Description:

There are four upper leg muscles, called your quadriceps, that attach onto the knee cap (patella) and shin bone (tibia). The patella sits in a groove of the thigh bone (femur) and is controlled by the quadriceps muscles. There is a layer of cartilage between the patella and femur to smoothen the gliding of the patella as the knee bends and straightens.

Patellar Tendinitis (Jumper’s Knee) is irritation and eventual damage of the tendon that attaches the patella to the tibia.

Patellofemoral Pain Syndrome (Runner’s Knee) occurs when the patella doesn’t track correctly in the groove of the femur as you bend and straighten your knee. If the patella does not move perfectly in the groove of the femur, there will likely be friction which could cause pain and irritation of the cartilage between the patella and the femur.

Symptoms:

Patellar Tendinitis:

• Pain directly below the patella
• Will initially only present during and directly after physical activity.
• Eventually, as the tendon tears and becomes more damaged, it may interefere with daily activities such as climbing stairs or rising from a chair.

Patellofemoral Pain Syndrome (PFPS):

• Pain directly behind the patella (on the back of the knee cap)
• Pain will often worsen with activity, because the patella is rubbing on the cartilage between the femur and patella every time you bend and straighten the knee.
• Similar to Patella Tendinitis, the pain may eventually interfere with daily activities such as climbing stairs or rising from a chair.
• Sometimes you may notice a “grinding,”,“popping,” or “crunching” feeling behind the patella.

Possible Causes:

• Poor foot biomechanics: Pronation is a necessary function of the foot. Pronation allows the foot to disperse shock, reduce the impact felt on the body up the chain, and adapt to the surface of the ground. However, overpronation is an excessive amount of pronation, in which the arch can collapse with each step. Overpronation can cause the foot to flatten out and the tibia (shin) to internally rotate, which in turn causes the knee drift medially (inward). This can cause abnormal tracking of the patella and pulling of the patellar tendon.

• Improper footwear: If you overpronate, your arch tends to collapse as you walk or run. By maintaining the proper foot alignment, it will also allow for better alignment in the knee, hips, and low back.

• Overuse: As you bend and extend the knee during activity, the quadirceps and hamstring can become increasingly tighter, causing them to pull on the patella unevenly. Over time, this can irritate both the patella tendon and the cartilage that sits between the femur and patella.

• Muscular imbalances: You have four quad muscles: vastus medialis, vastus intermedius, vastus lateralis, and the rectus femoris. If there is an imbalance in strength and/or flexibility, it could pull harder on the patellar tendon (causing tendinitis) or could pull the patella out of the femoral groove (causing PFPS).

• Heredity: Certain anatomical variations can also put excessive stress on knee. Leg length discrepancies can shift the load more to one leg through compensations. Women are predisposed to an increased Q-Angle (the angle at which the leg inserts into the hip), which may also cause the patella to track irregularly. "Bowed legs" and "knock knees" may also cause this.

Self treatment options:

• Support: If overpronation is determined to play a role, shoes with a supportive medial arch can help stabilize the foot and joints up the chain, including the knees and hips. You might consider adding removable insoles (i.e. Stabilites, Orange Insoles, Powersteps) to shoes you currently have that might not be supportive enough. Also, if you have a rigid foot that does not dissipate enough shock, you may need a more flexible shoe that allows the foot to pronate.
• Stretching and rolling: See below for pictures of suggested exercises. o Standing quad stretch, standing hamstring stretch, quad and hamstring foam rolling
• Strengthening: See below for pictures of suggested exercises. o Straight leg raise, side-lying straight leg raise, bodyweight squat, single leg balance
• Rest: “Play it by pain” – use pain to dictate your level of activity.
• Free Clinics: Take a FREE Good Form Running and/or Good Form Walking clinic to have your form analyzed! Our Stretch, Strengthen, and Roll class will cover common muscle imbalances and how to correct them.
• Be patient and consistent: Be consistent with the recommendations and you should start to notice improvements in 2-3 weeks.
• Products: Insoles, massage ball, Cho pat knee strap, a knee brace with patellar support, leukotape, KT tape

Note: We always recommend seeing a physician or attending our Injury Clinic on Wednesdays from 5:30-7:00pm for more information.

Exercises

Standing Quad Stretch: Stand next to a stable surface that you can use to help balance. Maintain good posture, bend your knee and pull your foot upward. Hold for 30 seconds and then bring it down. Repeat with the other leg. Rotate the upper leg in order to stretch the outer and inner quadriceps. Doing this without support will also help with your balance!

Straight Leg Raise: Lie flat on your back. Bend one leg with its foot flat on the surface. Dorsiflex your foot (pull your toes toward your shin). Tighten your thigh and lift your other leg. Keep your leg straight. Only lift to the height of the otherknee. Going slowly will increase the effectiveness. Do 10 reps. To strengthen the different quad muscles, perform the same movement with the foot and leg rotated outward and then rotated inward. Repeat with the other leg. Progress by adding ankle weights.

Standing Hamstring Stretch: Stand in front of an elevated object or stairs. Extend one leg, resting your heel on the object. Keeping your knee straight and maintaining good posture, hinge forward from the waist until you feel a stretch in the hamstrings. If you feel the stretch in your back, you are arching your back too much. Hold for 30 seconds. Repeat with other leg.

Single Leg Balance: Balance on one foot for 30 seconds while barefoot. If this is too easy, close your eyes and tilt your head back! Advance to single leg squats by bending your knee, being sure it does not drift to the inside and the hips remain level.

Side Lying Straight Leg Raise: Lie on your side. Dorsiflex your foot (pull your toes toward your shin). Slowly raise the top leg as high as you can without rotating your upper body or pelvis. Bring the leg back down to the starting position. Do 10-20 reps with each leg. Do the same movement with the toes pointed inward and then pointed outward. Progress by adding ankle weights.

Foam Rolling Quadricps and Hamstrings: Begin with both legs resting on the foam roller as you support yourself with your arms. Begin just above the knee and roll up two inches and down one inch, slowly progressing over the entire quad/hamstring. Progress up to the hip and then back down to just above the knee. To roll the inner/outer quad/hamstring, repeat with one of the legs rotated outward and then inward. You may progress by putting all of the weight on just one leg instead of both.

Body Weight Squat: Begin with your feet about shoulder width apart. Be sure that your weight is concentrated on the heels and not the forefoot. Bend at your hips and push your butt back. Continue sending your hips back until your knees bend. It is important to begin by sending the hips back and not bending at the knees. Keep your back straight, with a neutral spine, and your chest and shoulders up. As you squat down, focus on keeping your knees in line with your feet and ensure that the do not move forward in front of your toes. If your knees begin to drift inside of your feet or in front of your toes, correct them. Squat down as far as is comfortable without pain and with correct form. To stand back up, drive up through your heels, push the knees outward, and clinch your glutes at the top to be sure you're using them. The more slowly you do these, the more benefit you will get. Progress by holding weight.

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