Monthly Movements - Knee Pain

Patella Femoral Pain Syndrome

Knee pain can often manifest in people by their early teenage years, extending into adulthood. While many of my patients are convinced their pain is due to a more sinister structural injury, patella femoral pain syndrome is more often than not the culprit. Patella femoral pain syndrome is caused by the patella (knee cap), moving out of alignment and bumping into the end of the femur as we extend and flex our knee. This physical contact with the femur irritates and inflames the cartilage underneath the patella. The good news is that the pain is often disproportionate to the underlying irritation and it is very treatable. Below I have listed a few of the stretches and exercises I give to my patients. I do recommend you start with a week or two of the foam rolling and stretching prior to strengthening.

Foam Roll Quadriceps

-Roll along the top, inside and outside of the quad.

-If you find a tender spot, maintain pressure in that area while you flex and bend the knee.

-Spend 2-3 minutes per leg.

Why this works:

Foam rolling relieves tension in the quadriceps, helping the patella stay within its anatomical groove when engaging the muscle.

Couch Stretch

-Place the top of your right foot on the seat of your couch, or something of similar height.

-Drop the your right knee to the ground and hold for 30 seconds.

-Then lean forward and place your hands on the ground and drop your right hip towards the ground. Hold for 30 seconds.

-30 sets of 30 seconds in each position, per side.

Why this works:

This stretch lengthens all four muscles of the quadriceps. The first position stretches the portion of the quad that just crosses the knee joint. The second position stretches the part of the quad that crosses the hip. With a looser, more supple quadriceps there will be less force pulling the patella back into the femur during knee flexion.

Strengthening Exercises - Open Chain

Before beginning strengthening exercises, be sure to spend a week or two stretching and foam rolling the quad. If you can go through your everyday activities without pain, then it is appropriate to start the exercises below.

Straight Leg Raise - Flexion

-Lay on your back with your left knee bent.

-Engage your quad to straighten your right quadriceps.

-Keeping your knee straight, raise your right leg up until your thighs are parallel, then slowly lower your leg back down.

-Perform 3 sets of 15 reps. You can also try this with ankle weights.

Why this works:

This exercise strengthens the quadriceps muscle without bending the knee. With the knee joint stationary, the patella will not move out of its groove.

Knee Extensions

-Have a seat on something that will allow your foot to swing without the ground interfering.

-Raise your foot up until the knee is completely extended, then gently lower your foot.

-Perform 3 sets of 15 repetitions. You can also use ankle weights with this exercise. But it is best to avoid using weight until the knee is pain free with everyday activities.

Why this works:

The stronger the quad, the cleaner the contraction. That is to say, as the quad strengthens the alignment of the patella improves. Because we are sitting and our foot is off the ground, this movements is a very simple flexion and extension of the knee, reducing the likelihood that the patella will move out of its groove.

Strengthening Exercises - Closed Chain

Be sure to spend 2-3 weeks with the open chain exercises before beginning closed chain exercises.

Squat

-Stand with feet hip-width apart.

-Initiate this movement by bending the knees first, allowing them to move out over the toes.

-As the knees are moving forward, drop your hips down towards the grounds.

-Initially, only squat down to about 45 degrees of knee flexion.

-After 1-2 weeks, if there is no pain, progress to a depth that has your thighs parallel to the ground.

-After 1-2 more weeks, if there is no pain, work on getting your buttocks down as far as you can.

-Perform 3 sets of 15 reps.

Why this works:

Knee flexion and extension is impacted by more than just the quadriceps. Once we get the patella moving better, it is time to strengthen other parts of the lower extremity to keep the patella aligned in its anatomical groove.

At this point in the protocol it is time to start bringing in hip hinge (deadlift) style, split stance, and glute exercises. After a few weeks of rounding out the strength of your legs with these exercises, you can add in jumps and/or start returning to your sport of choice.

If you are having trouble with knee pain and have any questions at all, please do not hesitate to email me: derecksteffe@returntosportphysio.com.