My First Overuse Injury: Plica Syndrome

As my departure date to Alaska approached I finally decided to have my knee looked at by a professional to figure out what is wrong and also to put to rest the ‘worst case scenarios’ that were going through my mind.  A high altitude glacier is not the place to find out that the injury you ignored can get worse which could impact the safety of the entire team.  I booked an appointment with the CU Sports Medicine Clinic’s knee doctor who is also a marathon runner.  After talking to the doctor he tested my knee to rule out any ligament damage and took some X-rays to be sure he didn’t miss anything before telling me I had a common overuse injury and that going to Alaska was not a problem.


Diagnosis (Dx) – Plica Syndrome: Plica (PLI-kah) syndrome occurs when plicae (which are bands of synovial tissue around the knee) are irritated by overuse or injury.  Synovial plicae are the remains of tissue pouches found in the early stages of fetal development.  As the fetus develops, these pouches normally combine to form one large synovial cavity.  If this process is incomplete, plicae remain as four folds or bands of synovial tissue within the knee which is common for approximately 25% of the population.  The plica are usually harmless and unobtrusive; Plica Syndrome only occurs when the synovial capsule becomes irritated, which thickens the plica themselves.  This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella (kneecap).  The most common location of plica tissue is along the medial (inside) side of the knee.

The symptoms of Plica Syndrome are often confused with another common overuse injury–“runner's knee.” Runner's knee is mainly a tracking problem of the kneecap; while Plica Syndrome is a thickened lining of the upper border of the patella.  This thickening rubs across the knee, especially the lower end of the thigh bone, which can cause pain and irritation.


Treatment (Tx): Treatment should focus on decreasing the inflammation of the synovial capsule with a non-steroidal anti-inflammatory medication (Motrin®, DayPro®, Naprosyn®, Celebrex®, and Indocin® etc.) As the inflammation subsides stretching exercises that target the quadriceps muscles should be added as part of the treatment.

A Quad exercise:

1. Lie on the ground on your stomach.
2. Keep the top part of your quadriceps on the ground while curling your ankle up.
3. Slowly curl the leg till mild tension is felt.
4. After holding for 15 – 60 seconds, relax and repeat steps with your other leg.


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About Haliku

Mountain climber, ultrarunner, scuba instructor, world traveler, student of life
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1 Response to My First Overuse Injury: Plica Syndrome

  1. Ultra'thoner says:

    That was smart that you got it checked out. I'm glad that it is not anything more serious. Good luck!

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