Your patella, or kneecap, is a floating bone that slides up and down a groove at the end of your femur as you bend your knee. Your kneecap is designed to fit in the center of this groove. Sometimes, either after overuse or by injury, the patella no longer slides evenly in this groove, causing discomfort and pain. This is called patellar subluxation, or an unstable kneecap. In adolescents, minor patellar subluxation may correct itself. However, more major subluxations may require physical therapy. Consult with your physician to determine what treatment is best for you.
Stage One
Immediately after your patella sublexes, it is important to immobilize your knee with either a brace or a wrap, and see a doctor. Your doctor will be able to determine whether your patella has sublexed or if it has become fully dislocated. After determining the degree of subluxation, refrain from any load bearing activities or excessive bending of your knee. Ice applied to the knee can help reduce any swelling and control pain. Anti-inflammatory medications may also be prescribed for the same reasons.
Stage Two
After the initial swelling has subsided, it may be necessary to begin passive and active knee flexion and extension exercises. These exercises will help regain range of motion that you may have lost after the injury. Passive range of motion involves a physical therapist manually moving your kneecap by grabbing on to your lower leg and bending and extending your knee. Active range of motion involves the same motion, however instead of the physical therapist manually moving your leg, you will move your leg with your own muscles.
Stage Three
After you have regained some degree of flexibility in your knee, you may begin light resistance training. Your patella is held in place largely by your quadriceps tendon. By strengthening the muscles of the quadriceps, you can help keep your patella firmly in its groove on the base of the femur. It is important to do this under the direction of a physical therapist, because the muscles of the quadriceps must be strengthened evenly. If you develop a strength imbalance in your quadriceps, your patella may continue to track incorrectly.
Stage Four
After you have regained adequate range of motion and strengthened the muscles of your quadriceps, your doctor may clear you for normal activity after assessing that your patella is tracking properly. However, it may be necessary to continue with the resistance training exercises for your quadriceps to ensure that your patella will continue to track properly even after fully recovering from the injury.
References
- "Essentials Of Athletic Training"; Daniel D. Arnheim and William E. Prentice, 2002
- "Therapeutic Exercise: Foundations and Techniques (5th edition)"; Carolyn Kisner and Lynn Colby; 2007
