Patella Mobilization for Knee Pain

Patella Mobilization for Knee Pain


People with knee pain often overlook this simple mobility technique. Why? Probably because it’s not sexy. It’s not some cool, overly complicated exercise that they saw on Instagram. But simple goes a long way! No need to over complicate things.

This mobility technique may or may not be for you. How do you know? Start moving your patella (knee cap) around like described in the video. It should move freely in every direction pretty equally. If yours moves well in all directions, maybe it’s not for you.

But if yours doesn’t move freely in one direction, maybe it is for you! All you need to do is mobilize (push) your patella in the direction it’s stuck or doesn’t move too well. Over time, this force you’re putting into your tissues will improve your mobility and help remodel the tissue. After all, our tissues respond to force.

Why is this important for knee health? The patella provides leverage for the quadriceps muscles. It’s a fulcrum! And if the patella can’t get into the position that the knee and the quadriceps muscles need it to, then pain and discomfort may result over time. So make sure that patella is moving nicely!



Knee Flexion Lift-Offs

Knee Flexion Lift-Offs

Knee Flexion Mobility: A Brief Overview

It’s very common to have adequate amounts of knee flexibility, especially in knee flexion. But it’s also very common to have very little or no control over all of that flexibility. Unfortunately, this is often a reason why hamstring and knee injuries happen.

This is an amazing exercise to build strength and control in knee flexion. You’ll really feel your hamstrings working hard (And if you’re lucky, they’ll even cramp up!) to curl your leg.

Knee Flexion Lift Offs For Knee Mobility

The set up: in a half-kneeling position, grab two PVC pipes and place them in front of you (grab them at chest-height). These will allow you to drive tension into the ground and create tension throughout your entire body. Make sure your core is stable and your lower back doesn’t move. Start lifting one of your feet off of the ground, curling it towards your butt. Hold for 2-3 seconds and slowly lower it to the ground. Repeat for 10-15 reps for a few sets.

Enjoy the hamstring soreness along the way!

Oh, and if you have muscle cramps, don’t worry! We like to call that neurological confusion– your brain just doesn’t know how to communicate very well with your hamstrings…yet. So they cramp up. With more practice and increased strength, those cramps will go away! We promise.

Knee Flexion Passive Range Holds

Knee Flexion Passive Range Holds

Knee Flexion Mobility: A Brief Overview

Many people have adequate knee flexion flexibility, but have limited control and strength over that flexibility. And that’s not optimal!

Here’s an amazing exercise to work on controlling that flexibility and strengthening your hamstrings at their endrange. Enter knee flexion passive range holds!

Knee Flexion Passive Range Holds Explained

Start in a half-kneeling position and really pressurize and brace your core so you minimize movement from occurring in your lower back. If you have something to hold on to and drive into the ground to create tension, grab it and use it. You can always use the wall as seen in the video.

With one hand, grab around your foot and pull your heel towards your butt into maximal knee flexion. Again, make sure you’re not extending through your lower back. From here, slowly start to let go of your foot, trying to not let your foot fall to the ground. Really use your hamstrings to hold that foot in the air for 2-3 seconds! Repeat this for 10-15 repetitions for a few sets.

Ideally, you shouldn’t lose much range of motion when you let go with your hand (like Dr. Ryan did). As with all strength training though, your control and strength will improve, decreasing the deficit.

Tibial Internal Rotation PAILS RAILS

Tibial Internal Rotation PAILS RAILS

Tibial Internal Rotation: An Overview

Tibial internal rotation is a very common range of motion that most people are lacking. It is very important for overall knee health. It is also very important to have adequate amounts of tibial internal rotation for movements like the squat.

Tibial internal rotation is a coupled movement that occurs when the knee flexes and the ankle dorsiflexes. So if you have knee pain, a lack of ankle dorsiflexion, or trouble squatting, then make sure this range of motion is normal!

 Tibial Internal Rotation PAILS RAILS

In a seated position on the ground, flex your hip and knee, and place your foot on the ground (see video below for visual). Take your arm on that side and place it between your knee and back of your thigh, hugging your leg towards your chest. Take your opposite hand and place it on the outside of your foot.

From here, pull your foot (and leg) into tibial internal rotation. You should feel rotational movement happening at the knee. Hold this stretch passively for about 2 minutes.

After 2 minutes of passive stretching, push your foot outwards into your hand isometrically (tibial external rotation). There should be no movement happening, but push hard into your hand for 20 seconds. After the 20 seconds, try to isometrically pull your foot away from your hand into more tibial internal rotation as hard as you can for 20 seconds.

Repeat this cycle 1-2 more times. Repeat on the opposite knee if needed.

Knee & Patellar CARs

Knee & Patellar CARs

Knee & Patellar CARS: A Brief Overview

Controlled articular rotations (CARS), or joint circles, are a very simple and effective way to maintain our joint health and longevity, as well as maintain our joint range of motion. 

If you have a known mobility restriction, while CARS may clear up the restriction in the long-term, it is best to perform a specific stretch or exercise for the known restriction (see below).

If you do not have a mobility restriction, then CARS are an amazing movement tool to utilize to maintain your current range of motion.

If you want to learn more about CARS (joint circles), then download our FREE Daily Movement Routine below!

Most Common Knee Mobility Restrictions

If you have a limitation in knee flexion, then you may benefit from the couch stretch to lengthen your quadriceps and improve your endrange hamstring strength/control.

If you have a limitation in tibial internal rotation, then you may benefit from tibial internal rotation PAILs / RAILs.

Running & Knee Pain

Running & Knee Pain

We hear it often from runners. They don’t have knee pain until they start running. Or the pain doesn’t start until a certain point within their run.

It’s frustrating, we totally get it.

But there’s often simple solutions to the aggravating pain. What are they?

1. Make sure that your feet muscles are working well. Running can result in your body having to absorb 1.5-3x your body weight per foot strike. You foot strike 1,000+ times per mile you run. That’s a lot of force to absorb! Imagine if your feet muscles aren’t doing their job. Something up the kinetic chain will have to make up for it.

2. What’s your ankle and knee range of motion like? Do you have adequate range of motion? Are you able to control these individual joints? How does your patella move around?

3. Do you strength train? If you don’t strength train, yet have to absorb 1.5-3x your bodyweight with each foot strike, imagine how your muscles may get aggravated. Strength training may be what you need!

Is there something else that could be the issue?

Probably. These are just a few things to think about.

As always, get assessed.


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