Changes

** '''Weak Quads[[VMO]].''' The alignment of the kneecap is not related to the overall strength of the quads, but rather an imbalance of the muscles that make up the quads. [[File:Vastus medialis muscle short.jpg|center|thumb|200px|The Vastus Medialis Obliquus or [[VMO]], which is often blamed for mistracking of the kneecap.]] The quads consist of four muscles, and a relative weakness in a subdivision of one muscle, the Vastus Medialis Obliquus or [[VMO]], has been linked to kneecap alignment<ref name="KneeLinTomo"/> and knee pain<ref name="KneeVMOAtrophy"/>. A study suggested ** '''[[VMO]] Delay.''' There is some evidence that people suffering from knee pain (PFPS) has have a delay in the activation of the [[VMO ]] compared with the main quad muscles<ref name="KneeVMODelay"/> and another study noted that people with knee pain had a weaker (atrophied) VMO<ref name="KneeVMOAtrophyKneeVMODelayMeta"/>, which reduced the lateral force by 25%<ref name="KneeVMODelayPower"/>. (Remember Detecting this timing difference is normally requires sophisticated clinical equipment, but there is some suggestion that the weakness could delay can be caused felt directly by placing fingers on the knee pain, with people avoiding exercise belly of the [[VMO]] and stress rather than the weakness causing the knee painVL<ref name="PFClinical"/>.)

* '''[[Massage ]] the [[VMO]]'''. While the evidence for weak quads and [[VMO ]] is marginal, massaging the [[VMO ]] is easy and reasonably risk free. While the [[Foam Roller] is good for massaging most of the quads, it tends not to get to the [[VMO]], and if the [[Foam Roller]] is your only quad massage technique then it's possible that your [[VMO ]] is suffering from neglect. I would recommend using [[The Stick]] as well as using your elbow on the [[VMO]]. I've also found that using an electronic muscle stimulator on the [[VMO ]] can help. See main article on [[Massage]] for more details.* '''[[Massage ]] the glutes.''' Weak glute muscles have been linked to knee pain<ref name="KneeHip"/><ref name="Glutes"/>, so massaging them may help them recover their strength and functionality. * '''[[Electrical Muscle Stimulation]]'''. Strengthening the quad muscles using normal resistance training tends to put extra stress on the kneecap aggravating the injury. Resistance training the quad muscles tends to equally train all parts, rather than focusing on the [[VMO]]. Electrical muscle stimulation by contrast can directly target The only known way to selectively strengthen the [[VMO while putting relatively little stress on ]] is by the kneecapuse of [[Electrical Muscle Stimulation]]<ref name="PFClinical"/>. See [[Electrical Muscle Stimulation]] for more details.* '''Footwear'''. There are two types of footwear changes that may help with knee pain that are contradictory; minimalist footwear and orthotics. Personally, I am concerned that Orthotics may help with knee pain but cause other problems, and the use of orthotics goes against the evidence for minimalist footwear. However, there is more scientific evidence to support orthotics for resolving knee pain, even though orthotics may increase knee stress. My personal belief is that it is better to cautiously move towards [[Minimalist Running Footwear]] rather than use orthotics, but I want to be clear that there is not clear scientific support for my belief. ** '''Minimalist shoes'''. There is good evidence that running shoes increase the stress on the knee<ref name="ref14"/>, and that a more minimalist approach to footwear may be appropriate. There is plenty of anecdotal evidence<ref name="KneeMinCaseStudies"/> that minimalist footwear helps with knee pain, but only limited science<ref name="KneeMinShoes"/> to back it up. Also, changing too quickly to minimalist footwear may result in [[Too Much Too Soon]] injuries. See '[[Are your running shoes injuring you]]?' for more details. ** '''Orthotics'''. Studies have shown that orthotics reduce knee pain, with a greater benefit shown in those that have greater pronation<ref name="KneeOrthWedge"/><ref name="KneeOrthIm"/><ref name="KneeOrthWAS"/>. However, there are concerns that orthotics may also increase the stress on the knee<ref name="KneeFootware"/>. Personally, I am concerned that Orthotics may help with knee pain but cause other problems, and the use of orthotics goes against the evidence for minimalist footwear

* Supplements? * '''Taping'''. The use of tape has been shown to be effective at reducing knee pain<ref name="KneeLongTerm"/><ref name="KneeTapeBrock"/><ref name="KneeTapeMcConnel"/>, by over 90% in one study<ref name="KneeTapeEMG"/>. One study used tape to pull the knee cap towards the midline of the body<ref name="KneeTapeMedial"/>, others relied on evaluation to define the correct direction<ref name="KneeTapeBrock"/>. The most common method mentioned is 'McConnell taping'<ref name="KneeTapeMcConnel"/><ref name="KneeTapeBrock"/>, and instructions can be found by Googling 'McConnell taping'.

* '''Quad strengthening'''. A common recommendation is to strengthen the quad muscles to improve the tracking of the kneecap, especially the [[VMO]]. However, resistance training of the quads puts extra strain on the kneecap and can cause a worsening of the symptoms<ref name="PPConcepts"/>.