Pain Behind the Knee Cap
The knee is made up of multiple joints. Beyond the main hinge joint, there’s also the patellofemoral joint where the knee cap meets the thigh bone. This joint is unusual, in that the knee cap slides over the thigh bone, suspended in the quadriceps tendon. In terms of anatomy, this opens up the joint to vulnerability to misalignment.
Causes of Pain Behind the Knee Cap
maltracking, where the knee cap moves in an unusual way
osteoarthritis
cartilage injury (runners knee)
Maltracking and High or Low Patella
Maltracking is a common cause of knee pain in clinic. Patients often describe it as a crunchy or grinding sensation, which is worse when going downstairs. There might be reasons for the quadriceps muscles to be tight, which would amplify any issues with the way the knee cap moves. Prolonged sitting can shorten and tighten these muscles, so people who spend a lot of time driving or sitting at a desk might be more prone to developing these symptoms. Typically, the quadricep muscle closest to the inside of the thigh (vastus medialis) is usually a bit weak compared to the others. This means that the knee cap is pulled outwards when the quads engage. Strengthening the muscle is a big part of the standard treatment plan.
Tight quadriceps can also be to blame for another issue: patella alta. This simply means “high knee cap”, and describes a condition in which the knee cap literally sits too high up on the knee. The bone is meant to sit in a groove that matches its own shape, so when it sits too high, it is met with unexpected friction. This can irritate the cartilage, causing pain and swelling.
Less common than patella alta is patella baja: “low knee cap”. This usually follows surgeries like knee replacements, and should be responsive to conservative rehabilitation. It can also develop in relation to chondromalacia patellae in the absence of a history of surgery.
Managing Knee Cap Pain
Treatment depends on the exact cause of the pain. But in most cases, there will be impact on the cartilage within the joint. Due to the shape and pressure on the knee cap, it’s nearly unavoidable for changes here not to rub on the cartilage. Because cartilage has a poor blood supply, it can be a slippery slope to osteoarthritis.
The good news is that cartilage responds well to mobilising techniques. These include those techniques we use in the treatment room, but also exercises we can teach you to do at home.
As mentioned above, the quadriceps muscles play a big role in the movement and health of the patellofemoral joint. Exercises and stretches to keep the quads happy will help to support most issues within the joint. We can provide these exercises at your appointment.
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