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Another source of knee pain

Another source of knee pain
Rectus Femoris Pain or Problems with Your Kneecap? - Solving the "High Riding Patella"
Greetings! Spring is almost here, and of course that means you are thinking of all the trigger point self-care you will be doing to enjoy your outdoor activities, right? Well, you might have a couple other things in mind ... but certainly Spring will be more fun if your knees are in good shape! This means you need to know a little bit about your kneecaps. Your kneecaps (patella bone) are designed for more than just good looks. :-) Their real and very important function is to give added leverage to your Quadriceps muscles (knee muscles in the front of your thigh). When running, biking, swimming or climbing, you need all the leverage you can get to handle the amazing amount of force that is put through your knees. In fact, because of their importance, kneecap problems can be the unfortunate demise of an athlete’s career. But you don’t need to be an athlete to experience problems with your patella. Your kneecaps are needed even just to stand up from a seated position, climb up and down stairs and walk around. In this issue, we are going to look at a condition called “High Riding Patella” and the muscle that can cause it, which goes by the name of Rectus Femoris (erector of the femur/thigh bone). The Rectus Femoris is the long red muscle in the drawing below. Note that the primary trigger point ('x') is located up near front of the hip and the referred pain is right in the kneecap.
Riding High in the Groove The patella is a "sesamoid" bone, which essentially means it is “floating” within your Quadriceps tendon. When you bend or straighten your knee, the “floating” kneecap slides in a groove (called the trochlear groove) to stay in the best position for leverage, which is right in front of your knee joint. Due to this constant sliding up and down, the backside of your knee cap is coated in the thickest smooth cartilage of your entire body! This ingenious system works beautifully in a perfect world. However, when there are trigger points in the Quadriceps muscles, moving your knees may literally not go so smoothly. If the outside Quadriceps (Vastus Lateralis) are too short, the Patella is pulled to the outside causing friction and wear and tear. If the inside Quadriceps (Vastus Medialis) are too short, the Patella is pulled to the inside. And for our topic this month, if the Rectus Femoris is too short, the patella can ride too high in the groove, causing excess wear and tear on the cartilage and a loss of leverage needed for your knees to support you the way they were designed to! Symptoms you may experience with kneecap dysfunction include:
  • Pain in the front of the knee (see referred pain chart to the left)
  • Crunching or popping when you bend or straighten the knee
  • Trouble getting up after sitting for long periods (such as in the movies)
  • Difficulty fully flexing your knee
  • Difficulty extending your thigh
  • Pain walking downstairs or wearing heels
  • High Riding Patella and other kneecap problems
But not to fear, if the Rectus Femoris is the cause of your high riding patella and kneecap pain and problems, you can apply the same trigger point therapy principles as always to eliminate this dysfunction. Let’s take a look below at a couple quick tests and self-care tips for a healthy Rectus Femoris and a happy kneecap!
*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional. Please consult your physician to determine whether these self-care tips are appropriate for you. Referred Pain Drawing from Figure 14.1 vol 2, pg 250 Janet G. Travell & David G. Simons Volume 2-Myofascial Pain And Dysfunction, The Trigger Point Manual, The Lower Extremities, Lippincott Williams & Wilkins, Philadelphia, 1993
(2) Quick Self-Tests to Tell if You have Trigger Points in Your Rectus Femoris: Follow the instructions below to test whether myfoscial trigger points in your Rectus Femoris might cause kneecap problems. TEST 1: Heel to Buttocks Test PASS FAIL While lying on your stomach, grasp the top of the foot or ankle with the same side hand and pull the heel straight toward the buttocks. A Passing result is when you can bring your heel to touch the buttocks comfortably. A Failing result occurs when the heel remains further away from the buttocks (as shown). The further the heel is from the buttocks the greater the amount of myofascial dysfunction and trigger points present. TEST 2: Rectus Femoris Palpation As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points. The Rectus Femoris can be palpated from its origin at the front of the hip down to the kneecap. The landmark to use is the ASIS, which is the bony bump you find as you walk your fingers up your thigh and reach your hip (shown as tan circle in drawing to left). The most important trigger point is shown in red, just below the ASIS. To access this point, you need to have your hip straight, not bent. So, palpation of the upper Rectus Femoris should be done while standing or lying on your back. Press your fingers along the full length of the muscle (shown in green) down to the top of the kneecap, feeling for tender points and taut bands of muscle tissue. Press gently to tolerance.

Simple Self-Care Remedies Here are simple self-care tips for relieving myofascial pain and dysfunction in your Rectus Femoris: Step 1: Warming Up with Moist Heat To relax and warm up the fibers of the Rectus Femoris, take a warm bath or place moist heat such as a Fomentek bag over the front of your thigh for 10-15 minutes. Step 2: The Secret to Compression The secret to compression for the Rectus Femoris is to maintain the muscle on the stretch. You may use Jacknobber or Tiger Tail, but you must keep the hip straight or extended to reach the most important trigger point up by the ASIS. Here is a video of a very effective technique for combining a stretch and compression for the Rectus Femoris. Positioning your Jacknobber underneath your thigh as shown with the stretching strap, cover the entire length of the Rectus Femoris, looking for taut bands and tender spots. When you find a tender spot, press into the muscle to pain tolerance ("good pain" - not pain that is sharp or makes you want to withdraw). Hold for 10 seconds while completing at least two full breaths in and out. Then continue searching for more tender spots until the entire length of the muscle is covered. If the Jacknobber slips, you may modify the Jacknobber with cloth, as shown in this video:
Step 3: Stretching and Exercising the Rectus Femoris The video below shows the 3 Best Stretching Exercises for the Rectus Femoris:
  1. Standing Heel to Buttocks Stretch - perform 2 sets per side, holding 20 seconds per stretch
  2. Kick Butt Walking - perform 2 sets of 20 repetitions per leg to tolerance daily
  3. Lunge Walking - perform 2 sets of 15 repetitions per leg to tolerance daily
These exercises should follow your heat and compression steps. If you have any questions on performing these exercises, please contact us.
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