Patellofemoral (Kneecap) pain

is one of the most common types of knee pain. Does your knee make a noise as you walk up or down stairs? Does it get sore when sitting in confined spaces, if you cant straighten it?

 Kneecap Anatomy

Your kneecap is within the quadriceps muscle tendon. It sits in front of the knee joint. When we bend and straighten our knee it slides up and down a groove at the lower end of the thigh (femur) bone. It’s function is to give the quadriceps muscle, hence the knee, added strength. Your quadriceps is the large muscle on the front of your thigh. It can be divided into 4 segments (hence ‘quad’).

  Causes of Pain

Pain is due to the knee cap not tracking correctly within the groove in the femur bone.

When it doesn’t track properly there can be excess pressure on one part of the knee cap, and over time, wear and tear. The cartilage on the back of the kneecap may be damaged by excessive force on the kneecap through playing sports, kneeling, or injury.

 Causes of maltracking

  •  Misalignment of the femur bone above, or the tibia below, due to rotation at the hip joint, or ankle joint respectively.
  • When the outer part of the quadriceps muscle, vastus lateralis and ITB (iliotibial band) are tight, it pulls the kneecap toward the outer edge of the groove where it rubs against bone ultimately causing pain and inflammation.
  • The VMO (inner quadriceps muscle) may be weak.
  • Stand with your knees locked back may cause excess pressure on the back of the kneecap as it presses against the bone underneath. The same may happen if you wear heels a lot.
  • Trauma – if you have fallen on your kneecap.

Treatment:

Includes; myofascial release (soft tissue massage of tight muscles), re-education to retrain muscle activation of VMO, tape (to temporarily help realign the kneecap in the groove) while the muscles strengthen, and realignment of joints above and below – this is an area often neglected.  Strengthening exercises are specific to your particular problem because everyone’s body is different.

VMO Activation

– the most important muscle in the knee is the vastus medialis oblique (VMO). It helps to control the direction the kneecap glides in its groove. It also controls the final few degrees of knee extension, preventing the feeling the knee is just going to ‘give way, or keep extending’. It gives the knee more stability.

To work the VMO, place your fingers on the muscle just above the knee to the inside (see pic). Then draw your kneecap up, but specifically try to get that part of your quads working. Later you will incorporate this control into the knee when you lunge. It is important to be able to feel this muscle working. When you get it, keep practicing!

     

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