Digitalepiphany,

The couch stretch is a wonderful way to open up the quads (particularly the rectus femoris), but any action that increases tension in the quads also can also increase compression at the patellofemoral joint (the joint between the underside of your kneecap and the groove in the front of your femur. This is particularly true as the knee moves into deeper angles of flexion. Picture the patella being glued between the non-elastic strap of the patellar ligament (the ligament attaching your patella to your tibia) and the bulk of contractile muscle known as your quads. When the knee is relatively straight, tension added to the system is transfered from the quads to the patellar ligament via the patella fairly efficiently. With the knee flexed, however, this force is transmited around the curve of the anterior knee and much of it is converted to compressive force at the patellofemoral joint. This compressive force is compounded if you are resting the your knee on the ground (this can be alleivated somewhat with an airex pad, but is still not a good idea if you have active patellofemoral pain). While stretching the quads can be helpful with patellofemoral pain syndrome, high levels of compression at the joint surfaces will only serve to irritate your condition. I would reccomend that you avoid max tension at end range flexion, cut out kneeling postures, and spend more time on the foam roller. This will help to address the soft tissue with less loading on the joint. In addition, since your pain is along the lateral patella, you may have issues with lateral tracking (tracking problems involve the patella not moving correctly throught the groove in the front of the femur and excessive lateral tracking is actually quite common). While a Physical Therapist is the best one to analyse your joint mechanics, your coach or an observent friend can certainly help you to clean up any movement patterns that may be contributing (usually valgus collapse during squatting / jumping patterns). Releasing the lateral tissues including the IT bad can be helpful any may also be indicated with your history of trochanteric bursitis (dont’ roll right over the trochanter though!). Just remember, mashing a lacrosse ball into your soft tissue may be exquisitley painful, but these techniques should never create joint pain. If something hurts your joints, it is not right for you a this time. Address your other issues and then revisit it later to see if things have changed.

Good Luck,

Brian Bochette, PT, CSCS