Definitions

• The patella is the kneecap bone. The tendon encasing it and running above and below it is called the patellar tendon. It tracks in large grooves at the bottom of the femur and the top of the tibia. If it does not track smoothly, it becomes irritated and damaged.
  
  

Twisting

• Pronation is the collapse of the arch of the foot as weight is placed on it. (It also goes more commonly by the names "flat feet" and "fallen arches".) The tibia twists when this happens. This rotation is not confined to the bottom of the tibia, but continues up its full length, irritating the tendon and preventing its tracking smoothly. The immediate solution is a prescription orthotic to support the arch and prevent it from collapsing. Podiatrists measure the patient for orthotics in the doctor's office.
  
  

Physical Therapy

• Physical therapy of the knee can also incorporate exercises to reduce pronation. One example is to wrap an exercise band (elastic) around the outside of the ankle, anchor it somewhere in the opposite direction, then oppose the band through several repetitions by supinating (lifting the arch of) the foot so floor contact is mostly on the outside. Another exercise, which incorporates the eccentric contraction that so effectively damages the patellar tendon, is to step up on a box placed laterally, then step back down, making sure to keep the weight on the outside of the foot the whole time.
  
  

Solution for Cyclists

• A solution has been developed for cyclists to account for both pronation and supination (excessive arch). Called LeWedge, they are wedges that fit between the shoe and cleat, and perform a compensatory function similar to orthotics. LeWedge is not necessarily a replacement for orthotics, so thin orthotics may be fit into the cycling shoe as well.
  
  

Other Causes

• Other causes should be considered aside from foot pronation when diagnosing pain in the patella. Patellar tendonitis can have more than one source of irritation. Other causes are a weak vastus medialis, tight or weak hamstrings, tight calves and exposure to cold. These can be eliminated with longer, slower warm-ups; leg-extension exercises (being careful to avoid the 90- and 180-degree positions); stretching; and covering knees with vaseline and heating oils, clothing or even neoprene (like in scuba suits) for winter exercising. Icing and anti-inflammatories also reduce swelling, but knees should be warmed-up again (passively) after icing. Even walking with cold knees can renew damage, because of the damaging nature of eccentric contractions.