Patello-femoral knee pain is a common complaint of athletes and non-athletes of all ages and genders. It is a general knee pain felt between the patella (knee cap) and the femur (thigh bone). The pain is usually increased with bent knee activities against a resistance, while decreased with rest. Sporting activities, especially those involving running, ascending and descending stairs, sitting with the knees flexed for long periods of time, cycling, and squatting are the activities usually described as increasing the knee pain. Causes of the knee pain may include poor flexibility in the hamstrings, iliotibial band, and quadriceps; poor strength in the quadriceps; poor alignment in the lower extremity; and flat or pronated feet.
Prevention of patello-femoral knee pain may be achieved with a few simple exercises included in your warm-up routine to maintain flexibility and strength in the leg.
- Purpose: to stretch the hamstrings and reduce the compression under the patella.
- Correct position: Place the foot on the seat of a chair, with your hands behind your back. Keeping your back and knee straight, lean forward at the hips and hold. This stretch should be felt at the back of the thigh. With flexion of the foot up towards the head, a further stretch will be felt in the calf muscles.
Iliotibial Band (ITB) Stretching
- Purpose: to stretch the structures attaching to the outside part of the patella.
- Flexed Correct Position: Long sitting with one leg crossed over the other leg. Place opposite hands on the outside of opposite knees and keep your back straight. The hand on the bent knee should pull towards your body to feel to stretch at the hip and hold. This stretch should be felt on the outside part of the hip and in the buttock area.
- Extended Correct Position (eg. Stretching the right ITB): Stand with the back straight and the left leg crossed in front of the other for balance. Keep the back and right leg straight as you push the right hip towards the right. You can use your left hand placed on the left hip to assist in the stretch at the right hip. This stretch should be felt on the outer part of the right hip. Repeat for the opposite leg.
Quadriceps Strengthening Exercises
- Step Up: Place one foot on a sturdy stool or bottom step of a flight of stairs. Raise the body up onto the stool, keeping the flexed knee in line with the foot at all times through the exercise. Allow the straight leg which is off the stool to remain behind the stool. Lower the body slowly in a similar fashion, again with the straight leg behind the stool.
- Progressions: To increase the difficulty, the athlete may progress to the step up and over. The exercise will be done as described in (A). When lowering the body of the flexed leg, allow the straight leg to move to the front of the stool and step down. Repeat for the other leg and progress the number of repetitions.
The strengthening exercises should not increase the pain and should always be done with the knee in line with the foot when raising and lowering the body on the stool.
Prevention through stretching and strengthening exercises for the knees will ensure fun in all sports participation.