Knee pain and NPS

Okay, so you have knee pain. You head to your physician who takes one look at your knees and – wait, what? You have “Nail Patella Syndrome” – what is that? Where are your kneecaps? … THAT tiny little thing is your kneecap? Uhhh..

Sound familiar?

Yes, knee pain is very common in the world today. Of course, with NPS, additional difficulties present, making those with NPS more at risk for extra knee pain (ahh). Let’s start with a little history of how the knee works and how having NPS may affect that.

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The Knee Extensor Mechanism

This is a big fancy way of explaining how the knee works. The knee joint is only able to work properly with the help of a few important anatomical structures: The patella (kneecap), important ligaments and tendons holding it together, and the muscles surrounding the area.

What happens is your quadriceps muscle (thigh area), pulls on your kneecap via a tendon. Your kneecap is connected to your tibia (shin) via the patellar tendon. The kneecap provides an easier mechanical advantage for your quadriceps muscle to help extend (straighten) your leg.

Think about this *slightly dramatic but ya know* example: Someone is hanging off the side of a cliff (Okay let’s make it Mufasa from The Lion King). If only your arm is outstretched and all you’re pulling on is Mufasa’s head, it’s going to take a lot of strength to pull Mufasa back up, especially battling that awkward 90 degree angle. Now, if you have something in between you that you are each holding onto and pulling on, it’s going to be a little easier because there is a shorter distance between each of you to exert your force and pull.

Try watching this video below for more help with this explanation.

Okay, so now that you understand that.. Let’s figure out how NPS may differ.

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You may fall into one of the few criteria listed here.

1) You aren’t affected at all and you never have knee pain. If this is you, awesome! As we know, NPS affects everyone differently. If your kneecaps are normal and you never have knee pain – that’s great. You can definitely still benefit from these exercises below to help prevent any future injury. But in the meantime, keep doing you!

2) You have underdeveloped kneecaps. This is probably the most common thing people with NPS may present with in regards to knees. Smaller kneecaps means a smaller area of attachment for the tendons. This also means it may be easier to move the kneecap in the groove that it sits in – which may lead to … ta da! Subluxation and dislocation – something that many people with NPS have at some point in their lives. This means it is even more important to focus on strengthening the muscles surrounding the knee AS WELL as the hip and ankle (will discuss this in more detail below).

3) You don’t even have kneecaps. This is also fairly common in people with NPS. While there isn’t much out there on being born with no kneecaps, there are definitely exercise programs in regards to what to do after a patellectomy (surgical removal of the kneecap). Whether you are born with no kneecap or you have it surgically removed, if you saw above, you are missing a huge part of the knee extensor mechanism – your kneecap! This makes it more difficult for your quadriceps and other musculature surrounding the knee to keep your knees stable, keep you from buckling, etc. Once again, this means it is even more important for you to work on strengthening!

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Strengthening… Seems simple right? One difficulty here is that it is difficult for many people with NPS to gain muscle mass, which makes it even tougher to build up the muscles to surround your joints. BUT – in regards to knee pain from osteoarthritis (that typical “I’m getting older arthritis” that everyone talks about).. the main thing we recommend as physios is to STRENGTHEN the muscles surrounding the joint that is affected. Why? By increasing the muscle mass, you are allowing the muscles then to cushion your joint and take some of the impact and force whenever you walk, run, perform any activity. This means less impact on your knee joint itself. It will definitely take time, but once you begin to increase the muscle mass, you should be able to see some pain relief in the knee joint itself – spoken from someone who has fully experienced this, I promise!

I know I discussed strengthening muscles around the knee, but it is also VERY important to strengthen your hip and your ankle. Many times if your hips and/or ankles are weak, your knee will try to compensate and “pick up the slack.” This causes it to overwork, twist, and just do things it wasn’t meant to do. Which – yes – then can cause other knee pain.

So if you’re just beginning or you’re an avid fitness lover.. I will post a few videos here with exercises to benefit you (because everyone will differ)…

Gentle Knee Range of Motion Exercises

Beginner Strengthening

Advanced Strengthening

As I said in these videos, everybody will have a different threshold of how many repetitions and holds are appropriate for them. Generally, for stretches, I recommend holding for at least 30 seconds up to 2 minutes if you want. For many of the range of motion (ROM) exercises, I’d say 30 repetitions (2 sets of 15 or 3 sets of 10) would be okay. Strengthening exercises should start off at a lower total repetition if it is new for you and gradually work up depending on how fatigued or sore you are.

Again, if possible, to personalize this better and make these the BEST for you – try to see a Physiotherapist in person. This is more of a basic “get you started” kind of exercise regime 🙂

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Oh! And by the way, I do drink protein drinks a lot – plant based for me as it suits my stomach better than whey. This is not my recommendation or saying that you should, but I feel that it works for me and helps me recover better/helps me gain more muscle mass after lifting weights and such!

Now of course, I know many people result to total knee replacement surgeries. While the pain may be so unbearable that you feel you need to have surgery – you have to remember that  strengthening and improving mobility before is just as important whether you are planning for surgery or not. It’s actually recommended now to have physical therapy and strengthen your knee as much as possible before surgery so that you may have the most optimal recovery. Joint replacements are no cake walk, that’s for sure! There is definitely pain and a lot of rehab/recovery time. If you’re not sure why there’s so much pain – youtube a video on the actual surgery itself.. it’s eye opening how hard those surgeons have to manipulate, move, and bang on your body to get that new joint in (seriously). Again, sometimes this may be necessary, but regardless, it’s important to focus on exercise before as well as after!

No matter where your knee pain may be coming from.. no kneecaps.. decreased hip strength.. decreased range of motion.. etc. It is so important to exercise and do something! While not geared towards people with NPS, I have a few other blogs that are geared towards both stretching and strengthening in all populations. Check a few of them out here:

Benefits of Resistance Training

Dynamic Stretching

More Hip Strengthening

I hope this article and these videos helped! Feel free to leave a comment, email me, or send me a message if you have any other questions 🙂

Stay tuned for the next blog!

– Jen

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