Suffering from knee pain whenever you walk up stairs, squat or even sit for a long period of time? Tired of implementing the RICE method to alleviate your knee pain? Did you know that Patellofemoral pain syndrome (pain in the knee cap) can be alleviated and prevented with stretching and exercise.
What we’ll cover in this article:
- Anatomy Of A Healthy Knee
- What Happens Exactly When Pain Occurs
- 3 Exercises To Strengthen Knee Muscles
- 3 Stretches For Healing Patellofemoral Pain
What is Patellofemoral Syndrome?
Patellofemoral syndorome is a pain at the front of your knee, around your kneecap (patella). Most commonly occurs in people who participate in sports and lift weights, but it can also occur in nonathletes.
Physiology of Patellofemoral Pain Sydndrome
The patellofemoral pain syndrome leads to anterior knee pain in patients without any pathological changes at the cartilage of the patellofemoral joint.
The adverse relationship between the patella and trochlea during knee motion can be due to a functional misalignment when the knee collapses medially (inwards).
Possible causes may be decreased strength of the hip abductors or pronation or over prontation of the feet (ankle sinks inward or outward).
The functional misalignment is associated with quadriceps dysbalance, hamstring tightness or iliotibial tract tightness.
That means we can work on strengthening and stretching the quads, hamstrings and ITB. Exercising and stretching while dealing with knee pain will treat your patellofemoral pain.
THE ANATOMY OF A HEALTHY KNEE
Your knee is the largest joint in your body and one of the most complex. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap).
Ligaments and tendons connect the femur to the bones of the lower leg. The four main ligaments in the knee attach to the bones and act like strong ropes to hold the bones together.
Muscles are connected to bones by tendons. The quadriceps tendon connects the muscles in the front of the thigh to the patella. Segments of the quadriceps tendon—called the patellar retinacula—attach to the tibia and help to stabilize the patella. Stretching from your patella to your tibia is the patellar tendon.
Several structures in the knee joint make movement easier. For example, the patella rests in a groove on the top of the femur called the trochlea. When you bend or straighten your knee, the patella moves back and forth inside this trochlear groove.
A slippery substance called articular cartilage covers the ends of the femur, trochlear groove, and the underside of the patella helps your bones glide smoothly as you move your leg.
WHAT HAPPENS EXACTLY WHEN PAIN OCCURS?
Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. These soft tissues include the tendons, the bursea beneath the patella, and the synovial tissue that lines the knee joint.
PREVENTION OF PATELLOFEMORAL PAIN SYNDROME
You know the famous saying… “Prevention is better than cure”?
That is very true, especially in this case. What I’ve noticed through my experience is that people tend to focus a lot of time and energy on a handful of exercises, and thus, they wind up training the same muscles over and over.
This is generally because it is easy or feels good. Just like that one sided split. This can lead to neglect of other critical muscles, resulting in muscular imbalances, pain and injury.
The Gluteus Medius plays a vital role in many key movements of our body. It provides the movement of abduction (movement away from the body) and medially rotates the thigh (Internal rotation).
It is these movements that allows the gluteus medius to steady the pelvis and it’s daily actions such as walking, holding the pelvis in correct alignment.
When the glute medius is weak you’re unable to efficiently control your femur and as a result you could suffer from unaligned internal rotation. This can happen anytime you stand, walk or perform lower body exercises.
It causes excessive stress in different areas, hence creating the knee pain you might be feeling. Multiple studies agree that there’s a strong correlation between weak glute medius and knee pain. Not only this, but studies also indicate that strengthening a glute medius seems to drastically reduce knee pain by 43% in just 4 weeks.
How to strengthen the patellofemoral
Side-lying Hip Abduction
Step 1: Lie on one side with the bottom leg bent to 45 degrees and the top leg straight.
Step 2: Stack the hips and shoulders directly on top of one another.
Step 3: Engage the gluteus medius to lift the upper leg toward the ceiling; squeeze and hold the top position and then slowly lower the leg
Lateral Band Walks
Step 1: Place a Versa Loop band around the ankles, shins, or immediately above or below the knees.
Step 2: Maintain the squat position while stepping laterally, keeping tension on the band throughout.
Step 1: Place a Versa Loop band around the ankles, shins, or immediately above or below the knees and assume a quarter-squat position.
Step 2: Maintain the squat and step diagonally forward as if walking, and then walk backward toward the starting position
Doing these exercises regularly as a warm-up before workouts every day, not only will prevent patellofemoral pain syndrome, it will also result in better squatting and running performance.
Additional steps that to prevent patellofemoral knee pain
- Wearing shoes appropriate to your activities
- Warming up thoroughly before physical activity
- Incorporating stretching and flexibility exercises for the quadriceps and hamstrings into your warm-up routine, and stretching after physical activity
- Increasing training gradually
- Reducing any activity that has hurt your knees in the past
- Maintaining a healthy body weight to avoid overstressing your knees
However, patellofemoral pain is not a rare syndrome. Anyone can get it. Strengthening the muscles surrounding and supporting the knee is a great preventative measure for happy knees.
3 Exercises To Strengthen Muscles Around Your Knee
Straight Leg Lift
Step 1: Lie down with 1 leg bent at a 90-degree angle with your foot flat on the floor and extend your other leg fully.
Step 2: Tighten your quadriceps (thigh muscle) within your straightened leg and raise it to a 45-degree angle.
Step 3: Hold your leg in this elevated position for a second or 2 before slowly lowering it back to the ground.
Repeat for 20 repetitions then switch legs. You should do 2 or 3 sets per day.
Step 1: Begin by standing with your heels about 6 inches away from a wall and your feet about a foot apart. Your back and buttock should be pressed against the wall.
Step 2: Slowly slide your hips down the wall until your knees are bent at roughly a 45-degree angle.
Step 3: Hold that position for about 5 seconds, and then slowly slide back up to the starting position.
Step 4: Repeat this motion 10 to 15 times for 2 to 3 sets.
External Hip Rotation (AKA, the Clam)
Step 1: Lie on your side with your knees stacked and bent at 90-degree angles and your hips flexed at an angle of about 60-degrees.
Step 2: Keeping your heels stacked together and your pelvis anchored and perpendicular to the ground, lift your top knee as high as you can, hold for a second or 2 then lower it.
Step 3: Repeat this patellofemoral pain syndrome exercise 10 to 15 times per side for 2 or 3 sets.
To keep the knee in harmony we need to stretch and strengthen the supporting muscles. Gently stretching can prevent tight muscles and help prevent patellofemoral pain. Tight muscles around your knees and hips (quadriceps, hamstrings, gastrocnemius, and iliotibial band) could be the reason your knees are so stiff and sore after running, biking, squatting etc.
Iliotibial Band and Buttock Stretch
Step 1: Sit down on the floor with 1 leg bent at a 90-degree angle with your foot flat on the floor and your other leg fully extended.
Step 2: Twist your trunk to the right and use your left arm to gently “push” your right leg.
Step 3: Hold this stretch for 10 to 20 seconds, repeat 5 to 10 times, and switch legs.
Step 1: Lie on your back with 1 leg fully extended.
Step 2: With your other leg, wrap your hands around your thigh and slowly straighten your knee until you feel a good stretch in the back of your thigh.
Step 3: Try getting the bottom of your foot to face the ceiling.
Hold this stretch for 20 seconds, repeat 3 times, and switch legs.
If your hamstrings are very tight you can try these 11 stretches to lengthen the hamstrings.
Step 1: Face the wall, standing about 2 feet away and place your hands against the wall.
Step 2: Step forward with 1 foot and keep that knee bent slightly.
Step 3: Keep both heels on the ground, while leaning your hips towards the wall.
Step 4: Keep your back leg straight to stretch your calf muscle.
Hold this stretch for 20 seconds, repeat 3 times, and switch legs.
Let me know if these patellofemoral pain syndrome stretches and exercises helped you with your knee pain. If you need some motivation or personal feedback join me for a class.
In happiness and health,
Human Anatomy & Physiology, 11th edition, Elain N Marieb et al.