The kneecap or patella rests in a indentation within the thigh bone (femur).  In a healthy individual the patella glides up and down in a straight line within the groove as the knee bends and straightens.  If an inbalance exists in the side to side forces pulling on the patella the patella gets pulled outwards as it glides upwards in the groove.  This leads to excessive friction on the cartilage on the inner surface of the knee and subsequently pain.  This ‘maltracking’ of the patella can also be caused mal-alignment of the knee including:

• A large Q angle that is associated with wide hips (maltracking therefore more common among females)
• Over-pronating or flat feet
• Genu velum (knock knees)

Patella maltracking is more common amongst individuals who:

• Have a history of patella dislocation
• Participate in lots of high impact exercise
• Have a protruding or small patella
• Are adolescent females (softer patella and large Q angle)
• Have had a recent injury.  The vastus medialis oblique (VMO) muscle on the front-inside of the thigh pulls the knee cap medially (inwards) as the knee straightens. The VMO wastes away quickly with inactivity following injury.

Symptoms of Patella Maltracking

• Swelling possible that is aggravated by activity
• Aching pain at the front and outside of the knee.
• Crepitus – a clicking sound on knee movement
• Pain exacerbated by prolonged periods sitting down
• Pain exacerbated when using stairs especially going down stairs

Patella Maltracking Self Help

• Stretching the muscles on outside aspect of thigh including the ITB (iliotibial band)
• Utilise the R.I.C.E procedure (rest, ice, compression, elevation) to alleviate swelling and inflammation

Patella Maltracking Treatment

• Improvement of knee alignment by
• Reducing Q angle of knee – only possible if this is caused by weakness of the hip abductors and lateral rotators
• Prescription of orthotics to reduce over-pronation of feet
• Equalising forces acting on the patella by reducing ITB tension and strengthening VMO
• Taping knee to improve movement of patella

The iliotibial band (or ITB for short) is a wide band like tendon.  It originates at the hip, passes down the outside of the thigh and attaches at the upper outside of the shin bone (the tibia) just beyond the knee.  The Iliotibial band runs over the lateral femoral epicondyle which is a bony mound on the outer aspect of the knee, and it is susceptible to friction at this point.  At 20-30 degrees of knee flexion (bending) friction is at it maximum.  This degree of flexion corresponds to the angle of the knee as the foot contacts the ground when running and therefore repetitive friction is common amongst runners.  Individuals who have bow legs (genu varum), and individuals with feet that over pronate (flatten/roll inwards) when running are more susceptible to iliotibial band syndrome.

ITB syndrome symptoms

• Pain located on the outside of knee 2 cm above line of joint
• Pain increased when running, even more so when running downhill
• Pain at maximum with knee flexed (bent) to 20-30 degrees
• Pain increased by pressing into area of pain and bending and straightening the leg

ITB syndrome self help

• Rest and cessation of activities that exacerbate pain i.e. running, downhill running
• Ice therapy to reduce inflammation
• Stretching of iliotibial band
• Self massage using large foam roller

ITB Syndrome treatment

• Stretching and assisted stretching (MET) of iliotibial band
• Deep tissue massage and specialised myofascial release to reduce iliotibial band tension
• Prescription of correct stretching technique
• Prescription of orthotics or an exercises to rectify over pronation of feet

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