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