The quadriceps group contains some of the largest muscles in the body. They are highly active during lower extremity locomotion, such as running, jumping, and even in simple activities like walking. Problems in the quadriceps group can often lead to numerous disorder such as patellar tendinosis, chondromalacia, or the elusive anterior knee pain of patellofemoral pain syndrome.
Patellofemoral pain syndrome (PFPS) is the name given to a group of signs and symptoms related to anterior knee pain that usually involves patellar tracking disorders. A tracking disorder occurs when the patella is not being pulled straight between the two femoral condyles during flexion and extension movements of the knee. Tracking disorders lead to anterior knee pain but there has never been a strong correlation between observed tissue damage and the anterior knee pain in PFPS. As a result, different theories have arisen as to the primary cause of pain for PFPS.
In the research update section of the newsletter we discuss neuroplasticity as a possible cause of chronic musculoskeletal pain. One of the articles cited refers to neurological changes that have been identified and associated with PFPS1. It may be that the anterior knee pain of PFPS is not directly caused by a particular degree of tissue damage of the distal quadriceps, but instead the result of complex biomechanical and neurological disturbances in the region. If this is the case, detailed and specific work on all the tissues around the patellofemoral junction may be particularly helpful in addressing this condition.
The tissues of the quadriceps retinaculum are sometimes glossed over when treating knee and lower extremity complaints. While it is important to give attention to the of the bellies of the quadriceps muscles and the patellar tendon, it is also valuable to treat the retinacular connective tissues surrounding the patella (Figure 1).
One of the techniques that is particular helpful for addressing dysfunction in the patellar retinaculum is a pin and stretch technique (shown below). The retinacular tissues can sometimes be challenging to stretch and elongate on their own, and use of movement with additional load is very helpful in encouraging full tissue pliability in the retinacular tissues. This pin and stretch technique is most effective when it is performed in conjunction with other deep work to address hypertonicity in the quadriceps muscles themselves.
- Jensen R, Kvale A, Baerheim A. Is Pain in Patellofemoral Pain Syndrome Neuropathic? Clin J Pain. 2008;24(5):384-394