Knee Pain? – IT Band & VMO Patella Alignment

Knee pain can come from many sources, some traumatic and some insidious. One such cause is having the Patella, or knee cap, pulled out of alignment by unequal pulls from surrounding muscles.

The Patella is a bone that is completely buried within the massive tendon of the Quadricep muscles, (sesamoid bone). The Quadriceps consist of four large muscles on the thigh and their tendons conjoin to insert below the knee onto the Tibia at the Tibial Tuberosity.

The knee joint capsule and ligaments are protected by the Patella especially when the knee is bent and when kneeling. At rest with leg long, a Patella should have movement to the left, right, up and down.

If the Patella is correctly aligned when walking/jogging/running it gives protection by not exerting any compensation forces on the knee joint.

Many athletes and non-athletes have tight IT Bands for one reason or another; it is a common syndrome. The IT Band runs down the outside of the thigh and is similar to a band of super strong webbing. It is a tendon continuation of two muscles from the pelvis; TFL (Tensor Fasciae Latae) and Gluteus Maximus, and inserts onto the Tibia. It has a tendency to adhere itself with the underlying Quadricep muscle, Vastus Lateralis – (this is often the cause of discomfort when foam rolling the IT Band).

Excess tightness of the IT Band can pull the Patella out of alignment and also assist in creating other issues such as “knock knees”

The IT Band is countered by VMO, Vastus Medialis Oblique, which is part of the inner Quadricep Vastus Medialis. If VMO is weak the IT Band is highly likely to exert its compensatory pull and influence the Patella out of alignment.

How do you know if VMO is weak? When doing unsupported squats or lunges you should notice a nicely developed pear shaped muscular prominence just above the knee on the inner front of your thigh. If it is not obvious and it feels mushy then it is weak and needs strengthening. Lunges are among the best exercises to develop a strong VMO.

If the IT Band is too tight then it is going to need stretching and foam roll exercises to help release its excess tension.

Stretch IT Band

Stretch IT Band

The IT band is not one of the easiest muscles to stretch and foam rolling may have better results (to follow). As a static stretch, stand tall, and move one foot behind so that both outside edges of your feet are touching with one ankle behind the other, or spread the distance as shown in the photo. The leg that is behind is going to receive an IT Band stretch, raise that same side arm high, fully extended above your head and reach for the sky. Now, push your other hip towards that same side as you lean the upper torso with extended arm the opposite way. You will probably feel the stretch over your hip joint before feeling it in the IT Band. You can increase the amount of stretch by increasing the distance between the outside edges of your feet, (your ankles will no longer be touching). Hold 30-60 sec, 1-3 reps, 1-3x/day.

 

 

 

Foam Roll IT Band

Foam Roll IT Band

Side lay on the ground with a long straight body, no bending at the waist. Make sure one hip is directly under the other so your Pelvis is not leaning forward or backward. The lower elbow should be on the floor directly under the shoulder and its palm flat on the floor facing forward. Your top leg can be slightly separated so that the edges of both feet are on the floor or stacked one foot atop the other. This next position is similar to a side plank where you raise your hips high off the ground and then quickly insert the foam roller mid way under your IT Band. Gently roll to find a tender position then stop and stay on it. Raise that lower leg and foot off the floor and support your entire body weight by one shoulder and the weighted lateral thigh. You can rest the upper leg directly against the lower leg for increased pressure on to the IT Band or simply find a foot position to rest the upper leg. The upper arm can go anywhere you want it. Neither the upper arm or leg should take any supportive load. The entire load should be spread about one shoulder and the pressured point on the one IT Band. It can be painful. If you can, over the next 30 seconds slowly bend the lower knee then slowly straighten that knee 4x.

After you have done this 1x for 30 seconds take a brief rest, move the roller one inch up or down and repeat the exercise before switching to the other leg.


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