Excessive Lateral Patellar Compression Syndrome

with Rehab

ExitCare ImageExcessive lateral patellar compression syndrome involves an increase in pressure in the knee joint, that causes pain. The kneecap (patella) is a v-shaped bone that usually glides through the center of the groove in the thigh bone (trochlea). For people with this condition, the kneecap presses more on the outer (lateral) side of the groove, causing an increase in pressure and pain in the knee. This condition usually occurs without injury, although it may also follow an injury.

SYMPTOMS

  • General, spread out knee pain, most commonly in the front half of the knee, behind the kneecap, or in the very back of the knee. Less commonly, the pain may be above or below the kneecap.

  • Pain that gets worse with sitting for long periods, rising from a sitting position, going up or down stairs or hills, kneeling, squatting, or wearing shoes with heels.

  • Often, pain with jumping.

  • Often, an aching pain.

  • Giving way, catching of the knee.

  • Minimal or no swelling, no locking.

CAUSES

Excessive lateral patellar compression syndrome is caused by weakness in the thigh (quadriceps) muscles, that causes the kneecap to track poorly within the knee joint. The poor tracking of the kneecap may also occur in people who have an improper alignment of the knee and leg (bowlegged, knock knees). The poor tracking of the kneecap results in an increase in pressure on the outer side of the knee. The membrane that holds the kneecap in place (retinaculum) is stretched, which causes pain. The pain gets worse with use of the thigh (quadriceps) muscle.

RISK INCREASES WITH:

  • Tight back of the thigh (hamstring), front of the thigh (quadriceps), or calf muscles.

  • Weak front of the thigh (quadriceps) muscles.

  • Failure to warm up properly before activity.

  • Sports that involve running, jumping, or squatting.

  • Poor alignment of the legs (bowlegged, knock knees).

  • Born with (congenital) malformation of the kneecap or thigh bone groove (trochlea).

  • Previous injury or surgery to the knee.

  • Direct injury to the kneecap (falling on the kneecap).

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Use arch supports (orthotics) or knee pads.

PROGNOSIS

If treated properly, excessive lateral patellar compression syndrome is usually curable. If left untreated, the condition does not usually result in a permanent condition.

RELATED COMPLICATIONS

  • Frequently recurring symptoms and disability, severe enough to decrease an athlete's competitive ability.

  • Arthritis of the kneecap.

  • Kneecap dislocations.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness, weakness, paralysis), knee stiffness, dislocation of the kneecap, weakness, continued pain, compartment syndrome (if surgery is performed to cut the bone of the leg and move it).

TREATMENT

Treatment first involves ice and medicine, to reduce pain and inflammation. Since weak muscles often cause the condition, it is important to complete strengthening and stretching exercises to help the kneecap track properly in the thigh bone groove. These exercises may be performed at home or with a therapist. Your caregiver may recommend that you wear a knee brace, to help the kneecap track properly. For people with flat feet, orthotics may be advised. If non-surgical treatment is unsuccessful, surgery may be needed. Surgery involves cutting the outer side (lateral release) of the connecting band (retinaculum), with or without tightening the retinaculum on the inner side of the knee. Sometimes, surgery to cut the bony bump below the kneecap (tibial tubercle) and move it may be required (insertion of the patellar tendon into bone).

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections are rarely used for this condition.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 6 to 8 weeks, despite treatment.

  • Any of the following occur after surgery:

  • Pain, numbness, coldness, or discoloration (blue, gray, or dark color) in the foot.

  • Fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Excessive Lateral Patellar Compression Syndrome

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue. Inform your caregiver of any exercises that increase your knee discomfort.

ExitCare Image STRETCH – Lateral Patellar Mobilizations, Seated

  • While sitting, bend your knee 90 degrees or a little less. Place your foot flat on the floor.

  • Place the inside of your palm at the base of your thumb, on the inside border of your kneecap.

  • Press down on the inside border so that the outside border slightly lifts up.

  • You should feel a slight stretch on the outside edge of your kneecap. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Iliotibial Band

  • On the floor or bed, lie on your side so your right / left leg is on top. Bend your knee and grab your ankle.

  • Slowly bring your knee back so that your thigh is in line with your trunk. Keep your heel at your buttocks and gently arch your back so your head, shoulders and hips line up.

  • Slowly lower your leg so that your knee approaches the floor, until you feel a gentle stretch on the outside of your right / left thigh. If you do not feel a stretch and your knee will not fall farther, place the heel of your opposite foot on top of your knee and pull your thigh down farther.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Excessive Lateral Patellar Compression Syndrome

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • Only do your exercises in a pain-free range of motion. If the exercises that involve bending your knees while bearing weight cause pain, stop them and consult your caregiver.

ExitCare Image STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can, without increasing your pain, for __________ seconds.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your right / left knee, so that the knee bends slightly.

  • Raise only your lower leg, by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/0.5 kilogram increments.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door, and walk your feet out 18-24 inches. Place your feet hip width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

* Your physician, physical therapist or athletic trainer will alter this angle based on your symptoms and progress.

ExitCare Image STRENGTH – Quadriceps, Squats

  • Stand in a door frame, so that your feet and knees are in line with the frame.

  • Use your hands for balance, not support, on the frame.

  • Slowly lower your weight, bending at the hips and knees. Keep your lower legs upright so that they are parallel with the door frame. Squat only within the range that does not increase your knee pain. Never let your hips drop below your knees.

  • Slowly return upright, pushing with your legs, not pulling with your hands.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Hold a wall or counter for balance only, not support.

  • Slowly, step up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Quadriceps, Step-Downs

  • Stand on the edge of a step stool or stair. Be prepared to use a countertop or wall for balance, if needed.

  • Keeping your right / left knee directly over the middle of your foot, slowly touch your opposite heel to the floor or lower step. Do not go all the way to the floor if your knee pain increases. Just go as far as you can without increased discomfort. Use your right / left leg muscles, not gravity, to lower your body weight.

  • Slowly push your body weight back up to the starting position,

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quad/VMO, Isometric

  • Sit in a chair with your right / left knee slightly bent. With your fingertips, feel the VMO muscle, just above the inside of your knee. The VMO is important in controlling the position of your kneecap.

  • Keep your fingertips on this muscle. Without actually moving your leg, attempt to drive your knee down, as if straightening your leg. You should feel your VMO tense. If you have a difficult time, you may wish to try the same exercise on your healthy knee first.

  • Tense this muscle as hard as you can without increasing any knee pain.

  • Hold for __________ seconds. Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete exercise __________ times per day.