Front knee pain from muscle weakness in the local thigh muscles

In addition to the non-muscular causes mentioned above, muscle weaknesses in the thigh muscles can also be responsible for an altered joint function between the kneecap and the thigh. A reduced ability to stabilize the knee joint in the different phases of walking (lack of muscular guidance) reduces the shock absorption in the knee joint.

Local muscle system in the knee joint

Analogous to Spine there is also a at the knee joint local and a global Muscular system.
One and only local Stabilizer on the knee is that Vastus medialis obliquus muscle (VMO), the inner part of the M. quadriceps (thigh extensor). Its function is to actively pull the kneecap inwards / upwards and the when Patello-femoral pain syndrome to compensate for existing pull to the outside.

Physiotherapeutic examination of the local muscle system

A selective weakness of the inner muscle parts (vastus medialis) The cause of the anterior knee pain cannot be precisely investigated and proven, nor can it be trained completely in isolation without the involvement of the other quadriceps parts.
Nevertheless, when starting to train the thigh muscles, it makes sense to place particular emphasis on training perception and stressing the tension in the inner thigh muscles, i.e. the Training goes from local to global.
The use of one is favorable Biofeedback device (electronic device with which the tension and relaxation of a muscle can be made visible) so that the patient can better perceive the conscious nervous activation and tension of the VMO.

Physiotherapeutic technique: perception training and education of the VMO

Exercise modalities

3 series of 10 repetitions and 10 sec. Holding time / daily. over a period of 3 months, after which the exercise frequency can be reduced

Use of force:
only about 20-30% of the muscle strength, as the local muscle system has little movement function, but mainly stabilization and endurance functions.

Appointment with a knee specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

  • Lumedis - your orthopedic surgeon
    Kaiserstrasse 14
    60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

1. Exercise example

Starting position
Sit on the floor with long legs, weight cuff or sandbag over your foot, knee roll under the affected leg, the affected leg is turned outwards, looking at the knee joint

Exercise execution
The hollow of the knee is pressed onto the knee roll, the foot is stretched diagonally upwards towards the inner corner of the ceiling.

2. Exercise example

Starting position
as with 1. without weight load

Exercise execution
same controlled tension of the VMO without lifting the heel

Important: the tension should be carried out under eye and tactile control.

3. Exercise example

Starting position
Stand, step with the affected leg in front and slightly bent

Exercise execution
the heel is pushed forward into the ground and held in place.

4. Exercise example

Starting position
Stand on the affected leg

Exercise execution
the hands are folded and the arms are moved towards the ceiling, the eyes follow

Exercise example 5

Starting position: Stand on the affected leg

Exercise execution: the hands are folded and the arms are moved from right to left, the eyes follow

Increase: unstable surface (Use therapy devices such as air pads or rocking pillows, at home a foam cushion is sufficient).

One-legged balance training can be easily integrated into everyday life! (Brushing your teeth, talking on the phone, peeling potatoes).

Cave: one-legged stance shouldn't be longer than half a minute on one leg!

Front knee pain due to weakness of the global thigh muscles

Global muscle system in the knee joint

The global muscle system of the knee joint includes the 4-headed thigh extensor (quadriceps) and the hamstring muscles (ischiocrural muscles).
Their function is to extend or flex the knee joint during

  • Go
  • To run
  • Sit down
  • Get up
  • Going down stairs - and up

and to stabilize the knee joint in the various flexion phases.

Physiotherapeutic examination muscle weakness thigh extensors

The physiotherapist examines the patellar position and movement (position of the kneecap and its movement while the thigh extensor is tensing) while the quadriceps muscle is tensed. In addition, the strength status and the functionality of the thigh extensor and the thigh flexor are checked, since the muscular balance (muscle balance) is crucial for the stabilization of the knee joint. The consequence of a muscular imbalance (muscle imbalance) caused by quadriceps weakness -link- is an instability of the knee joint, which in turn can promote premature cartilage damage.

Test example M. quadriceps

The physiotherapist lets the patient do slight squats on the affected leg, paying attention to the execution and adherence to the leg axis (e.g. the knee joint deviates into the x-leg position). Then she / he tests the exercise on the sound leg. The so-called eccentric (braking muscle force, e.g. when going down stairs) quadriceps work is tested in side-by-side comparison.

If pain occurs during the test, the trunk position or the leg axis is changed during the squat. If this results in a change in symptoms (e.g. reduction in pain), the examiner can draw conclusions about a guiding instability of the kneecap and modify the strengthening exercises.

Therapeutic technique: muscle strengthening of the thigh extensor

The training of the quadriceps muscle takes place in secured knee-angle areas, in which the patellofemoral joint is exposed to the lowest shear and compression forces.
Exercises in the so-called closed chain (foot is firm, body moved) are preferable to exercises in the open chain (body is firm, leg moved), as they are more functional and offer better stimulus for cartilage structure.

In the closed chain, the knee joint should only be loaded from about 45 ° of flexion to full extension during the strength exercise.

Please note

In no case does the “self” diagnostic agent replace a visit to your trusted doctor! We also make no claim to the completeness of the differential diagnoses presented (alternative causes). We assume no liability for the correctness of the self-diagnosis you have made! We strictly reject any form of self-therapy without consulting your doctor!