Having done your annual Memorial Day Murph, you might have woken up the next day with sore knees and returned to the daily grind behind a desk. Everything feels fine…until you stand up. Come to think of it, every time you extend your leg it hurts and stairs are no joke. You may be experiencing patellofemoral pain.
Your knee joint is made up of the femur (thigh bone) and tibia (shin bone), but a lesser known joint that can become problematic is the patellofemoral joint; the junction between your knee cap and femur.
The end of the femur has two protrusions called condyles with a groove between them. Remember how you used to draw bones as a kid? It’s just like that. That groove acts like a trough that keeps the patella in line when you squat and stand. And the patella is smack in the middle of where the quadriceps muscle transitions to the patellar ligament (better known as patellar tendon). When you’re at the bottom of an ass to grass squat your patella should be nice and congruent with that groove. When you stand up, the tension releases and the patella glides within the groove until you’re at full extension. Kind of like this. Patellofemoral pain occurs when the patella just doesn’t want to slide in that groove.
What seems like a minor biomechanical issue can get pretty nasty. The femoral groove has raised edges and the patella rounded on both sides, like a fat almond. If the patella is grinding on that edge, it damages the cartilage covering both the back of the patella and the surface of the femoral condyle. Double duty cartilage damage = no fun. Plus, the cartilage on the surface of both the bones is not thick like the meniscus, it’s thin; just enough to keep everything slippery and sliding smoothly. Keep grinding and it can wear right through the protective covering. Now we’re talking bone on bone and tons of friction.
Patellofemoral pain occurs for a number of different reasons, both structurally and functionally. Structurally, your bony geometry might set you up for failure if you have wide hips, or femurs that are rotated. Functionally, musculature pulling or giving slack on the knee cap can mess with its ability to stay in the groove. Over time, even the joint capsule and ligaments on either side of the patella can become tight, leading to subpar movement.
If your problem is structural, there’s not a lot you can do, conservatively, to change the way your body is put together. Patellofemoral pain syndrome can lead to more serious issues like arthritis or subluxing/dislocating patella that could lead to surgical intervention. BUT there are a number of things you can try to manage the functional causes of your pain. Mobility is always a great place to start. Ask yourself these questions:
Am I acutely inflamed or is this an ongoing issue?
If you’re going on your third day of knee pain, applying some heat before mobility can help to make the tissues more pliable before doing any dedicated mobility work. Before that? Ice, NSAIDs , and compression. There are braces designed to control patellar motion and a taping technique called McConnell taping. It’s not as sexy as ROCKTAPE, but holds for days….literally.
Do I have full mobility?
Consider the hip and ankle too, not just the knee. A lot of times, hip and ankle dysfunction cause knee problems just because it’s stuck in the middle. If you’re not already in tune with your trouble areas, there are a number of resources out there to assess your functional mobility. Here’s one of them.
What is the quality of my movement? Do my knees feel creaky, achey, crunchy?
These are signs of poor tissue quality. If you’ve got a foam roller or lacrosse ball lying around, dig in to EVERY muscle in your lower extremity that lights you up. This below video demonstrates a pretty comprehensive foam rolling routine, pay particular attention to 5:10 on for the lower extremity. Remember, just because your knee is in pain, doesn’t mean that that’s the root of the issue. Self myofascial release can be eye opening, so take note to where your trigger points are.
Am I holding the standards and proper alignment for all the motions that have knee flexion/extension?
This can be a tough one to evaluate, so get some extra eyes on you. Developing good movement patterns before adding weight is essential to developing strength in all the muscles that help establish and maintain proper alignment. Some movements you may want to examine are squats, cleans, and that quick dip drive into your split jerk. Don’t forget about running and jumping…double unders, box jumps….Clovis. Yikes.
Written by Liz Caruso