Generalised knee pain can be a disabling condition with significant activity limitations. The good thing about the knee, though, is that there are “normally” simple exercises and processes that can be put into place to decrease pain whilst increasing activity levels. Of course, every knee is different in terms of structure, symptoms and effective rehabilitation.
A very common cause of knee pain is patella mal-tracking, simply meaning that the knee cap has moved position. The majority of the time the patella tracks laterally towards the outside of the leg, however, it can also move to various other positions including a slight twist.
Abnormal tracking of the patella is associated with an imbalance in activation of the outer quadriceps muscle Vastus Lateralis (VL) and the inner muscle Vastus Medialis Oblique (VMO). When there is an imbalance between these two muscles it can create limitations with regards to strength, flexibility and functional movement patterns. VL becomes very tight and takes on all of the workload of the quadriceps and VMO suffers with a wasting effect.
Abnormal patella tracking has a significant influence on knee pain and could lead to other knee injuries or conditions if it is not corrected. The main symptoms of patella mal-tracking can include one or more of the following: a grinding sensation, pain on ascending and/or more commonly descending stairs, pain on resisted knee extension, a visual weakness in VMO and possibly a slight bit of puffiness /swelling above or below the knee cap.
To combat this imbalance in the quadriceps, the VL on the outside needs to be rolled out and stretched and the VMO on the inside, isolated and strengthened. This is done by turning the foot outwards causing external rotation at the hip which will strengthen the VMO when performing, in particular, straight leg raises, knee extensions and body weight squats.
I have had a lot of personal experience when using this simple biomechanical change of external hip rotation when doing knee extensions, showing an improvement in pain levels and range of movement. There is also plenty of scientific evidence that reinforces this idea, if you would like to read any of the journals that support the points made here please see below.
Lin, F., Wilson, N. A., Makhsous, M., Press, J. M., Koh, J. L., Nuber, G. W. and Zhang, L. Q. (2010). In vivo patella tracking induced by individual quadriceps components in individuals with patellafemoral pain. Journal of Biomechanics, 43, 235-241
Sakai, N., Luo, Z. P., Rand, J. A. and An, K. N. (2000). The influence of weakness in the vastus medialis oblique muscle on the patellafemoral joint: an in vitro biomechanical study. Clinical Biomechanics, 15, 335-339
Singer, B.J., Silbert, P.L., Song, S., Dunne, J.W. and Singer, K.P. (2011). Treatment of refractory anterior knee pain using botulinum toxin type A (Dysport) injection to the distal vastus lateralis muscle: a randomised placebo controlled crossover trial. Br J Sports Medicine, 43, 640-645
Sykes, K. and Wong, Y. M. (2003). Electrical activity of vatus medialis oblique muscle in straight leg raise exercise with different angles of hip rotation. Physiotherapy, 89, 423-430
Warden, S. J. and Brukner, P. (2003). Patellar tendinopathy. Clinical Sports Medicine, 22, 743-759
