Kneecap problems common in girls
Originally published: October 26. 2008 3:01AMLast modified: October 26. 2008 2:14AM
Girls get kneecap problems.
Girls about 13 or 14 who are athletes especially have kneecap problems.
Oh, not all of them, but enough of them that it doesn't take too much to recognize that there are definite tendencies there.
The kneecap, more appropriately called the "patella" is the small, round bone in front of the knee. It lies between the quadriceps muscles on the front part of the thigh and the lower leg, or tibia.
I use the plural "quadriceps muscles" because there are actually four muscles there that come together and form a common tendon called the quadriceps tendon.
The quadriceps tendon connects to the top of the patella. The patellar tendon then connects the bottom of the patella to the front of the upper tibia.
The primary function of the patella is to increase the level length of those quadriceps muscles; in other words, to improve the mechanical advantage of the quadriceps or to allow them to more forcefully extend or straighten the knee.
We are actually not born with a patella but the Grand Architect allows our body to develop one to help us function more effectively.
The side of the patella that contacts the knee is where problems start. If the patella doesn't move up and down on the front of the knee smoothly or evenly, problems may arise.
There are several reasons why girls have more kneecap problems than boys, most related to the anatomic structure of the lower half of the body. The most common reason given is the relationship of the pelvis to the knee.
The idea is that females have a wider pelvis than males. Although maybe not really any wider than their male counterparts, the angle from the pelvis down toward the knee is often greater, resulting on a pull on the patella to the outside.
Symptoms can be at the outside border of the patella (where it collides with the outer knee bone, or lateral femoral condyle), the inside border of the patella (from stretching on those tissues as the patella drifts to the outside), or both.
Those with patellar problems often complain of pain with stairs, squatting, or being down on their knees. They will often have problems when they have to remain in a seated position with their knees bent, such as sitting in the back seat of a cramped car.
The right kinds of exercise can be very helpful in dealing with this problem. A physical therapist is your best source of information in that category.
Orthopedic surgery is infrequently needed but can solve some of the structural problems that lead to patellar problems.
We are using a couple of braces right now with good success. These are similar to the neoprene knee sleeves that you can buy at a lot of places but with some very important differences. The braces we prefer are available only through medical distributors or health care providers.
More and more, we are noticing that those with patellar problems tend to be flat-footed, or tend to be "pronators." Pronators are those people who tend to roll inward at the foot during gait. Runners usually know if they are pronators or not.
Addressing those foot arch problems may be one of the most important things that can be done to effectively deal with patellar problems.
In most cases, the solutions are simple and straightforward, using over-the-counter arch supports, doing the right kinds of exercises, and avoiding activities that compromise the patella.
Joe Black, PT, SCS, ATC, is a physical therapist and athletic trainer at Appalachian Therapy Center. Write to him at: Joe Black, c/o The Daily Times, P.O. Box 9740, Maryville, TN 37802.