| Knee pain has can be dressed up in many | | | | One of the main culprits behind the altered |
| different guises. Whatever someone decides to | | | | positioning of the patella is a weakness in |
| call it, all we need to know is that it | | | | vastus medialis obliqus (VMO). This muscle |
| usually occurs on the front of the knee and | | | | attaches medially (to the inside) on the |
| it hurts! | | | | patella with weakness here allowing the |
| | | | patella to drift laterally (outwards). This |
| The pain is normally associated with running, | | | | muscle is the first of the muscles to waste |
| walking down hills/stairs, or sitting with a | | | | following injury and lack of use of the |
| bent knee for long periods of time. This is | | | | quadriceps muscles. The quadriceps muscles |
| due to an alteration in the biomechanics of | | | | can start wasting within 24 hours of non-use! |
| the knee which is usually caused by an | | | | Treatment may therefore consist of |
| imbalance in the soft tissue structures. | | | | strengthening of the VMO muscle to alter the |
| | | | pull of the quadriceps on the patella thus |
| The pain within the knee joint usually | | | | correcting its position. |
| increases when the quadriceps muscles work | | | | |
| eccentrically (meaning the muscles working as | | | | Likewise shortening of vastus lateralis which |
| they get lengthened). This exerts a large | | | | attached to the lateral aspect of the patella |
| force through the patella (knee cap) when the | | | | may also result in an outward pull on the |
| muscles are used this way. The large force | | | | patella again affecting the Q-angle. |
| presses the patella against the femoral | | | | Treatment here would consist of heat, |
| groove, which if not located correctly causes | | | | stretching and massage to normalise the |
| pain. | | | | length of the muscle. In extreme cases |
| | | | surgery may be required to 'release' the |
| Mal-tracking of the patella within the | | | | muscle to allow the patella to re-position |
| femoral groove is the most common cause of | | | | itself correctly. |
| anterior knee pain. This is like a train | | | | |
| being driven off its rails which will lead to | | | | Other causes of anterior knee pain from the |
| a bumpy and uncomfortable ride! An imbalance | | | | patella-femoral joint include |
| in the pull of the quadriceps muscles (vastus | | | | |
| medialis, vastus lateralis, vastus | | | | " Tightness in certain structures (e.g. calf |
| intermedius and rectus femoris) which attach | | | | and hamstring muscles). |
| to the patella can alter its position. | | | | |
| | | | " Altered hip, knee or foot posture. |
| The angle of pull of the quadriceps muscle | | | | |
| through the patella is known as the Q-angle. | | | | " Anatomic variations such as a shallow |
| The Q-angle is determined by drawing a line | | | | patella-femoral groove. |
| from the ASIS (bony point on the front of the | | | | |
| pelvis) to the midpoint of the patella with a | | | | If knee pain is left untreated the articular |
| second line being drawn from the centre of | | | | surfaces of the patella-femoral joint may, in |
| the tibial tubercle (flat piece of bone below | | | | some cases, become affected and worn, |
| the knee cap) to the middle of the patella. | | | | exacerbating the problem. |
| The point where these two lines cross is | | | | |
| known as the Q-angle which should be 13Ú | | | | These are just a couple of examples of causes |
| in males and 18Ú in females. Anything | | | | of anterior knee pain. To have your specific |
| outside these ranges could be the cause | | | | condition diagnosed correctly it is advised |
| behind knee pain. Note when performing these | | | | that you seek medical advice from a |
| tests the leg should be relaxed. | | | | professionally qualified practitioner. |
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