Medical Marijuana as Pasin Treatment for Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome

Definition

The cartilage under your kneecap (patella) is a natural shock absorber.  Overuse, injury or other factors may lead to a condition known as chondromalacia patella a general term indicating damage to the cartilage under your kneecap.  A more accurate term for chondromalacia patella is patellofemoral pain syndrome.

The most common symptom is knee pain that increases when you walk up or down stairs. Simple treatments such as rest and ice often help, but sometimes physical therapy or even surgery is needed to ease patellofemoral pain.

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is pain in the front of the knee.  It frequently occurs in teenagers, manual laborers, and athletes.  It sometimes is caused by wearing down, roughening, or softening of the cartilage under the kneecap.

Crackling Knees

Patellofemoral pain syndrome, also known as runner’s knee , is one of the  most common body wreckers.

Knee pain can be caused by:

  • Anterior knee pain
  • Arthritis including rheumatoid arthritis, osteoarthritis, and gout
  • Baker's cyst a fluid-filled swelling behind the knee that may accompany inflammation from other causes, like arthritis
  • Bursitis inflammation from repeated pressure on the knee, such as kneeling for long periods of time, overuse, or injury
  • Connective tissue disorders such as lupus
  • Dislocation of the kneecap
  • Iliotibial band syndrome a hip disorder related to injury of the thick band that runs from your hip to the outside of your knee
  • Infection in the joint
  • Knee injuries an anterior cruciate ligament injury or medial collateral ligament injury may cause bleeding into your knee, which makes the pain worse
  • Tendinitis a pain in the front of your knee that gets worse when going up and down stairs or inclines
  • Torn cartilage (a meniscus tear) pain felt on the inside or outside of the knee joint
  • Torn ligament (ACL tear) leads to pain and instability of the knee
  • Strain or sprain minor injuries to the ligaments caused by sudden or unnatural twisting

Less common conditions that can lead to knee pain include the following:

  • Bone tumors
  • Osgood-Schlatter disease
Patellofemoral pain syndrome may be caused by overuse, injury, excess weight, a kneecap that is not properly aligned (patellar tracking disorder), or changes under the kneecap.

What are the symptoms

Patellofemoral pain syndrome usually causes a dull, aching pain in the front of your knee. This pain can be aggravated when you:

  • Walk up or down stairs
  • Kneel or squat
  • Sit with a bent knee for long periods of time

You may also experience a grating or grinding sensation when you extend your knee.

The main symptom of patellofemoral pain syndrome is knee pain, especially when sitting with bent knees, squatting, jumping, or using the stairs (especially going down stairs). You may also experience occasional knee buckling, in which the knee suddenly and unexpectedly gives way and does not support your body weight.  A catching, popping, or grinding sensation when walking or with knee movement is also common.

If the knee pain does not improve within a few days, consult your doctor.

How is patellofemoral pain syndrome diagnosed?

Your health professional will conduct a medical history and physical exam to determine the cause of your pain. In some cases, imaging tests including X-rays or magnetic resonance imaging(MRI) may be done.  These tests allow a doctor to view the tissues inside your knee to rule out damage to the structure of the knee and the tissues connected to it.

How is it treated

Exercise Eases Patellofemoral Pain
For patients with patellofemoral pain syndrome, exercise supervised by a physical therapist was more effective for pain and function than the traditional treatment of rest and avoidance of stress on the knee, a randomized Dutch study found.

Patellofemoral pain syndrome can be relieved by avoiding activities that make symptoms worse.

  • Avoid sitting or kneeling in the bent-knee position for long periods of time.
  • Adjust a bicycle or exercise bike so that the resistance is not too great and the seat is at an appropriate height. The rider should be able to spin the pedals of an exercise bike without shifting weight from side to side, and the legs should not be fully extended at the lowest part of the pedal stroke.
  • Avoid bent-knee exercises, such as squats, deep knee bends, or 90-degree leg extensions.

Other methods to relieve pain include:

  • Taking nonprescription anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium, to decrease swelling, stiffness, and pain.
  • Ice and rest.
  • Physical therapy exercises. Exercises may include stretching to increase flexibility and decrease tightness around the knee, and straight-leg raises and other exercises to strengthen the quadriceps muscle.
  • Taping or using a brace to stabilize the kneecap.
  • Surgery.

It Is Now Possible To:

  • Heal your knee faster
  • Quickly relieve the pain of your Knee injury (so you can walk again)!
  • Heal more completely without internal scar tissue
  • Avoid re-injuring your knee in the future.

Anyone can injure their knee badly, not just professional athletes.  Knee injuries are very common and are often a result of a quick twist or a blow to the knee or overuse of the knee joint.  Stretching or tearing of the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL), tearing of the meniscus, tendinitis in the patellar tendon or quadriceps tendon, and Hoffa's Syndrome are all frequent knee injuries.  Regardless of the type of soft tissue that is damaged, it is painful and your knee can feel very unstable.  Knee injuries can persist for years and be disruptive to your way of life. Recovery can take a long time but proper healing is essential to regain strength and get you back to the activities you enjoy.

Every time you flex your knee, those ligaments and muscle tissue move; when they are inflamed, every movement hurts.  Once this tissue is injured it's painful and becomes very difficult to recover 100% without proper treatment.

It is almost impossible to keep from re-straining your knee because even when the pain is gone you still aren't fully healed.  . We continually re-injure the area through our daily activities which can often lead to knee replacement surgery later in life.

Constant re-injury needs to be avoided at all costs.  Obviously, it delays the healing process, but what's worse is that every re-injury and additional healing cycle increases the amount of scar tissue that builds up in the area of your original knee injury (ACL for instance).  Scar tissue is hard, inflexible, and tough to get rid of.  The more scar tissue that develops, the more you lose the range of motion in your knee.  The more scar tissue that develops, the more likely you will wind up with chronic pain or permanent damage like arthritis.  Scar tissue means that your leg doesn't perform as well as it once did and it makes it much more prone to injury again later on.

If you have inflammation in your knee or in the muscles surrounding the knee, it's very important to heal it quickly and completely. You must avoid the build up of scar tissue. If you don't, a knee injury may plague you forever.  This is where pro athletes have the advantage.  They use therapeutic tools to speed their healing so that they are 100% healed before they resume their sport. Even once they return to the sport, they use these tools constantly to heal any recurring meniscus or ligament damage before it can build into something big.  For professional athletes,having the right tools means all the difference. For the rest of us having the right tools should be just as important.

If you have a knee injury, it's very important to heal this quickly and completely. Do not allow this injury to plague you forever!

What You Need To Heal a Knee Injury:

  1. High quality Ultrasound Therapy to increase the rate of recovery (decreases inflammation and flushes toxins from inflamed tissue) and to break down scar tissue.
  2. A Professional Cold Compression Knee Wrap to reduce pain and inflammation. (as soon as possible)
  3. A Deep Tissue Therapeutic Knee Wrap to increase bloodflow to the injured area.
     
Three tools are what you need for rapid healing. These are the tools that top professional athletes use to treat their injuries every single day. And just like these athletes, you can treat yourself at home.  In fact, if you want to heal properly you have to treat yourself because you need to treat your injury every single day.

Rapid Healing

Anyone in the healthcare business knows that your blood supplies the oxygen and much needed nutrients required to heal an injured muscle, ligament or tendon - the problem is that an injured knee means your blood flow is usually restricted in the injured area through inactivity and inflammation (swelling).  The trick is to (1)reduce the swelling to "open up" the area for greater blood flow and (2) increase the blood flow in the injured area.  Blood flow needs to be stimulated in the injured area.  The increased blood flow when you are at rest means you are not risking reinjury.  Without the risk of reinjury, most patients can recover from their injuries at an advanced rapid rate.
A knee joint injury is a race against time.  The faster and stronger you heal your knee, the less chance there is for re-injury or knee problems later on.Reduction of Swelling (and Pain from Swelling)

Would you know you injured yourself if there was no pain?  Probably not!  Pain and swelling perform a useful role in letting you know that you did, in fact, injure yourself. Pain and swelling are what get you to seek out medical attention in the hopes of finding a way to reduce the pain and heal your injury.
Inflammation around an injured knee can create extreme pain and reduce your ability to move.  You need to reduce the inflammation in your knee and avoid reinjury to see a reduction in pain.

We all know that if the injury was healed, the pain would go away.

Doctors routinely prescribe therapeutic ultrasound as a primary treatment for all forms of soft tissue inflammation.  It is an effective treatment for knee strains, quadricep/hamstring muscle and tendon strain, meniscus tears, stretched or torn ligaments, tendinitis, and a hyperextended knee.  In addition, ultrasound therapy can reduce the painful symptoms of osteoarthris and chronic knee pain.

Typically these treatments at a clinic happen twice per week.  Really though, you would get maximum benefit from getting ultrasound treatments  three  times each day, every day.

Besides prolonging your suffering, constant re-injury leads to the build up of scar tissue on the injured tissue and non-uniform healing. Then, even when you're healed, your knee doesn't work as well as it used to.

You end up with reduced flexibility, less strength, and potentially life-long problems.
Ultrasound treatments can reduce the amount of scarring inside your knee joint.  In fact, ultrasound treatments are regularly used by doctors and physical therapists to break down existing scar tissue.
Cold compression wraps work because they interrupt and slow nerve and cell function in the damaged area.  Once blood vessels are damaged they can no longer carry oxygenated blood to the damaged tissue and therefore cells begin to break-down.The deep cold slows cell function thereby reducing cellular break-down.

During normal daily activities, movement promotes blood flow through our body.  Our body responds to the activity by sending oxygen and nutrient-rich blood to the muscles, tendons, ligaments and surrounding tissue.  When your knee is injured and at rest, the blood flow to that area is greatly reduced.

Risk factors

  • Age.   Patellofemoral pain syndrome typically affects adolescents and young adults. Knee problems in older populations are more commonly caused by arthritis.
  • Sex.   Women are twice as likely as men are to develop patellofemoral pain.  This may be because a woman's wider pelvis increases the angle at which the bones in the knee joint meet.
  • Certain sports.  Participation in running and jumping sports can put extra stress on your knees, especially if you've recently increased your training level.

Complications

Patellofemoral pain can lead to difficulty with routine activities, such as squatting and climbing stairs.

Prevention

  • Increase your activity level slowly over time.  For example, when you begin exercising again, walk rather than run.
  • Always warm up before exercising and cool down afterward.  Stretch your quadriceps and hamstrings.
  • Replace your sports shoes often.  Get good advice about proper footwear for your foot shape and mechanics.  For example, if you land on the outside of your heel and turn your foot inward when you walk (pronate), consider anti-pronation footwear.

Medical Marijuana for Chronic Pain

Chronic pain treatment and management are challenging for patients and doctors, but medical marijuana may be able to provide chronic pain relief where many traditional chronic pain medications do not.  Cannabinoids have well-documented analgesic properties that make medical marijuana an effective medicine to treat many cases of chronic pain syndrome.  In scientific studies, most medical marijuana patients experience pain relief.  Medical marijuana as a chronic pain management tool can reduce patients' pain and improve quality of life, without the same serious side effects associated with use of some pharmaceutical pain relievers.

Medical Marijuana Can Help with Chronic Pain Management

Pain relief is one of medical marijuana's most well-known benefits. In fact, the  North American Academy of Family Physicians, the Canadian Public Health Association, the American Nurses Association, and even The New England Journal of Medicine endorse the use of medical marijuana for the treatment of severe chronic pain.

In a 2000 study, 70-80% of patients experienced pain relief when using medical marijuana. For chronic pain patients, one of the most unpleasant aspects of traditional chronic pain treatment is the long-term use of opioids. These drugs have many side effects in the short and long term. They can also be difficult for many people with chronic pain to obtain in sufficient quantities to provide adequate chronic pain management. Medical marijuana can replace or reduce the use of opioids in chronic pain treatment, as it did for a 47-year-old woman in a 2003 case study, who experienced less pain with reduced doses of three opioids and a small amount of medical marijuana, compared to large doses of opioids only.

The Institute of Medicine found in 1999 that, "THC is significantly superior to placebo and produces dose-related analgesia peaking at around 5 hours, comparable to but out-lasting that of codeine." Side effects were minimal and dose-related, including slurred speech, sedation and mental clouding, blurred vision, dizziness and ataxia. By comparison, many opioids, including codeine, can have side effects including hallucination, seizures, difficulty urinating, and a rapid or irregular heartbeat. People with chronic pain can often manage their pain using medicinal marijuana while regulating their own dosage in order to avoid side effects.

Cannabis is even seen as an effective treatment for one of the most mysterious and challenging types of chronic pain, chronic neuropathic (nerve injury) pain. In 2006, medical marijuana was named the most promising treatment for neuropathic pain by a group of elite pain researchers convened at a MedPanel summit.

Chronic Pain Treatment and Management Plan

Pain.   Studies, including Grant's (San Diego University), have found that cannabinoids have analgesic effects. Furthermore, cannabinoids also appear to enhance the effects of opiate pain medications to provide pain relief at lower dosages.

The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm the herb is effective in reducing muscle spasms.

Grant conducted five studies funded by the state of California involving volunteers who were randomly given real marijuana or placebos to determine if the marijuana provided relief not typically provided by traditional medicines.

Cannabinoids, marijuana's pain relieving elements have been found in previous research to be very similar to pain relievers that our bodies naturally produce.  Research, however, is still being conducted to find out exactly how cannabinoids work. According to Grant's research, there is good evidence that cannabinoids should be used either as an adjunct or a first-line treatment.

Marijuana (Cannabis sativa, C. indica) is a medicinal herb from the same plant family as hops, the main ingredient in beer.  The active ingredients in marijuana are chemicals known as cannabinoids, which also exist naturally in the human body. Cannabinoids attach to receptors in the brain and immune system and can affect bodily functions, including mood, pain, metabolism, muscle control and inflammation.  Marijuana contains more than sixty cannabinoids, making it an important medicinal plant for a wide range of conditions.

Pain

The cannabinoids in marijuana are potent pain relievers.  In a study reported in the 2009 issue of "Neurotherapeutics,"  Drs. Rahn and Hohmann tested several cannabinoids on nerve pain.  The researchers found that cannabinoids derived from the smoked plant, from synthetic compounds, and from plant extracts were all effective in treating pain.

Inflammation

Inflammation is at the root of many chronic diseases.  A major active ingredient in marijuana is cannabidiol, which has anticonvulsant, anti-epileptic and anti-inflammatory properties.  In a study published in the 2009 issue of  "CNS Neuroscience and Therapeutics,"  lead author Dr. T. Iuvone notes that inflammation was a common symptom in many neurodegenerative diseases and actually contributed to the progressive degeneration of nerve cells.  The researchers found that cannabidiol has neuroprotective and anti-inflammatory actions.

Generally Indica  hybrids  are the best medicine for chronic pain.  Hybrids are a mixture of Indica x Sativa giving you the best of both worlds.

Also apply a cannabis liniment that you prepare yourself.  Liniment-preparation thinner than an ointment;  a liquid or semi-liquid, alcoholic, oily, or saponaceous preparation to be applied to skin with friction as a counterirritant.

Pain Strains:

ChemDawg, Kali Mist, Blueberry, Cannatonic, Romulan, Afghani, Chronic, Trainwreck, Strawberry Cough to name a very few.

References



Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:section 7.
Miller RH III, Azar FM. Knee injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier:2007:chap 43.
Porcheret M, Jordan K, Croft P. Treatment of knee pain in older adults in primary care: Development of an evidence-based model of care. Rheumatology. 2007;46:638-648.
Labropoulos N, Shifrin DA, Paxinos O. New insights into the development of popliteal cysts. Br J Surg. 2004; 91(10): 1313-1318.


  • Neurotherapeutics; "Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside"; Rahn, E.J. and Hohmann, A.G.; October 2009

  • CNS Neuroscience and Therapeutics; "Cannabidiol: A Promising Drug for Neurodegenerative Disorders?"; Iuvone, T. et al; 2009

  • Neuro Endocrinology Letters; "Clinical Endocannabinoid Deficiency (CECD): Can This Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and Other Treatment-Resistant Conditions?"; Russo, E.B.; April 2008

  • The Journal of Pharmacology and Experimental Therapeutics; "Antitumor Activity of Plant Cannabinoids With Emphasis on the Effect of Cannabidiol on Human Breast Carcinoma"; Ligresti, A. et al; September 2006

  • Molecular Cancer Therapeutics; "Cannabidiol Enhances the Inhibitory Effects of Delta9-Tetrahydrocannabinol on Human Glioblastoma Cell Proliferation and Survival"; Marcu, J.P. et al; January 2010

  • Neurotherapeutics; "Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside"; Rahn, E.J. and Hohmann, A.G.; October 2009

  • CNS Neuroscience and Therapeutics; "Cannabidiol: A Promising Drug for Neurodegenerative Disorders?"; Iuvone, T. et al; 2009

  • Neuro Endocrinology Letters; "Clinical Endocannabinoid Deficiency (CECD): Can This Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and Other Treatment-Resistant Conditions?"; Russo, E.B.; April 2008

  • The Journal of Pharmacology and Experimental Therapeutics; "Antitumor Activity of Plant Cannabinoids With Emphasis on the Effect of Cannabidiol on Human Breast Carcinoma"; Ligresti, A. et al; September 2006

  • Molecular Cancer Therapeutics; "Cannabidiol Enhances the Inhibitory Effects of Delta9-Tetrahydrocannabinol on Human Glioblastoma Cell Proliferation and Survival"; Marcu, J.P. et al; January 2010