Anterior knee pain -- treat yourself first

No one wants to start off the new year with nagging knee pain.  Probably 80% of the patients we see in the PT clinic who come in with complaints of pain in their knees when:  climbing up stairs; going down stairs or inclines; prolonged sitting; squatting.  This is also usually accompanied by tightness in the calf and hamstring muscles. 
An imbalance in the quads (the big anterior thigh muscle) can cause a maltracking problem with the kneecap.  The inner quad gets overpowered by the outer quad.  So the patella then starts grinding on the lateral femoral condyle (the end of the femur/thigh bone on the outside edge).  If this goes on too long then one can wear down the cartilage and end result is a knee replacement. 
I don't have any input about the viscosupplemntation injections.  But can speak positively about glucosamine. 

Self treatment: First stretching needs to be done for calves, hamstrings as well as IT Band, hip rotators and quads in respect for our sport.
Strengthening for the quad, particularly the VMO - vastus medialis oblique.  This is done by a few basic exercises
1.  Quad sets -- flexing the thigh.  Lie down on the floor.  Tighten thigh by pushing your knee down into the floor.  Your heel should lift slightly off the floor.  Hold 5 seconds, relax and repeat.  Up to 100 a day.
2.  Straight leg raises -- lie on your back, bend your good knee and rest your foot on the floor.  Do a quad set on the bad knee and then lift the leg up off the floor about 8 - 10 inches.  Hold for a moment, lower slowly, rest, relax, repeat. 
3.  Short Arc Quad (some PT's don't agree on this one) -- lie down on the floor, place a coffee can behind your knee, lift your foot up off the floor and straighten your knee out fully.  Hold a moment, lower smooth.  Don't plop.  If either SLR or the SAQ hurts then slightly rotate your entire leg out sideways (or laterally) your toe points somewhat towards the wall instead of the ceiling.
4.  Hip aDduction - lie on your right side, keep the right leg straight, bend the left knee and place your left foot on the floor in front of your right knee.  If it bothers your hip, you can place it behind the right knee.  But this also tells you that you need to stretch your hips!  Lift the right leg up off the floor a few inches.  Keep the knee straight.  Hold a moment, lower slowly.  Relax and repeat.
5.  Hip aBduction -- lie on your right side, bend your bottom right leg to help with balance.  Keep the top left leg straight, lift up the top leg 10 inches or so.  But not so far that you allow your hip to roll back.  I don't know that anyone on this list is a Rockette, but there's no need to lift very high.  :)

Once able to perform 30 reps comfortably then you can begin to add light weights on all of the exercises.  I start my patients and myself with 2# and gradually work up to 5#.  Then when able to do these well then I switch to using therabands, big rubberbands, and do the exercises in standing.  This is also a great way to work on balance too.  In standing also concentrate on your posture and keeping your abdominal muscles tight to help stabilize your trunk.
Lastly, lots of bicycle with the seat up tall.  To activate the VMO we need to get the knee nearly straight.  If the seat is down too low, it just doesn't kick in as well and can cause more patella grinding/wear and tear/pain.  Avoid deep squatting  and lunging. 
Swimming is another good way to work out sore knees too.
I hope everyone's training programs are going well and we all can go into the new year with NO injury and avoid injury yet all together!

Merry Christmas,
Lubbock, Texas

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