Patellar pain, also known as chondropathia patellae, is often the result of overloading, incorrect loading or due to a poor condition of the muscles, tendons and ligaments. In most cases, the front of the thigh (quadriceps muscle) is in muscular imbalance with its counterpart, the back of the thigh (ischiocrural muscles). This results in increased pressure of the patella into the joint and abrasion of the cartilage under the patella. This causes patellar pain, especially during long periods of stress. In conjunction with deviations in the knee joint, patellar pain is also affected.
Procedure in physiotherapy
In physiotherapy for patellar pain it is especially important to find the exact cause. The physiotherapist pays attention to the general statics when standing and walking in order to recognize a muscle imbalance and abnormal patterns and to train them in the further course of the treatment. A precise examination and palpation of the knee of the surrounding structures may reveal any swelling in the area of the patella, pain points or trigger points in the musculature, especially in the quadriceps femoris muscle, since it attaches to the tibia via the patella tendon and thus has direct contact with the patella.
The collateral ligaments or the retinaculum (holding ligament of the patella), which extends over the entire patella, may also have pain points. The article Patellar Tip Syndrome might be of interest to you in this regard. In the acute phase of pain, the relief of the knee is the priority.
This is achieved in therapy by ice treatment together with gentle traction for the knee joint and slight patella mobilization. These techniques together with the ice stimulate the metabolism and the harmful substances are broken down. Depending on the extent of the existing swelling, a lymph drainage can be performed.
In addition, the patient is instructed to keep the leg still at home and to reduce the swelling and pain with cold packs. As soon as the acute swelling and pain subsides, the physiotherapist takes care of the structures surrounding the knee. The M. Quadriceps femoris probably shows trigger points or hypertonus, which the therapist improves with certain trigger point techniques or transverse stretching of the thigh muscle.
Pain points in the collateral ligaments or patellar tendon, which have arisen due to overloading, are treated with transverse friction (as a supplement also with ice). The finger is placed and pulled at right angles to the structure, thus stimulating blood circulation and metabolism. In order to improve the support of the patella, the patella is mobilized in the direction that does not work well because there is probably too much tension.
Once the pain has completely disappeared, it is important to strengthen and stretch the corresponding muscles in case of patellar pain. A special condition training (strength, endurance, coordination and mobility) provides a better stability of the knee joint. Practice one-legged stand (important: keep knees slightly bent)
- Move with the other leg in all directions (write 8s)
- Therapist gives resistance to pelvis, knee or foot
- Throw the ball so that the concentration is no longer on the knee
running on a mat, trampoline, wobble board
- Normal walking to get used to the underground
- From walking stop on command and hold position
- Faster running (increase → out of the movement stop)
- Practice one-legged stand (see above for increase)
Sports-specific exercises:
- Jump on trampoline or mat and land on one leg → Hold position
- Sprint on a big mat
- Lunging steps on Airex or large mat
- All variations or increases possible (passing balls under the leg, staying in position longer, throwing the ball, connecting exercises for the arms.
etc. )
Further exercises can be found in the article Exercises with an existing runner’s kneeFor all exercises, as is generally the case with strength training, a proper execution applies, i.e.
- Never push the knees out over the toes
- Push buttocks out backwards at a knee bend, upper body remains straight
- Belly and back tension is maintained
M. Quadriceps femoris:
- Supine position or seat: push through the hollow of the knee of the stretched leg so that the M. Quadriceps is tensed (increase: lift stretched leg in pushed through position)
M. Quadriceps femoris:
- Knee bend (variations: stay in the bent position or just wall sitting, wide or narrow slide or even lateral knee bend)
M. Quadriceps femoris:
- Failure steps
Further exercises are listed in the article “Exercises against knee pain“. Ischiocrucial Musculature:
- See above knee bend and lunge
- 4-foot-stand: Stretch leg bent or stretched upwards
Ischiocrucial musculature:
- Bridging (supine position, feet raised, pelvis lifted)
Ischiocrucial musculature:
- Variation: Lift legs alternately, push pelvis up and down, write numbers with stretched leg
Further strengthening exercises can be found in the article RetropatellarararthrosisFor further exercises for the M. Quadriceps, please refer to the article “Physiotherapy on the machine
- Leg press
- Leg Extensions
- Leg curl
Especially the quadriceps femoris muscle is often shortened in cases of patella problems.
It runs across the patella and ends in the patella tendon at the tibial tuberosity of the tibia. Another effective method is fascial training. Here, the glued fasciae are rubbed out by the muscle. M. Quadriceps femoris:
- Stand; pull foot to buttocks
Ischiocrucial musculature:
- Stretch out leg as far as possible upwards and pull stretched leg towards body
- Long seat: touch the pulls with your hands and keep your knees stretched
- Stand: touch the floor with your hands, keep your knees stretched
For further stretching exercises please refer to the article Stretching exercises
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