Ask the PT: Knee Pain
I have been experiencing a lot of knee pain around my kneecap. It comes and goes, but is generally worse after walking or standing for long periods of time. I don’t really want surgery, so what can I do?
Knee pain is very common and can have a number of causes. Be sure to check with your doctor if your knee pain is constant or severe, as more aggressive intervention may be appropriate. The most common complaint is Patello-Femoral pain, or pain in and around the kneecap, such as you describe. This is caused by an abnormal position and tracking of the kneecap (or patella) on the femur bone during knee flexion. This can be due to a number of postural or muscular factors. Some of the most common include:
Poor structural alignment
Oftentimes the misalignment is not actually in the knee, but in the joints above or below the knee. A misalignment or injury in the hips may affect the alignment of the knees. If someone is knock-kneed, for example, this posture can pull the kneecap laterally. Additionally, if there is pronation (rolling in) of the foot or flat feet, that can pull on the kneecap as well. A physical therapist or trainer can conduct a postural analysis to address your specific issues.
Muscles play a large roll in the stability of the pelvis and kneecaps. It is important to attain three-dimensional muscular balance in the quadriceps, hamstrings, gluteal muscles, inner and outer thigh muscles. The gluteus medius in particular plays an important role in knee alignment because it stabilizes the pelvis and prevents the knee from rolling inward. If this muscle is weak, other muscles like the gluteus maximus and TFL may take over to stabilize the pelvis, further causing the patella to slide out of place. A good Pilates exercise to strengthen the gluteus medius is the side-lying leg series (see the instructional video).
Finally, you can prevent knee problems before they start by maintaining a proper weight, getting moderate exercise, and practicing Pilates or GYROTONIC® regularly!