The patella is held in place by the quadriceps muscles and it also attaches to the tibia via the patella ligament (aka as the patella tendon). The back of the patella is covered in hyaline cartilage. When a patella femoral injury occurs, it is usually the result of a mal-tracking issue. The vastus medialis oblique atrophies and as a result there is a lateral pulling of the patella, often causing pain behind the kneecap. The patella serves to increase the efficiency of the quadriceps muscles, absorption and transmission of PF joint reaction forces, and serves to protect the anterior knee.
Possible Causes of Patella Femoral Problems
- Knock-kneed (Genu Valgum)
- Lack of iliotibial band flexibility
- Tightness of hip flexors, hamstring, and gastrocnemius
- Weak vastus medialis muscle
- Pain behind the knee cap
- Pain while sitting for a long of period of time
- Pain is worse when moving downhill or down stairs
- Popping, snapping, or grinding in the knee
Your physician will evaluate your injury by taking a complete medical history, including mechanism of injury, prior injuries and symptoms. Your physician will perform a complete physical examination of your knee. Your physician may recommend an x-ray.
- Rest – Avoid exercises or activities that cause you pain
- Ice – use ice for 20 minutes on/ 40 minutes off throughout the day, for the first 72 hours since the injury occurred, and after exercise
- Take an anti-inflammatory or pain medication as prescribed by your physician
- If tightness exists, then resist patella motion by taping and bracing. You can also use a knee sleeve to keep the patella in place and offset lateral tracking
- Strengthen the adductors and inner quadriceps muscle, specifically your vastus medialis oblique
- Orthotics may be recommended by your doctor or physical therapist to offset physical imbalances
A surgical release may be recommended by your physician if patella femoral syndrome persists. A release is done through arthoscopic surgery and it is a release of the lateral retinaculum. This is always used as a last resort and is followed up by physical therapy.
Your physical therapist will work with you to strengthen the adductor muscles and inner quadriceps muscle, specifically your vastus medialis oblique.
- Keep your inner thigh muscles strong
- Stretch before and after you exercise