Vivian Grisogono

It is especially important in kneecap pain syndrome (anterior knee pain or chondromalacia patellae). it is a static exercise involving minimal movement of the kneecap. It re-trains fine control of the nerve which activates the vastus medialis obliquus muscle (VMO), and provides stability on the inner side of the knee. Without this fine control, the kneecap cannot move freely and efficiently in its track, the knee is stiff and can be painful. It is essential for preventing knee pain. It counteracts the VMO-undermining effect of holding or using the bent knee for long periods, for instance through sitting still, running down hills and steps, skiing, or cycling with the saddle too low. It helps to prevent the knee from becoming fixed in a bent position (fixed flexion deformity), which can lead to, or result from degenerative changes (osteoarthritis).After injury: In any knee problem, control of the vastus medialis obliquus muscle just above the inner side of the kneecap is undermined immediately, and the knee’s basic stability is lost. This exercise is essential, and must be done from the earliest possible moment as soon as knee pain starts, and following major or minor injuries, including ligament strain, cartilage (meniscus) tear and cruciate ligament rupture. It should be done both before and after any knee surgery, including arthroscopy, knee ligament reconstruction or a knee replacement operation. It is also important following injuries to the hip region, thigh muscles and lower leg. It is especially important after injuries to the calf muscles or Achilles tendon, which can cause a limp and so undermine the knee’s stability.
Position: Sit on a flat surface with your legs straight in front of you, knees relaxed.
or: Sit on the edge of your chair with your heel on the floor, so that your leg is straight and your knee relaxed.
Movement: Tighten the thigh muscles of one leg gently to draw the kneecap upwards on your thigh. Hold for a count of 2. Relax completely, stay relaxed for a count of 6 before repeating the exercise.
Repetitions and frequency: 3-10 times, as often as you can every day. Exercise one leg at a time at first. When you have good control you can exercise both knees simultaneously.
Note: Avoid pain. Do not contract the muscles hard. Concentrate on feeling the movement of the kneecap as it glides upwards and pay particular attention to releasing it. Check whether the muscles have relaxed totally by pressing your kneecap from side to side: it should move freely either way. If you cannot do this exercise at all because the nerve-muscle co-ordination is inhibited, electrical muscle stimulation (under the guidance of your practitioner) may help to restore function.