Restoring proper patellofemoral mechanics is essential for optimal functioning of the knee joint. Kneecap stiffness or patellofemoral joint hypomobility is often a problem with patellofemoral pain syndromes or runners knee pain. I also find this to be a major issue after knee surgeries: arthroscopic knee surgery, total knee replacement, etc. Any type of strain or injury which results in knee swelling, tightness, pain resulting in adhesions of muscles and connective tissues can cause impaired mobility of the kneecap. This is a physical therapy joint mobilization technique to improve the flexibility of the patellofemoral joint. Caution: avoid if you have history of knee dislocations or hypermobility of the kneecap.

Transcript:

Hey guys, this is Manu Kalia, physical therapist and Ayurveda herbalist. So I’m going to show you guys a mobilization technique specifically for the kneecap. It’s a physical therapy technique to stretch out the kneecap or actually stretch the fibers around the kneecap. So we’re addressing the patellofemoral joint. Patella is your kneecap and femur is the thigh bone where the kneecap sits on. So often post injury if there’s swelling, there are adhesions that are formed around that joint, you can have things…the kneecap gets kind of bound up and it doesn’t move as well. It could also be due to the tibio femoral, the other joint, the main knee joint, which is your femur and tibia, the bottom bone. That not moving effectively also can affect this joint. For our purpose, we’re going to try to mobilize this joint.

Post surgically I see this a lot after arthroscopic surgeries, total knee replacements and a lot of other types of injuries, and then definitely runner’s knee, patellofemoral issues – people often are bound up through here and the kneecap is not moving effectively. So more often the quadriceps being really tight or quadriceps tendon, or the lateral structures, IT band and a lot of these other structures, some quadriceps expansion inserting into the outside border of the kneecap, getting bound up. So all these tissues are tightened up and that’s why often there’s that lateral drift of that kneecap. Alignment is a little bit off. So that mechanically affects the transfer of force and load through that joint and can cause problems.

So we want to get that joint moving better so it moves good, up and down moves properly, side-to-side movement is good too. So the way we’re going to do that is you’re going to basically look for the sticky or tight spots, and then we’re going to get in there and we’re going to stretch out that tissue. So let’s look at the top and bottom. So here’s the top of the kneecap. I’m going to grab on with the heel of my hand and the bottom part is held with my fingertips. Now, remember, I’m not pushing down into it, I’m going at parallel planes, I’m doing this movement. I grasp it and I move it back and forth. I go down and I hang out here and I stretch. I might go out to the side a little bit. So remember, you’re looking for not just straight down, you’re looking for different angles to see where things are tighter. So I’m going to hang out there, oscillate, I’m stretching— one, two, three, four, five—for about 20, 30 seconds, and I come back out of it. And I go to another spot and I’m oscillating it and I stretch, stretch, stretch. I’m going to go to the side now and I’m going to grab it here and glide from the lateral to medial going inwards, so from outside to inside, and I’m stretching. So really a lot of time people feel pretty strong stretch along this whole border here when you do that.

So let me give you a closer view. Come on over. Don’t be shy.

So now what we’re going to do is just to show you guys a top view. So here is the kneecap that I was showing, top of the kneecap, the bottom, up and down movement. So I grab through here and I’m just moving that up and down, just hanging out here and just stretching. Just hold and you will pulling all along this border. Right up here—this is the outside border—grab it in a diagonal. I’m stabilizing with the other hand so the leg doesn’t move as much from this side and I’m stretching that tissue again 20, 30 seconds, move to the next spot outside here, grab the kneecap, and I’m gliding it inwards so it’s going essentially this way. So I’m basically hitting all these different spots to see where I’m tight through here. So as I said, often this top and the whole outside area can be quite tight on runners. IT band issues, patellofemoral issues, with a lot of these problems you can really stiff and bound up.

So try that and do that about…spend four to five minutes or so in that position just kind of working through that whole tissue to free it up. You get a little sore initially. Do it like every other day and as you get better at it, as it gets easier and easier, you can mobilize it a bit more. And the soreness should subside as the mobility improves in that tissue.

Now a word of caution. So if there’s hypermobility, excess mobility or if you’ve had dislocations of the kneecap, you obviously don’t want to do that. You don’t want to mobilize the joint further if you’re already unstable through there, there’s a history of dislocations of that kneecap whether due to anatomic positioning of the joint or other issues. So don’t do that if that’s the case. But the rest of you, for your runner’s knee issues, IT band issues and patellofemoral issues, you want to get a lot of this stuff moving better. Get in there and mobilize that joint and get yourself moving well.

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