Issue link: https://www.massageandbodyworkdigital.com/i/1439667
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 27 3 the patella. The angle between these lines is the Q angle (Image 4). The wider the pelvis, as occurs in females, the larger the Q angle. The quadriceps pull more laterally when the Q angle is larger and not as much straight up and down. The increased lateral pull from the quadriceps pulls the patella in a more lateral direction, resulting in patellar tracking problems that become a primary factor in the client's PFPS pain. There is also an increased incidence of valgus (knock- knee tendency) alignment at the knee in women. The increased valgus alignment also causes the quadriceps to pull more in a lateral direction. Other postural alignments in the lower extremity can also play a role. Increased foot pronation during gait may be another potential cause of alignment and corresponding patellar tracking problems. Weakness in the hip abductors or external rotators may also contribute to the problem. When the external hip rotators are weak, the femur may be pulled toward medial rotation. With the hip more medially rotated during knee flexion and extension, the patella has a tendency toward lateral tracking. As we can see, most of these alignment problems involve the patella tracking too much laterally and not straight up and down. The most distal portion of the vastus medialis in the quadriceps muscle group functions to offset the lateral pull on the patella. Because of the oblique orientation of these Moment arm Patella increasing knee's moment arm. Image courtesy of Complete Anatomy. While the patella does offer some protection for the knee, its primary role is improving mechanical function at the joint. Force production at a joint is dependent on a physics principle called the moment arm. So, what on earth is a moment arm (it has nothing to do with time or the upper extremity)? Most joint movements occur around a point called the axis of rotation. Envision an imaginary rod going through the knee joint right at the axis of rotation, with the tibia rotating around that rod during flexion and extension. The moment arm is the length between the joint's axis of rotation and the line of force that acts on the joint (Image 3). The primary function of the patella is to increase the length of the moment arm for knee extension, which makes the quadriceps more powerful. These higher force loads during knee extension and flexion can also be a contributing factor to patellofemoral pain. WHAT CAUSES PATELLOFEMORAL PAIN? PFPS is most common in young people, especially those between the ages of 12 and 17 involved in running, jumping, or other vigorous lower extremity activity. But the condition is also prevalent in people of all age ranges who suddenly increase activity loads or do something that involves high force loads during knee flexion and extension. Overactivity appears to be the biggest problem. Women develop PFPS more often than men, although the reasons for this are not fully clear. Several factors play a role in that increased incidence. The first is a larger Q angle in women. The Q angle, also called the quadriceps angle, is formed by imaginary lines that connect bony landmarks. One line extends from the tibial tuberosity through the midpoint of the patella. Another line passes from the anterior superior iliac spine to the midpoint of 2 Quadriceps retinaculum. Image courtesy of Complete Anatomy. Quadriceps retinaculum