Does your knee cap click, pop or feel like its comes out of joint? Do you get pain at the front of the knee squatting or walking up and down stairs? Patella-femoral maltracking is the translation, deviation and or displacement of the patella (knee cap) from the intercondylar/trochlear groove of the femur (thigh bone). In severe cases maltracking may also result in subluxation or dislocation or the knee cap from its groove.
Patella-femoral maltracking presents as anterior knee pain caused from excessive lateral pressure on the patella-femoral knee joint articulation [1] and can be the cause for a number of conditions that can be described as patella-femoral pain syndrome. Characteristics of patella maltracking may include altered patella positioning; trochlear dysplasia or increased trochlear groove distance; a high tibial tuberosity; or increased hip-knee angle, external tibial rotation/ internal femur rotation [2]. Further soft tissue irregularities including weakness or atrophy of the quadriceps - primarily vastus medialis obliquus (VMO); tightness of the lateral retinaculum, hamstrings, iliotibial band and vastus lateralis; or a lesion of the medial retinaculum contribute to patella maltracking [2].
In short, any restriction, weakness or imbalance observed in different individuals may lead to poor movement efficiency and increased load on the patella-femoral joint; therefore causing it to track improperly. Thus reviewing all segments of the body and joints of the lower limb during functional tasks is important for us as physio’s. Opposed to just identifying issues at the patella-femoral joint itself, other segmental changes such as the balance and strength of deep hip muscular can also effect biomechanical characteristics and load on the knee. Patella maltracking is more common in females due to factors such as increased pelvic width/ hip to knee angles, patella height and tibial tubercle position [2,3,4]. This issue is quite often seen in younger girls due to growth as an adolescent, poor movement/motor control and weakness through the knee and hip muscles. Observing lower limb alignment during gait or squatting helps identify any excessive pronation (rolling in) through the feet, rotation through knees/hip/ and pelvic control. Further symptoms such as cracking noises or pain with sit to stand/ stairs, or tenderness compressing the knee cap are also something to consider with patella femoral knee pain
Our Physio Central Coast can provide the guidance you need to recover from your knee pain to living happy and healthy. We provide:
Assessment and diagnosis
Education and advice
Structured hands on treatment and exercise therapy to facilitate recovery
Home exercise prescription
Return to pre-injury activity
So your knee cap doesn’t want to stay where it belongs? What do we do about it?
There is 3 stages to making a full recovery from patella-femoral maltracking
Phase 1: [muscle activation and re-education]
VMO activation/strengthening [2,3,5], Hamstring/ITB stretches [2]
Taping techniques and bracing to offload the knee joint and reduce your pain limitations [2,7,8,9]
Education with standing/sitting posture, Gait, load/activity management. [2,10]
Assess other contributing forces. Foot, hip, pelvic, thoracic range of motion and alignment [10]
Phase 2 : [Strengthening]
Progress VMO strength with resistance training
Correct alignment issues with manual techniques
Gait training [2,10]
Foot mobility [10], Core strengthening
Gluteus medius and deep hip muscular activation and strengthening [2,5,6]
Core strength
Phase 3 [functional training]
Increase knee strength/power and endurance specific to individual needs. E.g Sport, walking, gardening.
Assessment and diagnosis for each individuals injury should always be conducted prior to developing a treatment plan with exercise prescription and appropriate progressions. Should you have any further questions or would like to discuss your heel or foot pain with a physiotherapist, please contact Our Physio Central Coast (02) 4339 4475.
References
[1] Kramer, P. G. (1986). Patella malalignment syndrome: rationale to reduce excessive lateral pressure. Journal of Orthopaedic & Sports Physical Therapy, 8(6), 301-309.
[2] Colvin, A. C., & West, R. V. (2008). Patellar instability. Jbjs, 90(12), 2751-2762.
[3] Grelsamer, R. P. (2000). Patellar malalignment. JBJS, 82(11), 1639
[4] Metin Cubuk, S., Sindel, M., Karaali, K., Arslan, A. G., Akyildiz, F., & Özkan, O. (2000). Tibial tubercle position and patellar height as indicators of malalignment in women with anterior knee pain. Clinical Anatomy, 13(3), 199-203.
[5] Frosch, S., Balcarek, P., Walde, T. A., Schüttrumpf, J. P., Wachowski, M. M., Ferleman, K. G., ... & Frosch, K. H. (2011). The treatment of patellar dislocation: a systematic review. Zeitschrift fur Orthopadie und Unfallchirurgie, 149(6), 630-645.
[6] Boling, M. C., Padua, D. A., & Alexander Creighton, R. (2009). Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. Journal of athletic training, 44(1), 7-13.
[7] Sisk, D., & Fredericson, M. (2020). Taping, bracing, and injection treatment for Patellofemoral pain and patellar tendinopathy. Current Reviews in Musculoskeletal Medicine, 13(4), 537-544.
[8] Leibbrandt, D. C., & Louw, Q. A. (2015). The use of McConnell taping to correct abnormal biomechanics and muscle activation patterns in subjects with anterior knee pain: a systematic review. Journal of physical therapy science, 27(7), 2395-2404.
[9] Crossley, K., Cowan, S. M., Bennell, K. L., & McConnell, J. (2000). Patellar taping: is clinical success supported by scientific evidence?. Manual therapy, 5(3), 142-150.
[10] Barton, C. J., Levinger, P., Menz, H. B., & Webster, K. E. (2009). Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait & posture, 30(4), 405-416.