The knee is one of the most important joints in the human body. It supports our weight and allows us to walk, run, jump, and ultimately move effectively. For this same reason, it is one of the joints that suffers the most and is at a higher risk of injury.
A large number of people, both athletes and non-athletes, experience a knee injury at some point in their lives, particularly to the patella, which due to its position and function can be influenced by genetic and external factors. Among the most common patella injuries, dislocation is one of the most frequent, along with patellar chondromalacia.
In this article, we will discover what can cause this injury and how it is treated from a physiotherapy perspective. To understand how dislocation occurs, we must first know that the patella is the bone that protects the knee and connects it to the quadriceps so that we can bend and extend the knee. Given the importance of the patella for our movement, it is not surprising how many injuries happen in this area, especially dislocation, which occurs when the patella moves or completely leaves its own cavity.
Generally, patella dislocation is caused by a strong trauma that causes it to move from its usual position, which we know as direct dislocation. But there are also other risk factors for patella dislocation:
- A weak VMO (Vastus Medialis Obliquus): This muscle, part of the quadriceps and responsible for maintaining the patella in its position during movement, can increase the risk of dislocation if it is not strong enough or its fibers are not properly oriented.
- Flat feet: This condition causes misalignments throughout the body, which can cause the patella to move or even come out of its cavity.
- A larger than normal femoral angle (or Q angle): This disorder can cause the knees to be very close together, and when extending the leg, the patella can slip out, increasing the risk of dislocation.
Patella dislocation presents symptoms very similar to other knee injuries:
- Swelling of the knee.
- Reduced mobility.
- Deformities caused by displacement of the patella, which in severe dislocations can be visible to the naked eye.
- Pain around the patella, which is difficult to soothe and may worsen if the dislocation is followed by a fracture.
A good diagnosis is important, for example, to rule out an anterior cruciate ligament tear, among other injuries. A medical history evaluation, a careful knee exam, and an X-ray are usually enough to diagnose the dislocation. Regarding treatment, physiotherapy mainly focuses on controlling inflammatory signs by resting, applying ice, and elevating the leg to reduce blood flow and inflammation. Of course, in case of dislocation, a doctor should be consulted as soon as possible, who generally prescribes anti-inflammatories to relieve pain and inflammation. However, physiotherapy plays a crucial role in rehabilitation.
Essentially, the role of the physiotherapist will vary as the injury and its severity progress:
- Two weeks after the injury: Application of splints, ice, bandaging to reposition the patella, and isometric quadriceps exercises to ensure strengthening and allow the posterior leg muscles to move normally.
- Three to five weeks after the injury: Strengthening and quadriceps enhancement exercises, such as knee extensions at the edge of the bed or wall-supported squats. This will help the patient bear their own weight on the patella and increase the range of motion.
To increase knee flexion range, exercises such as walking, swimming, or cycling, as well as proprioception exercises for the knee, are recommended, with intensity increasing over time.
In the final weeks of rehabilitation, the patient can progressively return to their normal sports activity. Prompt diagnosis of this type of injury and strictly following the advice of a physiotherapist in rehabilitation will allow the patella to return to its initial position and enable recovery of normal activity.
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