Patellar Femoral Malalignment Exercises

Patellofemoral misalignment is a common type of knee pain often called "runner's knee," although not just athletes are affected. Most cases aren't serious enough to require surgery, but you may have to adjust your workout routine to prevent further injury. The proper types of exercise not only treat the condition; they may be able to prevent it from occurring.

Identification

The patella, also known as the kneecap, is attached to your lower leg femur bone by a pulley-shaped structure that allows the patella to track up and down when you flex and extend your knee. The whole structure can become misaligned, meaning that it doesn't track smoothly in its normal motion, leading to pain, stiffness and even a feeling that the kneecap itself is slipping. Runner's knee is usually caused by overuse, but other contributing factors can include inflammation, wide hips, knock knees, weak quadriceps muscles, tight hamstrings or calf muscles and pronation, or an excessive rolling outward of your feet.

Exercise Benefits

Although some exercises can make misalignment worse, others are beneficial. Stretching is particularly useful, especially for the lateral retinaculum muscle, iliotibial band, hamstring muscles, quadriceps and Achilles tendon. A study published in 1992 in the "American Journal of Sports Medicine" followed 51 patients with patellofemoral pain and alignment problems during an exercise program for eight weeks. The majority of the subjects were pain-free following a rehabilitation program that included stretching exercises focusing primarily on the vastus medialis oblique muscle, one of the four quadriceps muscles of the thigh, and the iliotibial band, a muscle from the outside of the hip joint to the lower leg just below the knee.

Recommendations

Therapists at the Orthopaedic Surgery and Athletic Medicine in San Antonio, Texas, recommends using quadriceps sets, where you lie on a flat surface like a bed with your legs straight, tightening the muscle at the front of the thighs as you press the back of your knees down toward the bed, and hold for a few seconds. Other helpful exercises include straight leg raises, in which you lie with one leg straight and the other bent, and then lift and lower the straight leg; and hamstring stretches, where you sit on the floor with both legs straight, extend your arms and reach forward at the waist while keeping your knees straight, and hold for 10 seconds.

Considerations

A part of your therapy, you may need to wear knee braces, to modify the position of the patella, or tape, to keep the patella stable and prevent it from sliding. Since foot pronation puts abnormal stress on the feet and the knees, consult your doctor to see if you need orthotic inserts for your walking and exercise shoes.

Prevention

To prevent patellofemoral misalignment and knee pain, lose weight and stay in shape with strength training. Warm up for five minutes prior to running or any other exercise and then do a few light stretching exercises. Use good, supportive shoes and proper running form as you increase your training gradually, and avoid sudden changes in exercise intensity. Avoid running on hills in general---but steep hills in particular.