chapter 3: History and Physical Examination

History of Overuse?

Anterior knee pain frequently results from overuse. Overuse occurs when the type, duration, frequency and/or intensity of loads applied exceeds the body's ability to adapt. Such pain is usually activity related. Tissue overload may occur in peripatellar soft tissues or in the patella itself depending on the type of activity and the areas of relative weakness or inflexibility. Although anatomic malalignment may be present in overuse patients and might even predispose some knees to overload, even normally aligned knees can be plagued by overuse pain syndromes. Although the examiner can rely on physical examination to differentiate involved structures and alignment and make an accurate diagnosis, the history must be probed for correctable instigating causes of overuse injury.

Overuse is relative to the degree of musculoskeletal conditioning present and may occur as a result of activities of daily living, work or sporting activities. In any of these situations, precipitating causes must be sought. Overuse is common in running athletes and requires evaluation of recent training, taking into account factors such as running surface, mileage increases, excessively worn shoes or orthotics, adequate stretching and training on hilly terrain or banked tracks. Frequently, training errors will be uncovered and must be corrected to prevent recurrence of symptoms. Job‑related overuse demands specific questions to define work activities and positions. Uncovering contributing factors to overuse is an important part of treatment because activity/training adjustments must be made during the healing phase of recovery. Patient education is necessary to prevent recurrence.






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