Patella Alta or high riding patella is a condition where the kneecap alignment is off. The kneecap sits too high possibly resulting in knee pain, patellofemoral syndrome, knee stiffness, etc. This problem can be structural or due to tight quadriceps, quadriceps tendon and patellofemoral joint restrictions. Mobilizing the patellofemoral joint and improving the mobility of the quadriceps muscles and tendon can be helpful in correcting the alignment and relieve knee pain.
This is Manu Kalia, physical therapist and Ayurveda herbalist. I’m answering a question by one of my viewers, and this is also a question that’s been asked by a lot of other people. The question is about kneecap position, and the person mentioned that he’s having, as per x-ray, kneecaps are riding higher up, they’re positioned higher, then they’re not aligned where they’re supposed to be, which is causing some crunching sound especially when getting up from a squat position, or with bending and straightening of the knee there’s some clicking and crunching sound. So it’s patella alta – that’s the technical name for it or the medical name for the problem. And both kneecaps are riding higher. They’re aligned higher.
So here’s a model of your knee. Here’s the kneecap, and if the kneecap sits too high, with bending or straightening the irritation that it causes, the rubbing that it causes, could be causing the crunching sound, possibly wearing down of the cartilage or just irritation of that tissue. And the question was, “Is there a way to improve the mobility in a downward direction because it sits too high or it moves too much in the upward direction? Can you improve the mobility and possibly affect the alignment a little bit so it moves better in a downward direction also?”
So we have to also consider whether these are anatomical differences, so this is just the way the kneecap is or that individual’s kneecap is, just the way it sits, that’s the way they come. The second part is, of course, tightness of a lot of these structures. Maybe the quadriceps is so tight; the quadriceps tendon is so tight. Maybe that’s affecting and pulling things up more and limiting the downward movement of the kneecap. So we have to also consider that part.
And so once you consider those things you have to say, “Okay, well, what are some of the things that this person could do to improve the mobility of that kneecap?” So one thing of course would be to work on improving the flexibility or the mobility of the quadriceps, the front thigh muscle, so improving the mobility of the quadriceps tendon by doing mobility or stretching exercises and also by doing massage or breaking down thickening or adhesion that might have formed along that tissue. Maybe it’s too tight. Maybe there could be restrictions and it’s just not letting that kneecap glide down.
And finally also, improving the actual joint mobilization techniques, so improving mobility of that joint. So I’ve shown some kneecap or patellar mobilization techniques in the past. This is the kneecap. So let’s do this one. So a simple thing to do would be, so if the kneecap sits too high, you want to work at gliding it down. So you’re going to grasp just above that with your…heel of my hand and my fingers right on my kneecap, I could just do downward…I’m not compressing the kneecap, I’m gliding the kneecap parallel almost. So I’m just gliding that tissue down to stretch a lot of these structures or mobilize a lot of those structures.
So this is a joint mobilization technique. I can get to the end range. I can holdandcan oscillate gently and work on improving the mobility of that tissue. If there’s a lot of tightness and thickening around here, you could also do cross-friction massage techniques, which I’ve shown before for quadriceps tendon issues or tendinosis-type problems, but you can get in there. You can also use a lacrosse ball or a tennis ball and do mobilization of that quadriceps tendon as well as quadriceps muscle to improve the tissue glide also, and then of course doing actual stretching or mobility exercises to improve the mobility of the quadriceps muscle too.
So consider a lot of these things and they can be done to improve the mobility. They’re easy enough to do, to figure out. If the joint is stiff and maybe the muscle is tight and the tendon is tightened up, if you improve the mobility and the kneecap starts to glide better in a downward direction, see if that does affect the crunching sound or you have less discomfort or stiffness with squatting to standing up, or for that matter, when you are bending and straightening that knee you have less of those issues. Easy enough thing to do to test and see whether when you do these things it improves the mobility of that tissue, you have less crunching, clicking sounds, and for that matter, you have less stiffness or discomfort.
I hope that answers your question, and I hope this helps a lot of other people who have similar questions about kneecap alignment also, especially in a patella alta upwards position. Please share the video if you think this can help someone else and subscribe to the channel. Thank you.