Exercises for Patella (Kneecap) Pain, Patellar Tendinitis, and Common Operations for Kneecap Problems: - Understanding kneecap problems and patellar tendinitis - Conservative rehabilitation protocols - Rehabilitation protocols for lateral release, patellar realignment, medial patellofemoral ligament re

References

About the Authors

Dr. Frank Noyes is an internationally renowned orthopaedic surgeon and researcher and Founder of the Cincinnati SportsMedicine and Orthopaedic Center, the Cincinnati Sportsmedicine Research Foundation, and the Noyes Knee Institute. He has conducted landmark research on the biomechanics of ligaments, prevention of ACL injuries in the female athlete, the diagnosis of knee injuries and problems, and the results of treatment for a variety of knee disorders.

Dr. Noyes has won awards from the American Academy of Orthopaedic Surgeons, the American Orthopaedic Society of Sports Medicine, the Orthopaedic Research and Education Foundation, and the University of Cincinnati. He was inducted into the American Orthopaedic Society for Sports Medicine’s Hall of Fame in 2008, was selected as one of the 25 Best Knee Surgeons in the U.S. by Becker’s Orthopedic & Spine Review in 2010, and has been selected as one of the Best Doctors in America every year since 1992. Dr. Noyes is an author on 320 scientific articles and textbook chapters. Please visit http://noyeskneeinstitute.com/ and http://www.cincinnatisportsmed.com/ for more information about Dr. Noyes.

Sue Barber-Westin is the Director of Clinical Research at the Cincinnati Sportsmedicine Research Foundation and the Noyes Knee Institute. Her work has focused on the clinical outcome of a variety of knee operations, methods used to determine the results of studies, differences in neuromuscular indices between male and female athletes, effects of neuromuscular training in female athletes, and prevention of ACL injuries in female athletes. Sue is an author on 145 scientific articles and chapters.

Noyes and Barber-Westin are editors of 2 textbooks: Noyes’ Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes and ACL Injuries in the Female Athlete: Causes, Impacts, and Conditioning Programs. They have written 11 other eBooks on knee ligament, meniscus, kneecap, arthritis, malalignment, partial and total knee replacement, and knee scarring (arthrofibrosis) problems designed for both patients and medical professionals. Please visit http://noyeskneebookseries.com for further information on these eBooks.

Introduction

Patellar (kneecap) pain is one of the most common reasons patients seek medical treatment at orthopaedic and sports medicine clinics. Patellar pain - which is often associated with patellar instability or tracking problems - is especially concerning in younger individuals who are physically active. Women are at a higher risk than men for developing patellar pain. Unfortunately, 70-90% of patients will suffer chronic or recurrent problems with kneecap pain.

Patellar pain can come from many different sources and a variety of terms have been tossed around the Internet that describe this problem, including patellofemoral pain syndrome, anterior knee pain, runner's knee, and patellofemoral chondromalacia. The pain may start from an injury or appear to come out of nowhere...one day, your kneecap simply starts hurting. Or you may have started a new, vigorous exercise program in order to loose weight and get healthy, only to find that the exercises or machines you are using hurt. Patellar pain can be very frustrating and reduce the quality of life if it becomes a chronic, long-standing problem. If you have had kneecap pain for a long period of time and have not seen an orthopaedic surgeon, it is important to do so in order to obtain a diagnosis of what is causing your problems.

The term tendinopathy indicates, in general, a disease of a tendon. More specifically, tendinitis (also spelled tendonitis) refers to an acute tendon injury or pain that is accompanied by inflammation. Patellar tendinitis represents an injury to the tendon that connects the patella to the shinbone (tibia). The patellar tendon plays an important role in the way you use your leg muscles - from activities as simple as walking to more complex movements in sports such as running or kicking a ball. It is part of what is called the extensor mechanism of the knee. The other parts are the kneecap, quadriceps tendon, and quadriceps muscles. The extensor mechanism allows you to straighten your knee and provides strength for all weight-bearing activities.

Some of the main structures of the knee, including those that make up the extensor mechanism. The quadriceps (thigh) muscles are the vastus intermedius, rectus femoris, vastus medialis, and vastus lateralis. The patellar tendon is shown, which connects the patella (kneecap) to the shinbone (tibia).

Patellar tendinitis is usually due to overuse, or repeated stress that causes tiny, microtears in the tendon, resulting in inflammation and pain. This condition is often seen in athletes involved in sports that require frequent jumping, such as volleyball and basketball - hence the frequently used term, jumper's knee. Strenuous occupations that require work on ladders or a lot of climbing can also cause patellar tendinitis. Individuals with poor flexibility in the leg muscles or who have abnormal lower limb biomechanics can develop patellar tendinitis. Other risk factors include a sudden increase in training time or intensity, poor footwear, lack of rest, limited muscle flexibility in the hamstrings and quadriceps, and poor body mechanics related to abnormal alignment.

The body will try to heal the microtears in the patellar tendon, but if the stress continues, the tears increase in number and size and can weaken the tendon structure. The pain is usually located either just below the kneecap or in the middle of the patellar tendon, which is quite sensitive to simple touch. After a long period of time, the condition becomes chronic and is referred to as patellar tendinosis. This condition may occur in older individuals as a result of degeneration of the tendon from years of repetitive micro-trauma. Unlike patellar tendinitis, there is no inflammation in the tendon. The degenerative changes in the tendon may even cause it to tear.

Although there is a considerable amount of information available on the Internet about patellar pain and patellar tendinitis, not all comes from medical professionals with the clinical and research knowledge that knee specialists have. Home remedies such as rest, ice, elevation, and over-the-counter pain medicines may not solve the pain, or keep it from returning time and time again. Unfortunately, the longer you try to treat these problems yourself, the worse they may become and improper treatment may result in damage eventually occurring to the joint lining of the knee or to the patellar tendon.

The good news is that the majority of patients with patellar pain and patellar tendinitis can be greatly helped with the right orthopaedic medical treatment and physical therapy program supervised by a physician-physical therapist team. After treating patients for nearly 4 decades with these problems, we decided to write this eBook to describe the physical therapy exercises and other treatment options that are frequently successful.

We have written two other eBooks on kneecap problems: Patellar (Kneecap) Pain and Problems: Everything You Need to Know to Make the Right Treatment Decision and The Unstable Patella (Kneecap): Everything You Need to Know to Make the Right Treatment Decision. These eBooks provide information on basic knee anatomy, biomechanics, what a comprehensive knee examination consists of, potential diagnoses related to patellar problems, conservative treatment options, and different operations used when all conservative treatment measures fail to alleviate pain.

This eBook should not be used for self-diagnosis and treatment of patellar pain or patellar tendinitis. Only a qualified orthopedist or sports medicine-trained physician can make a definitive diagnosis of knee problems. For medical professionals, we recommend our textbook Noyes' Knee Disorders. Surgery, Rehabilitation, Clinical Outcomes for more comprehensive information regarding the diagnosis and treatment of patellar pain and alignment issues, and other knee problems such as knee ligament tears, preventing knee ligament injuries in the female athlete, and lower limb realignment procedures.

Physical Therapy: Why It Is So Important Whether or Not You Have Had Surgery for Kneecap or Patellar Tendon Problems

Physical therapy: the treatment of injuries and physical conditions by a trained person under the supervision of a specialist in physical medicine. (www.bing.com. Encarta World English Dictionary [North American Edition], 2009 Microsoft Corporation.)

Sports Physical Therapy is a specialized practice that focuses on prevention, evaluation, treatment, rehabilitation, and performance enhancement of the physically-active individual. (http://www.spts.org/about-spts/what-is-sports-physical-therapy)

The overall goal of a physical therapy program for any knee problem is to restore normal function so