Knee Pain under the Knee Cap & Associated Weak Hip Muscles
Pain around the kneecap region is an extremely common injury with people who run on roads and also amongst athletes. The injury is termed Patellofemoral Pain Syndrome (PFPS) which is an unbrella name for irritation of the synovial fliuid with the patellofemoral joint and inflammatory stress to patella tendon which sits below the knee cap. Patellofemoral refers to the knee joint between the knee cap (patella bone) and the thigh bone (femur). The condition occurs when the knee cap (patella) is constantly being pulled too far outwards by the lateral quadriceps muscles. Athletes commonly experience knee shortly after commencing their running. Likewise a GAA player experiences similar pain when playing on grass pitches. The knee pain gets progressively worse over a period of time and relieved with rest. In addition running down slopes aggravates pain.
How do we treat this condition? Well in this article I will focus on Muscle weakness in the Muscles that Abduct the Hip Joint .i.e. the muscles that lift the leg outwards. If these Hip Abductor muscles are weak or are not firing correctly then the Hip Adductors muscles or inner groin muscles cause the knee joint to angle abnormally inwards towards and beyond the midline (imaginary vertical line running through centre of the body). This causes an increase in the angle of the inside knee joint thus applying excessive load to the patella femoral joint on the outer area of the knee. This abnormality occurs during weight bearing of foot (stance phase) during running. By simply using the conservative exercises of strengthening the inner quadriceps and strapping the patella, while helpful, fails to address the Hip Abductor weakness.
What are the Hip Abductor Muscles
The Gluteus Maximus extends the hip backwards, rotates the Hip outwards and lifts the Hip sideways. A strong firing Glute Maximus helps stabilise the weight leg during knee bending movements and helps prevent excessive falling inwards of the knee. If the glute max is weak, the athlete will commonly have excessive tight quadriceps and Illiotibialbands (ITB). Gluteus medius is major external rotator of the Hip Joint which is what is needed to counteract the hip joint rotating inwards during weight bearing squat movements. Exercises to strengthen the glute medius include the A) Clam, B) Sideplank with Hip Abduction and Single leg Squat. However these should only be performed under the guidance of a qualified Professional.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Clonmel & Thurles.
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