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Plica is soft tissue that is present in about a fair amount of the population (estimates range from 50-95%). It’s essentially a fold in the synovial membrane on the anteromedial (front and middle) aspect of the knee. We all have it when we’re in utero, but for some, it’s reabsorbed during development. For those that still have it, it can be asymptomatic, or for some, it can become thickened and inflamed when the knee is overused. Risk factors include altered patella mobility, tightness of the quadriceps or hip muscles, muscular imbalances, improper technique with repetitive movements, a change in activity level or exercise routine, abnormal hip or knee structure, abnormal hip or knee biomechanics, trauma, or twisting. Plica syndrome may manifest as pain and/or tenderness in the anteromedial knee, catching or snapping when bending or straightening the knee, tightness in the knee, painful movement (especially the arc between 30° and 60°), pain with transfers, pain with stair climbing, or weak quadriceps.
Your therapist will target your rehab based on his/her findings as to what may be contributing to your plica pain. This could include strengthening weak muscles, stretching tight muscles, gait training, stair training, transfer training, neuromuscular re-education, and addressing proper biomechanics and patellar tracking.
Strengthening exercises may include double or single leg squats (or mini squats), the leg press, steps-ups, lunges, or closed chain walking (forwards, backwards, and sideways). Your therapist may also focus on VMO activation via short arc quads (in parallel or turned-out) and things of the like. In addition to strengthening, stretching the quadriceps, hip flexors, and hamstrings may be beneficial. Pay attention to your biomechanics as you do things like go up stairs or get up out of chairs. Your knees may fall in towards the center of your body a bit instead of staying in line over your foot and ankle, which may be caused by weak gluteal muscles in the hip. This can, in turn, put extra pressure on the anteromedial portion of your knee. If this is the case, your therapist will add gluteal strengthening to your regimen, as well. Your therapist may also look at the biomechanics of your feet as you walk, jump, and land, as they may affect how your whole leg absorbs impact. Outside of exercises, bracing and taping (via kinesiotape or leukotape) may also be utilized for proper tracking and support.
In some instances, surgery is required, where the portion of the plica that’s interfering with movement will be resected, or cut out. If surgery is required, your doctor will most likely recommend RICE for a few days before starting rehab to reduce pain and swelling, increase AROM, improve strength, gait, and balance, and eventually, add in agility training, like running and jumping.
I hope you enjoyed our exploration of the knee. Please keep in mind that the list of injuries here is not exhaustive. If there is another injury you’d like me to go over, please let me know in the comments section.
Next up: a break from the joints, and a look into which kinestiotape lasts the longest. Stay tuned!
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