Patella Mobilisation: Understanding, Techniques, and Benefits for Knee Health

What is Patella Mobilisation?

Patella mobilisation is a manual therapy technique involving specific movements of the kneecap (patella) to restore its natural gliding motion, reduce pain, and improve overall knee joint function.

Understanding the Patella and Knee Joint

The patella, commonly known as the kneecap, is a sesamoid bone embedded within the quadriceps tendon. It sits in a groove on the front of the thigh bone (femur) called the trochlear groove, forming the patellofemoral joint. Its primary role is to increase the mechanical advantage of the quadriceps muscle, allowing for more efficient extension of the knee.

Normal Patellar Movement: For the knee to bend and straighten smoothly, the patella must glide effectively within the trochlear groove. This involves precise superior-inferior (up-down), medial-lateral (side-to-side), and rotational movements. Any restriction in these accessory motions can lead to pain, stiffness, and impaired knee function.

What is Patella Mobilisation?

Patella mobilisation refers to a set of manual therapy techniques applied to the kneecap with the goal of restoring its optimal mobility. These techniques involve skilled application of force to the patella in specific directions to encourage movement that may be restricted due to injury, surgery, overuse, or chronic conditions.

Purpose of Patella Mobilisation:

• Restore Normal Arthrokinematics: To ensure the patella glides correctly within the trochlear groove during knee flexion and extension.
• Reduce Pain: By improving joint mechanics and potentially modulating pain signals.
• Improve Range of Motion: Overcome stiffness that limits knee bending or straightening.
• Facilitate Quadriceps Function: A well-tracking patella allows the quadriceps to work more efficiently.

Types of Patella Mobilisation Techniques

Patella mobilisation techniques are typically named by the direction of the glide applied to the patella relative to the femur. They are performed with the knee in varying degrees of flexion, often in a relaxed position.

• Medial Glides: Moving the patella towards the inside of the thigh. Often used to address lateral patellar tilt or tracking issues, which are common causes of pain.
• Lateral Glides: Moving the patella towards the outside of the thigh. Less commonly performed than medial glides, but can be indicated for specific restrictions.
• Superior Glides: Moving the patella upwards, towards the hip. Essential for improving knee flexion.
• Inferior Glides: Moving the patella downwards, towards the foot. Crucial for achieving full knee extension.
• Rotational Mobilisations: Involving subtle rotation of the patella. These are more advanced techniques used to address complex restrictions.

Self-Mobilisation vs. Clinician-Assisted: While many of these techniques can be taught for self-mobilisation, especially medial/lateral glides, complex or more aggressive mobilisations should always be performed by a qualified healthcare professional.

Indications for Patella Mobilisation

Patella mobilisation is a common intervention within physical therapy and rehabilitation programs for a variety of knee conditions.

• Patellofemoral Pain Syndrome (PFPS): Often associated with poor patellar tracking and pain around or behind the kneecap.
• Post-Surgical Rehabilitation: Following procedures such as ACL reconstruction, total knee replacement, or patellar fracture repair, where scar tissue or disuse can limit patellar mobility.
• Knee Osteoarthritis: To maintain or improve joint mobility and reduce pain in degenerative conditions.
• Limited Knee Range of Motion: When stiffness, rather than structural damage, is limiting knee flexion or extension.
• Patellar Tendinopathy: To address underlying biomechanical factors contributing to tendon overload.

How Patella Mobilisation Works (Physiological Mechanisms)

The therapeutic effects of patella mobilisation are multifaceted:

• Mechanical Effects: Directly stretches the joint capsule and surrounding soft tissues (e.g., retinaculum), improving tissue extensibility and restoring accessory motion. This allows the patella to track more smoothly.
• Neurophysiological Effects: The movement and pressure on the joint can stimulate mechanoreceptors, which may help to modulate pain signals and reduce muscle guarding or spasm around the knee.
• Fluid Dynamics: Mobilisation can help to promote the movement of synovial fluid within the joint, which is vital for cartilage nutrition and waste removal.
• Improved Quadriceps Activation: When the patella tracks optimally, the quadriceps muscle can activate and contract more efficiently, leading to better strength and stability.

Who Performs Patella Mobilisation?

Patella mobilisation is a skilled technique typically performed by healthcare professionals with expertise in musculoskeletal rehabilitation.

• Physical Therapists (Physiotherapists): These are the primary practitioners who utilize and teach patella mobilisation as part of comprehensive rehabilitation programs.
• Osteopaths and Chiropractors: May incorporate patella mobilisation within their scope of practice.
• Qualified Athletic Trainers: Often use these techniques in sports rehabilitation settings.

It is crucial that these techniques are performed by a knowledgeable individual who understands knee anatomy, biomechanics, and proper force application to avoid injury and maximize effectiveness.

Important Considerations and Precautions

While generally safe and effective, patella mobilisation is not appropriate for everyone and requires careful assessment.

• Contraindications:
  • Acute fracture or dislocation of the patella.
  • Acute inflammation or infection in the knee joint.
  • Unstable knee joint or hypermobility.
  • Presence of a tumor or malignancy.
  • Recent surgical repair where movement is contraindicated.
  • Severe osteoporosis.
• Pain Response: Mobilisation should generally not cause sharp or increasing pain. Mild discomfort is common, but significant pain indicates the technique may be too aggressive or inappropriate.
• Not a Standalone Treatment: Patella mobilisation is typically one component of a broader rehabilitation strategy. It is often combined with therapeutic exercise (strengthening, stretching, motor control), activity modification, and education.
• Proper Technique: Incorrect application of force or direction can exacerbate symptoms or cause injury.

Integrating Patella Mobilisation into Rehabilitation

For optimal outcomes, patella mobilisation is integrated into a holistic rehabilitation plan. It often precedes or accompanies:

• Quadriceps Strengthening: Exercises like squats, lunges, and leg presses, ensuring proper form to maintain good patellar tracking.
• Hip and Core Strengthening: Addressing proximal weakness that can contribute to poor knee mechanics.
• Stretching: Addressing tightness in the quadriceps, hamstrings, IT band, and calf muscles.
• Motor Control and Neuromuscular Re-education: Training the body to move efficiently and with proper alignment.

The specific techniques and intensity of mobilisation will be tailored to the individual's condition, pain levels, and response to treatment.

Conclusion

Patella mobilisation is an evidence-based manual therapy technique used to restore optimal movement of the kneecap, alleviate pain, and improve overall knee function. By addressing restrictions in patellar glide, it plays a vital role in the rehabilitation of numerous knee conditions, particularly those involving patellofemoral pain and stiffness. When performed by a qualified professional and integrated into a comprehensive exercise program, it can significantly contribute to successful recovery and return to activity.