Dr Natalie Collins   

Senior Lecturer in Physiotherapy
School of Health and Rehabilitation Sciences
The University of Queensland

Kneecap pain in young people - does it mean arthritis later?


Arthritis Queensland's Allen and Gwen Warren Fellowship 

2018 recipient

About the Project 

"Did you know that one-quarter of young people live with kneecap pain? Those affected experience pain around the front of their knee, typically during activities such as squatting, walking up and down stairs, running, jumping, and sitting for prolonged periods.

Not surprisingly, this can impact substantially on someone’s ability to complete their occupational and daily tasks, and to be physically active.

We used to think that kneecap pain had no serious consequences, and resolved on its own. We now know that young people with kneecap pain experience considerable pain and impaired function, and have reduced quality of life.

Importantly, at least half of those affected will have long-term recurrent and persistent symptoms, for up to 25 years.

We need to start viewing kneecap pain as a chronic joint pain condition, and better understand why so many people with kneecap pain have persistent problems. Emerging research findings suggest that younger people with kneecap pain may be a high-risk group for kneecap osteoarthritis (OA). Kneecap OA is the most common type of knee OA, and has no cure.

Kneecap pain and kneecap OA share a number of similarities in pain patterns, function difficulties, and physical impairments. We recently found that x-ray features of kneecap OA are common in young and middle-aged adults with kneecap pain. In our group of people with kneecap pain who were aged 26-50 years, 25% had a diagnosis of kneecap OA on x-ray. This is considerably younger than the age that we typically expect to see signs of knee OA. Importantly, more than 40% of our group had early x-ray signs of kneecap OA, which is the biggest risk factor for developing kneecap OA later on.

So what does this mean?

We need to better understand this group of ‘young people with old knees’, so that we can better manage kneecap pain from the onset. With support from Arthritis Australia, we will follow this group of people with kneecap pain over the next five years to see how many have signs of kneecap OA, and how this relates to their pain and function.

We will explore whether factors such as strength, knee alignment and walking patterns can predict onset and progression of kneecap OA. Which is important as these facts can all potentially be modified with simple, non-surgical interventions, such as physiotherapy.

This work will inform our future management of people with kneecap pain, and lead to targeted treatments to stop or slow the progression of kneecap OA in this younger, at-risk group with kneecap pain. Waiting until someone has kneecap OA could be too late… if we can stop OA early in the disease process, we have the best chance of reducing the enormous personal and societal burden of this condition. We are also researching different treatments for these two conditions. Based on work from my PhD studies, which found that simple shoe inserts can reduce kneecap pain in younger adults, we are investigating whether shoe inserts can also reduce pain in older people with kneecap OA. "


Arthritis Research SNAPSHOT: Does kneecap pain in youth mean kneecap arthritis when you're older - Dr Natalie Collins. 



About the Grant 

Arthritis Queensland’s Allen and Gwen Warren Fellowship

$50,000 AUD

The Arthritis Queensland’s Allen and Gwen Warren Fellowship is a post-doctoral fellowship to support medical and clinical research into treatments for all forms of relevant musculoskeletal conditions and recognised symptoms arising from the conditions e.g. pain. Preference is for a Queensland based graduate.

The Fellowship is named in honour of Allen Warren and his late wife Gwen. Allen served on the Board of Arthritis Queensland for 30 years until his retirement in 2018. 




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