Strengthening for Patella Pain

The Aim of Strengthening Exericses

Which muscles need strengthening?

• It is usually the Vastus medialis obliques (on the inside of the thigh near the knee) and the gluteus medius muscle on the outside of the hip that require strengthening.
• This helps to control excess patella movement and help maintain knee aligment.
• The aim of strengthening should be to encourage the patella to track in the proper position and to spread the forces throughout the joint.

When can strengthening begin?

• As soon as the exercises can be performed without pain. It may be necessary to tape the patella to relieve the athlete of pain.

Quad contraction

• This is suitable for the athlete that has pain and is unable to perform standing exercises.
• The athlete sits on the floor with a foam roller or rolled up towel under the knee so that it is slightly bent.
• The hand is placed on the vastus medialis muscle (just above and to the inside of the knee cap) so the athlete can feel it contracting.
• It is essential that the athlete learns to isolate the vastus medialis muscle and feel it being used for strengthening to be effective. A muscle stimulator or tens machine can help in the early stages.
• Contact the muscles, hold for 3 to 5 seconds, relax and repeat 10 times.
• The foot should lift up off the floor as the knee straightens.
• This exercises should be performed 3 to 5 times a day if pain allows.

Clam

• Lay on your side with the knees bent to 90 degrees and feet in line with your spine.
• Lift the top knee away from the bottom knee.
• Make sure you keep the lower back and pelvis still and don't rock backwards.
• You should start to feel the Gluteus Medius muscle at the back, top of the hip working.
• Start with 2 sets of 10 repetitions and gradually increase to 3 sets of 15-20.

Lunge

• This exercise should be started as soon as pain will allow. Tape the knee if necessary to avoid pain.
• Stand one foot in front of the other, the injured knee forwards. Bend the front knee enough to feel the vastus medialis is working. Aim to keep the knee pointing forwards - don't let it fall inwards.
• Return to starting position and repeat. Aim for 3 sets of 10 repetitions.
• Again it may be better to perform a number of sets throughout the day, especially in the early stages of rehabilitation or for a particularly weak muscle.

Step down

• A more advanced exercise than the lunge. Again it should be emphesised that the knee should be kept straight throughout the exercise and the athlete should be aware that it is the vastus medialis on the inside that is working.
• The athlete drops down off the step as far as is comfortable (this does not always need to be all the way down) and returns to the starting position.
• Repeat 10 times and aim to perform a number of sets throughout the day.