Learn Yourself Lesson: The Suprapatellar Pouch

If you have one or more of the following this is going to be magical information:

  • knee pain (this is not a substitution for medical advice)
  • difficulty keeping knees out while squatting
  • run a lot
  • jump a lot
  • knees go forward when you squat
  • sitting a lot

The suprapatellar pouch and surrounding area is a well forgotten mobility area that takes the brunt of our training, poor movements (current or old) and sitting habits. We’ve spent time in mobility class working on this area and everyone has seen instant relief! Take a look at the image below to see where the suprapatellar pouch is.

anat2829As you can see it sits right on top of the femur, underneath the quadriceps tendon and patella. It is also called the suprapatella bursa, but it’s different than the other bursae around the knee because it actually has a direct connection to the knee joint (through the synovial membrane) [1]. Just like any other area of the body, when compressed over time it gets irritated and can get inflammed. This creates a big source of pain, as well as causing long term tissue damage (if left unfixed) and changes in movement patterns (due to pain and tightness of the surrounding areas caused by the irritation).

It gets compressed because there are so many major muscles, ligaments, tendons and connective tissue that cross the knee joint. The suprapatellar pouch is built to withstand the connection with the other parts of the body, but when our muscles aren’t kept mobile and we aren’t moving well it starts to get irritated. One of the main movement faults that irritates this area is knees forward when we squat, run or jump. This creates a movement pattern that uses all the muscles in the anterior part of the knee, but doesn’t get the posterior chain active to counter balance. That’s why the coaches are always focusing on keeping your knees back to get the hamstring working, and knees out to get the glutes working. It’s common to have people/athletes who are quad dominant. They may feel strong, but they are really sandbagging their potential by not using all the muscles and causing an overuse injury in the front of the knee that will eventually surface.

10884-0550x0475Most of us know how to roll out the quads, which is a good start. But you can see that there are many other areas that need to be tackled as well. And if you can tolerate it, the double or single lacrosse balls are way more affective (in my opinion and experience) in working these areas rather than the foam roller. You want to make sure that you work all around the knee cap, as K-Starr is doing in the image below. You may also have to “spoon” the ball to get the inner part of the knee and lie on your side to get the side of the knee.

MobilityWOD - PSE Chapter2x1In order to mobilize the areas around the knee cap let’s take a look at the image of the front of the knee again, and notice how much white there is all around the knee. These areas need work as well, but are too superficial to tolerate pressure from the lacrosse ball. The best way to get this is to use a softer/grippy ball like the Yoga Tune Up ball or you can try one of the dog toys we have at the gym (I prefer the latter but at least the dog toys are softer than the lacrosse ball). Start by just using your hands to roll the ball all around the knee cap (see the pink areas in my childish drawing below), basically in all the areas that you can’t get with the lacrosse ball mobilization described above.

photoThe green area in the image above is where you will put the softer/grippy ball to mobilize the connective of the patellar tendon to the lower leg bond (tibial tuberosity). You should be able to feel a part of your lower leg that sticks out more right below the knee cap. You can either put the ball on a chair and kneel onto the ball that way, or you can go on the ground and sit on your heel to get more pressure. Then roll around, or pin the ball down and start to rotate your leg like a windshield wiper. This will start to break up some of that junk that has built up from poor mechanics. We’re all guilty of them at one point. And even if you’ve fixed them and you’re perfect now, you may still have some residual junk in there. It never hurts to check it out and see how magical you feel after!

photoReferences:

1. Deliwala et al. The Suprapatellar Pouch of the Knee and It’s Disorders. Gujarat Medical Journal. February 2010.

2. F Netter.

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