Ask a PT

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Posted - 02/13/2008 :  00:31:49  Show Profile  Reply with Quote
Our user asked: "My orthopedic surgeon did an MRI of my knee and said it is healthy and much younger than my physical age. Yet my left knee swells up from time to time and it has become very painful at times. Until about a month ago I was very active and worked out three times a week. The surgeon refered me to a physical therapist who wanted me to come in three times a week but my work did not allow this. They gave me a sheet with some exercise instructions to strengthen certain leg muscles and help make my knee cap track properly. However, I'm not the type to do this without proper explanation for what and why. They were too much in a hurry to explain. Can you tell me how I can tell which muscles are in need of strengthening and how to choose the best exercise for each?"

Ask a PT Response: "From what you described, it appears you may have been diagnosed with Patellofemoral Syndrome (PFS). This pain is usually a result of a condition where the kneecap (patella) is not moving correctly in the groove which is created at the end of the thigh bone and at the top of the shin bone (tibia). When this happens the patella may track more laterally or towards the outside of your knee. Muscle imbalance at the knee is often associated with PFS. The quadriceps muscle plays the most important role with the tracking of the knee cap but issues with the iliotibial band (ITB) and hip adductor muscles may also contribute to improper alignment of the knee cap as well. If the quadricep muscle or ITB is too tight, this can lead to pulling of the patella one way and result in pain or other symptoms such as edema. Weak quadriceps often contributes to PFS as well since the weak quadriceps allows the patella to track more laterally. Often times physical therapists will issue stretches for the quads, hams and ITB to help correct for any imbalances. Quadricep strengthening exercises such as terminal knee extension, partial lunges, partial squats, short arch quads, and quad sets are just a few of the exercises that a PT could issue to a patient to assist with strengthening the quadriceps muscle. Strengthening the quadriceps muscle, particulary the inner portion of it (vastus medialis oblique) will assist with better tracking of the patella. If your PT found other areas of weakness from conducting the evaluation, you will want to strengthen those areas as well. Other contributing factors to PFS could also be flat feet or high arches, bone alignment, poor mechanics with activities such as running, walking etc. and overuse. I hope this answers your question. Thank you for using CyberPT."