The patella (kneecap) sits in a groove formed by the femur and tibia.  Normally as the knee bends and straightens the patella glides straight up and down within the groove.  If there is an imbalance in the sideways forces acting on the patella the patella tends to get pulled laterally (outwards) as it moves up in the groove thus causing excess abrasion on the hyaline cartilage (smooth low friction covering) on the underside of the knee.  This ‘maltracking’ results in knee pain.  Maltracking can also be caused by poor alignment of the knee i.e.

• Genu valgum (knock knees)
• Large Q angle – associated with wide hips and therefore maltracking more common amongst women
• Pronating or flat feet

Affected groups

• Participation in lots of sport – especially high impact sports
• Adolescent females (large Q angle) and softer patella
• Small or and protruding patella
• Recent injury.  The muscle on the antero-medial thigh (front-inside) is called the vastus medialis oblique (VMO).  It plays an important role in pulling the knee cap medially (inwards) as the knee straightens.  This muscle wastes away very quickly with inactivity and therefore can adversely affect the tracking of the knee.
• Dislocation of patella in past

Symptoms

• Aching pain at the front of the knee beneath the patella.
• Pain along the inside border of the knee.
• Swelling – especially after activity
• Clicking on moving knee (crepitus)
• Pain aggravated by using stairs especially descending stairs
• Pain aggravated by sustained periods of sitting

What you can do

• RICE (rest, ice, compression, elevation) to reduce swelling
• Stretch ITB (iliotibial band) and muscles on lateral (outside) aspect of thigh

What we can do

• Rebalance myofascial (muscle and tendon) forces acting directly on patella by reducing tension in ITB
• Prescribing exercises to strengthen VMO
• Improve alignment of knee by
• Prescribing orthotics and reducing over-pronation in feet
• Reducing Q angle of knee where this is due to weakness in the abductors and lateral rotators of the hip

Tags: knee pain, medial knee pain