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Massage Today
September, 2002, Vol. 02, Issue 09

Sharp Anterior Medial Knee Pain

By Ben Benjamin, PhD

Question: Where is the medial quadriceps expansion?

Answer: At the medial side of the patella.

The quadriceps muscles join together into the quadriceps tendon just above the patella.

The tendon then passes over the patella in the form of an aponeurosis (or flat-sheet structure) and envelops the kneecap, tucking slightly under the medial and lateral aspects of the patella, fitting like a shower cap. It then continues down to attach to the tibial tubercle. This section is called the patellar ligament.

Medial quadriceps expansion (arrow B). Most therapists have never heard of this important structure. It is the cause of frequent knee pain when negotiating stairs, walking up hills, or engaging in more vigorous activities such as running, biking or racket sports. The nature of the pain can be achy but is often very sharp, especially when the adhesive scar tissue is in the inferior medial corner.

Resisted extension of the knee. Resisted extension of the knee is usually the assessment test that verifies the presence of this injury. However, because this tendon is so strong, this assessment test will often not show a positive result unless the activity that causes the pain is done immediately before the test is performed.

Treatment is usually fairly straightforward. With the client lying supine, the therapist forcefully pushes the patella medially with the thumb of one hand and applies friction therapy with the index finger of the other hand. The finger is placed under the medial side of the patella and pressure is applied anteriorly (toward the ceiling). The direction of the friction movement is from head to foot.

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