We discussed what was the point of kneecaps or as you now know they are called patella.
Today I'd like to chat about the problems they cause and how to treat them.
The good news is that if you suffer from patellofemoral problems exercise has proven to have the best outcomes for this type of pain. To make sure you get the best possible result its important to target the areas and specific movements that are contributing to the problem.
Patellofemoral pain can be divided into 4 categories;
· Muscle strength , movement control issues:
This type of knee pain is most common in younger age groups and has a higher incidence in females.
It is usually caused by weakness of the muscles surrounding the knee and hip that then leads to altered movements when we walk, run, climb or descend stairs and squat.
It may also be associated with movement issues at the foot.
As well as getting the muscles stronger it is important to retrain the movements that cause you the most pain such as squatting or stepping down. It may also be important to look at improving running style or walking technique if these are problem activities.
· Compressive type knee pain:
Especially common in age groups over 40 and is more related to themouter edge of the patella being squashed against the cartilage of the long thigh bone , (femur). This is usually associated with tightness of the muscles around the knee as well as some hip related weakness and can respond to hands on physiotherapy.
· Post surgery:
Not a common problem but if someone has had knee surgery and has not been able to straighten the knee fully this can cause irritation of the knee cap due to sustained compressive forces placed upon it. Similar in its treatment to the compressive type knee pain.
Thankfully we don’t see a lot of this but any direct blow to the knee cap with the knee in a flexed position can create irritation to the cartilage on the back of the knee cap.
What are the best exercises for patellofemoral pain ?
Firstly this depends on the specific issues causing your knee pain, general exercises have a role but the best results will come with a combination of both general and specific exercises related to you.
As a rule of thumb its always best to exercise in a range of movement in which you have no or minimal pain. This means you are getting the muscles stronger and improving the technique without upsetting the sensitive area on the back of the patella. You don’t throw fuel on a fire to put it out !
5 Areas to address in patellofemoral pain.
Its often the case that just strengthening the knee on its own is not enough to get rid of your knee pain , so here are our top 5 areas to address for an outstanding outcome.
1. The Hip
If the muscles at the hip are weak then this can cause the knee to drift inwards, causing increased pressure on the outer edge of the knee cap. Getting the hip stronger helps to reduce this.
2. The Knee
The thigh muscles, (quads) , are the main muscles that need to be strengthened for knee pain. It is important to work the knee in a range of motion that is pain free so as not to irritate the joint further, this is especially true for more compressive types of PF joint issues. To help this the use of tape while exercising can be beneficial.
Also important is looking at the technique of how you straighten the knee. Oten if the thigh muscles are weak people will “snap” the knee back into extension,this uses the hamstrings more than the quads and adds to the stress on the knee cap.
3. The foot
Much like the hip if the foot is not in the correct position then this creates stress around the knee as the lower leg, (tibia) rotates too much putting increased pressure on the patella.
If your feet tend to roll in when you squat in bare feet and you get knee pain but the knee pain eases when you wear supportive shoes such as runners then this indicates the foot plays a role. Specific foot strengthening exercises may help but it is likely that shoe inserts or orthotics may be of benefit and part of the overall solution.
4. The core
Especially important in sports such as netball as an often missed component of rehab or injury assessment is the ability to maintain or stop the body moving too far over the leg on landing.
To help prevent this happening it is necessary to create the necessary strength in the core and hip muscles.
In more compressive types of pain stretching thigh muscles, hamstrings and calf can be of benefit as well as strengthening the hips. To help with the stretching being more effective using a foam roller to self release these muscles first can be of great benefit.
And here’s a little video to put it all together for you showing you the types of exercise we use in treating knee cap pain.
In summary this common complaint is best addressed with a focused exercise program to target the way you move, get the weak muscles stronger and the tight muscles longer.
If you are having issues with knee pain please feel free to contact us or make an appointment with the team here