds to the spinach and seeds. A fish oil supplement is also in the offing. Aching all over? Think magnesium.

Arthritis pain in knee

Whilst kneecap pain is readily treated with chiropractic, that emanating from within the greater part of the joint is a far greater challenge to the clinician, be s/he medical or chiropractic. The cartilage lining the ends of the bones does not regenerate of itself unless unloaded; weight loss is the most effective treatment. 

Arthritis pain in knee; patello femoral pain syndrome is just one of the many degenerative conditions.

Chronic arthritis

Chronic arthritis is in part a dietary issue; kneecap pain is just one manifestation.

There are over 100 forms so the term chronic arthritis is something of an anachronism. A magnesium deficiency pertains mainly to the most common form, known as osteoarthritis; it is wear and tear degeneration of the cartilage in the joints.

Nutrition has much to do with the disease; chronic inflammation caused by too much omega-6 oils and too little from cold water fish and freshly ground flaxseed is another common cause.

Obesity is another common cause directly related to poor nutrition. You will notice most of the folk suffering from the disability associated with arthritis in the knee and hip are, or have been obese; there certainly are exceptions that prove the rule. Absolutely avoid icings that are loaded with hydrogenated fats; like Bettercreme sucks.

Case file

Remembering that whilst case files prove nothing, they are simply what are known as anecdotes, they do provide useful and interesting information; however, beware, because they can also be very misleading.

Ms J, a 40-year old woman had experienced what she called a weak knee for some months; in her youth she had played a lot of hockey and had various injuries. One morning she woke up with severe pain, unable to straighten the joint and stairs were a nightmare. After three days she consulted me.

The difficulty was that the examination pointed to different tissues involved. Clarke's test was certainly positive pointing to a patello femoral pain syndrome, but McMurray's was the real cause of her problem.

Mobilising her knee immediately released the meniscus lock and she could walk relatively normally but it took over a month, and half a dozen treatments, to heal. She emailed me yesterday to say that it was almost normal. Perhaps more important she had suffered for years from chronic headaches; just two treatments released those fixation and she has not had one in two months.

Eggs Florentine and magnesium

There are few easier ways to get your magnesium up for your patello femoral pain syndrome than eggs Florentine

  1. Wash a large handful of spinach, perhaps cutting out the stalks if old. Slice.
  2. Drop into a pot with just a smiggen of boiling water, and turn the heat on high. Put the lid on. 
  3. Meantime prepare a few of your favorite herbs and spices. I like a clove of garlic, a few sweet basil leaves, a slither of chili and couple slices of tomato. When the spinach is boiling hard, add your herbs.
  4. When it's boiling hard again, crack an egg onto the bed of spinach, put the lid on again, and turn off the heat after a minute; after two minutes if you are using gas or an induction cooktop stove as the heat stops immediately. 
  5. Smear a slice of toasted low GI bread generously with butter. Omit the toast if you are banting. 
  6. Using a shallow bowl pour all the contents of your pot onto the toast, including all the juices; that's where much of the magnesium is for your painful joints and night cramps. Eet smakellijk as we say in Holland. Enjoy. 
  • Banting diet rebuttal.

Personal Health Insurance

A few thoughts on medical insurance; the benefits and dangers on going without; are you disciplined enough to put away a sum every month? Otherwise you need Personal Health Insurance.

Steve Jobs

Goodbye Steve, I love my AppleMac, in fact the love of my life. We won't forget you. Make a good job of upgrading Moses's tablets...

One last question though: why did you have to dislocate the patella in the process of making the Apple the best computer in the world?

Steve Jobs thought differently.


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.