The patella normally glides up and down through the groove. As the knee is bent, pressure between the patella and the groove is increased prolonging and/or repeatedly causing this increased pressure can lead to irritation, which in turn causes an inflammatory response. This pressure is increased if the patella does not ride properly through the groove, but 'tracks', meaning it travels more to one side, making it closer to the femur. This is the case if there is a muscle imbalance between the lateral quadricep muscles, which pull the patella up and outwards, and the vastus mediaiis, which is the only quadricep muscle that pulls up and slightly in. If the vastus medialis is weak from disease, injury or disuse, the outward pull from the other muscles can result in greater pressure or even the patella rubbing against the femur. The inflammation causes pain, swelling and may lead to roughening and eventually maybe cracks in the cartilage covering of the underside of the patella.

Forces acting on patella

1. Muscle weakness or imbalance.
2. Knee injury
3. Anatomy - narrow groove, wide hips, asymmetrical patella, knock knees, tibial torsion, flat feet.
4. Inflexible Achilles tendon and/or hamstrings (back of leg).

1. Ice pack, with leg straight, 20 minutes.
2. Ice massage, tith leg straight, 20 minutes.

Above: Making an ice pack, ice pack, ice massage.

An ice application should be done 2-3 times a day and after any activity

The aim of treatment is to reduce inflammation and correct the cause.

1. Rest - avoid any activity that causes pain. Continuing painful activity will aggravate the condition. In particular, avoid:
a) sitting with knees bent
b) squatting
c) stairs
d) kneeling, i.e. any bent-knee activity

2. Ice applications twice daily and after any activity.

3. An anti-inflammatory medication may be prescribed and must be taken as prescribed.

4. Physiotherapy - may include:
a) ice
b) heat
c) ultrasound
d) electrical stimulation
e) exercises

Exercises can be used to stretch and strengthen the thigh muscles.

Strengthen

The vastus medialls should be selectively strengthened.
Press leg into table, foot stays on table, toes up and slightly pointed in.
Straighten leg, toes up and slightly pointed in.
Straight leg, lift, hold and gradually relax.

Leg press

Each single exercise should take 6 seconds. For example, lift-2-hold-2-relax-2. Do 3 sets of -10 for each. Some resistance can gradually be added or number increased as strength improves, thus controlling the patella in the groove.

Stretch
llliotibial Band

1. Stretch and strengthen.
2. Proper training principles, i.e. warm up and down, gradual increases.
3. Proper equipment - e.g. shoes.
4. Proper use of equipment, e.g. for cycling, high seat, low gears.
5. Maintain desirable body weight. However, if overweight, the above 4 are even more important. Non-weight bearing activities such as swimming, cycling may be more appropriate.
6. Continue to apply ice after exercise or activity.

1. Braces or supports to hold patella in groove.
2. Taping, similar to this, can be done by a physio as part of a specialized physiotherapy program.

3. Orthotics, if the cause of your knee pain is foot structure or lower leg alignment.

There are other conditions and problems that cause pain around the patella, such as recurrent subluxation or dislocation of the patella, meniscal lesions, bipartite patella, synovial plica, fat pad lesions, quadriceps contractive.

While the previous advice is still valid, these conditions should also be identified and corrected.

DISCLAIMER
The information in this brochure is of a general nature. Individual circumstances may require modification of general advice from an appropriate health professional eg Doctor