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Patella Release

“I was watching an older youtube vid with Katy describing how she works with the knee alignment – the idea of a patella that can be engaged and disengaged proving the knee is not locked out, I understand. But, when it comes to movement, sport, etc..the patella needs to lifted and engaged, yes?”

I received this email from someone recently and thought it would be a good topic for a blog post. The patella is otherwise known as your knee cap. This bone is capable of moving in all directions. The four quadricep muscles that run down the front of your thigh converge in a single tendon and the patella is in this tendon. The tendon continues past the knee joint and attaches to the front of the lower leg at a point called the “tibial tuberosity.” If you sit in a chair, bend over and look at the front of your shin just below the knee, you might be able to see a small protruding bump. This is the tuberosity where the patellar tendon attaches.

Why does the patella have to move? What is the function of the patella? The patella is a sesamoid bone. These bones occur in other places in the body as well, and act to increase leverage so that the action can be more efficient using less energy. This video is something I show to all my students at some point.

You can see that the quadriceps act to extend (straighten) the knee using the patella as a fulcrum. This model has a patella that is attached via magnet to the shin bone (tibia) but in actual fact, the patella is floating in front of the knee joint and when the quads pull on a straight knee, it moves the patella UP and IN. There is a groove on the front of the knee called the patellar groove, and the back of the patella is shaped to fit within this groove so it can slide up and cover the knee when the knee is straight. But the quads do not need to continuously pull up on the patella! When the weight of the upper body falls down through the line of gravity, the knee should not require constant straightening, the bones are just loaded in a way that maintains that without constant work. So the quads can turn off, the patella can relax to a position where it is not being pulled into the groove.

When does the patella have to become active, and do we need to consciously activate it? I would say not, because any time you use your quads for a specific purpose, the tension on that tendon will act to increase forces over the patella drawing it inward.

The answer to the question above is: in what movements do you use your quads and why? When Katy Bowman is talking about patella release, it is generally in a standing position where the friction of the patella in the patellar groove would be potentially damaging if maintained. The quads don’t need to be contracting in order to just stand.

What movements require quads to be active? Running, climbing (stairs for example) all require quads to pick up the leg and lift it to the next step.

Have a look at this blog post and the embedded videos to see how stair climbing can be more or less about pushing the patella into the knee joint: http://www.alignmentrescue.com/stair-climbing-101/

Climbing can (and should) be more of a posterior driven movement, save the moment when the leg is lifted and planted, but the drive upward should come from the hip extensors, not the knee extensors (quads). So even this activity should not require a lifted and engaged patella.

Most sports require constant change of position, which having a locked engaged quads and pulled up/in patella would inhibit. In most cases, the action of the quads is changing constantly (think soccer) and having a patella locked up is not possible.

I can think of one instance where the patella might be engaged very strongly. Dancing on pointe with the leg extended would require quads contracting and the patella would be “up” because of the quad action. But the dancer would not be thinking about this – it happens as a result of quads engaging. And the moment they come down, the quads can relax (even momentarily). It cannot be a conscious contraction or they would be unable to do what they do, as would most athletes at their sport. I’m not very knowledgeable about heavy weight lifting, but I imagine if someone were to hold a very large weight over their head with their legs straight, in that moment a locked knee could give them a safety advantage in the same way a dancer on pointe would want a rigid support under them.

When the knee flexes, the tendon is lengthened, which causes the patella to “ride” the groove, but this is also just as the result of the tendon being pulled as the lower leg swings relative to the upper leg. So in sports or activities that require the knee to constantly bend and straighten (think tennis), this would always be changing.

So I would say that my answer is no. The patella does not need to be lifted and quads engaged in any conscious and continuous manner for any sport or movement, and that if things are working as they should, the activation of the quads when the knee is extending will draw the patella up and in and then when the quads relax, the patella will release.