The knee cap is a floating bone: it sits in the tendon formed by the quadriceps muscles and slides over the main knee joint. The mobile nature of the joint makes it more prone to dislocation and misalignment than other joints.
Patella Maltracking
When the knee cap moves out of the ridge it should move along, it’s known as maltracking. Most commonly, the patella moves outwards due to relative weakness of the vastus medialis (VMO): the quadriceps muscle closest to the thigh. You’re more likely to experience this if you have hypermobility or the anatomy of your knee is less supportive of the knee cap. A history of injury, especially to the ligaments, can have an effect too. In any case, strengthening the VMO is key to recovery. Your osteopath can prescribe you the correct exercise and monitor to make sure it’s still effective. As you improve, we might want to give you more challenging exercises to keep it as strong as possible.
Patella Alta (High Knee Cap)
Because the knee cap sits in the quadriceps tendon, it is affected by the tension of the muscles. If the muscles are tight, they can pull the bone higher up the knee. This can be painful, as the cartilage rubs against a part of the thigh bone that doesn’t fully accommodate it.
The quadriceps and other hip flexors can become excessively tight if you spend a lot of time with your hip bent. For a lot of people, this means sitting at a desk all day. Again, we can give you stretches to help, and you might find that strengthening the glutes and hamstrings helps to maintain better balance. But of course, if you can limit the time spent sitting in the first place, that will help too. It might be as simple as making sure you get up and stretch between meetings or on an hourly basis; or you may prefer a standing desk or chair that encourages less hip flexion.
Encouraging hip flexion is important: hip osteoarthritis often affects hip extension first, and it may go unnoticed for a while as the body adapts. Sometimes it’s only picked up once it’s caused the lower back and neck to compensate as you develop a hunched posture.
Patella Baja (Low Knee Cap)
Much less common than the above is patella baja, where the knee cap sits too low down. It can arise as a side effect of a knee replacement, or in association with chondromalacia patellae. Post surgery, the development can be due to muscle wasting or insufficient rehabilitation. Careful strengthening may be enough to resolve the issue.
Osteopathy for the Knee
Your osteopath will examine your knee and beyond to get a detailed picture of the whole problem. Treatment and exercises will aim to resolve the root cause, and help you manage what can’t be changed. Working on the hip or ankle might be helpful, and a combination of stretching and strengthening can help you continue to improve between sessions.
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