I went hiking about 5 months ago. Several days later, I started to have diffuse knee pain. I stopped being able to bend my knee completely. Shortly afterwards it became swollen and inflamed. I had joint line tenderness, which can indicate a meniscal tear. My knee felt very unstable and there was a lot of “popping” with moving it. It went through some periods of getting better and then I would make a wrong move and was back to pain and swelling. During all this time, kneeling was out of the question. I was convinced I was dealing with a meniscal or ligamentous tear which can mean surgery.
When the pain was enough enough, I tried treating my knee. I would focus on the back of the knee where I experienced a lot tenderness. The calves, hamstrings, and popliteal muscles were tender over the knee joint. I also worked a lot on the lateral and medial side of my knees. Although it did help and the swilling would significantly reduce when I would treat it, my knee still did not feel “right” and I was still apprehensive with it. One day when things were really bad, it finally dawned on me to try treating my knee cap (patella). There was excellent tenderness all around it and underneath it were I could reach. Immediately after releasing this, my knee felt significantly more stable, less painful, and I had much better range of motion. Within two weeks, it healed completely and now feels as if there was never a problem with my knee. I started to evaluate and treat this on many of my patients and here's what I found:
- The area around and under the patella is commonly tender. It is important to understand that the patella is part of the knee joint capsule. The knee joint capsule working properly is crucial for full knee flexion, or bending motions. Releasing the joint capsule and it's associated fascia is important to restore normal function to the knee.
- Patellar strains can keep the tibia and femur (the main bones that make up the knee joint) misaligned. Releasing the knee joint capsule around the patella then frees tension that keeps the tibia and femur from articulating properly. It can keep the tibial plateau anteriorly or posteriorly translated (slipped) on the femur.
- Releasing the patella will help relax the quadriceps and hamstrings. In previous articles, I discussed how joint dysfunctions will cause the muscles to reflexively contract to protect the joint limiting the full range of motion of the joint. Therefore restoring normal anatomy will allow the splinted muscles to relax. This can be a useful area to consider with patellofemoral tracking disorders where the lateral portion of the quadriceps is considered to be “too strong” in relation to the medial portion resulting in the patellar dysfunction.
Analyzing The Patella
I will only discuss areas to evaluate for dysfunctions around the patella. As a practitioner, use any treatment methods that you prefer. I recommend gliding your fingers perpendicular to the muscle fibers. Usually back and forth along the borders of the knee cap will expose tenderness. In addition, gliding the patella over in multiple directions and evaluating the tibial and femoral joint surface underneath where the patella generally lies. There are often very tender areas underneath the patella and will also amplify a dysfunction between the tibia and femur. In addition, be sure to look for tender points on the posterior surface of the patella as best as possible.
Releasing the patella has helped me to not just resolve knee pain, improve hamstring flexibility, low back pain and more. I have found this area to be often overlooked and not considered by many practitioners. This may be a useful idea to try in your practice.