Physical Therapy Guide to Patellar Instability
Patellar instability describes a range of conditions where the kneecap is displaced from its normal position. It can result from sports or other injuries or develop over time due to daily activities. Patellar instability affects about 7 out of 100,000 people in the United States. People in their teens and 20s are most likely to be diagnosed with some form of the condition. It is most common in teen female athletes.
Symptoms can include pain, swelling, and problems walking or using the stairs. A person may notice a feeling that the kneecap could become displaced. Once a person has had an episode of patellar instability, there is an increased risk for a recurrence.
What Is Patellar Instability?
Normally, the kneecap (patella) rests in a groove on top of the thigh bone (femur). As the knee bends and straightens, the kneecap stays in this groove as it slides up and down. Think of the groove as a train track and the kneecap as the train. Patellar instability describes a situation when the "train," or the kneecap, "comes off of the track." It can occur during movement (if the kneecap does not stay in the groove). It also can occur without movement (if the kneecap does not rest properly in the groove).
Patellar instability can result from an injury, or develop over time with daily activities.
With traumatic injury. A specific injury can force the kneecap fully out of its groove, such as a:
- Direct hit to the knee.
- Quick direction change while running and "cutting" in sports.
The more extreme form of this injury is called patellar dislocation. It occurs equally in males and females. After a dislocation, knee pain will limit your activity. Most often, the kneecap can return to its proper place on its own. Sometimes, however, the kneecap does not relocate on its own. If it does not, you may require a medical procedure called a reduction.
Without a traumatic injury. Patellar instability also can occur without a specific injury. In these cases, the kneecap comes part of the way out of the groove. This occurs most often in females. The kneecap is unstable and does not fully stay in the groove during everyday activities. The knee becomes more irritated and painful with repeated activity. Pain is most common when:
- Walking on uneven terrain.
- Going up or down stairs.
- Rolling over in bed.
When combined, several factors can lead to patellar instability over time. Some of these can be addressed, and some cannot. They include:
- Abnormal bone structure. A shallow or rotated groove does not provide a stable base upon which the kneecap can rest and glide.
- Muscle weakness. The muscles around the hip and knee may not be strong enough to control the leg’s position and keep the kneecap stable.
- Soft tissue malfunction. Ligaments and tendons hold the kneecap in place. In very flexible people, or those with prior episodes, these tissues may stretch more easily. Over time, they can become too lax (loose) and lose their ability to hold the kneecap in place. Also, if the soft tissue on the outside of the knee is too tight (due to injury, overweight, or an underlying condition), it can pull the kneecap out of the groove.
- Poor movement patterns. Running, jumping, and landing with the knee in a bad position can make the kneecap vulnerable to this condition.
How Does It Feel?
Patellar instability causes pain and other symptoms. These can limit your ability to do daily and leisure activities.
You may experience:
- Knee pain. This is most common when climbing or going downstairs, squatting, running, jumping, or cutting during sport activities.
- Feeling the kneecap shift or slide out of the groove.
- Lack of confidence in your knee’s stability. You may notice this most when walking on uneven ground, landing from a jump, using stairs, or rolling over in bed.
- Weakness in your leg, as if your knee might give way.
- Swelling and stiffness in the knee.
How Is It Diagnosed?
Your physical therapist will review your medical history. They will then complete a full exam of your knee. They also will examine other areas, such as the hip and foot, that might contribute to your condition. Their goal is to assess the degree of your injury and determine its cause(s) and contributing factors. This will help to determine your treatment program.
Your initial exam can include several tests. Your physical therapist may:
- Assess the strength and mobility (movement) of your knee and kneecap.
- Observe how you walk, step onto a stair, squat, or balance on one leg.
- Locate the most painful area. Your physical therapist may gently press on the front, side, and back of your knee to find where it is most painful.
- Ask you questions about your daily activities, exercise routines, and footwear. This can help to identify other factors that may contribute to your pain.
X-rays or MRIs are rarely needed to diagnose patellar instability. However, they may help to assess bone alignment and rule out other problems after a traumatic injury or repeated episodes of patellar instability.
How Can a Physical Therapist Help?
You and your physical therapist will work together to develop a plan to achieve your specific goals. Based on your exam, your physical therapist will select treatment strategies and design a personalized program for your condition. Your physical therapy treatment program may include some or all of the following:
Pain management. Your physical therapist may use several pain-relief strategies. The most common one is to apply ice to the area. Often, they will provide or recommend a knee brace to hold the kneecap safely in position. Your physical therapist also may recommend that you avoid certain activities for a period of time.
Range of motion exercises. Knee motion is often limited after an injury. Your physical therapist will guide you through targeted exercises to help restore range of motion without worsening your condition.
Muscle strengthening. Improving and balancing the strength in your leg can help control kneecap stability and reduce your risk for reinjury. Your physical therapist will select safe resistance exercises for you. You may begin by doing exercises lying on a table. You then may advance to doing exercises while standing. Your physical therapist will choose the right exercises for you based on your age, physical condition, and goals.
Functional training. Once your pain eases and your strength improves, you will need to safely transition into more demanding activities. The way you move can affect the stability of your kneecap. Your physical therapist will help you build your kneecap stability and lessen your chances of reinjury. They will teach you safe, controlled movements. Your physical therapist is an expert who can design a series of activities to help you move your body correctly.
Patient education. Your physical therapist will work with you to identify and change any external factors causing your pain. This can include the type and amount of exercise you do, and your footwear. They will look at all possible personal factors and recommend improvements. They will develop a specific exercise program designed to help you return to your desired activities pain-free.
Physical therapy promotes recovery by addressing factors that you can modify. These include lack of strength, flexibility, and body control. Your physical therapist also may recommend a rest period during which you avoid activities that aggravate your knee. Afterward, they will help you gradually resume safe activities. At the right time, they will carefully guide your progression into more demanding activities.
If patellar instability remains untreated, pain will persist and may worsen, resulting in long-term difficulty.
** from choosept.com
