Patellar Mobilization

Mobility / Early Rehab Beginner Week 1+

Overview

Patellar mobilization involves gently moving the kneecap (patella) in various directions to maintain its mobility. After ACL surgery, scar tissue and swelling can cause the patella to become "stuck," limiting knee flexion and extension. Regular mobilization helps prevent this stiffness and is a critical early rehabilitation technique.

Why Patellar Mobility Matters

The patella must glide smoothly for normal knee function:

Flexion: Patella glides upward as knee bends
Extension: Patella glides downward as knee straightens
Quad function: Patella is part of quad mechanism
Stair climbing: Requires full patellar mobility

A "frozen" patella can permanently limit knee ROM if not addressed early.

Key Benefits

Prevents patellar adhesions from forming
Supports full knee flexion and extension
Reduces anterior knee pain
Can be done independently at home
Takes only a few minutes
Safe immediately after surgery (with clearance)

How to Perform

Setup

Sit or lie with leg extended and relaxed
Knee should be straight (0 degrees) or slightly bent
Quad muscle must be completely relaxed
Place thumbs or fingers on sides of kneecap

Medial/Lateral Glides (Side to Side)

Place fingers on outer edge of patella
Gently push patella inward (medially) toward other knee
Hold 5-10 seconds with gentle pressure
Release and push patella outward (laterally)
Hold 5-10 seconds
Repeat 10-15 times each direction

Superior/Inferior Glides (Up and Down)

Place fingers on top and bottom edges of patella
Gently push patella upward toward hip
Hold 5-10 seconds
Push patella downward toward foot
Hold 5-10 seconds
Repeat 10-15 times each direction

Note: Inferior (downward) glide is especially important for knee flexion.

Circular/Figure-8 Patterns

Gently move patella in small circles
Clockwise for 10 rotations
Counter-clockwise for 10 rotations
Can also do figure-8 patterns

Important Precautions

Be gentle: This should not cause pain
Relax the quad: Muscle must be completely relaxed for patella to move
Avoid incision: Don't press directly on surgical incisions
BTB graft: Be extra gentle if you had patellar tendon graft
Stop if painful: Mild discomfort OK, sharp pain is not

BTB Graft Special Considerations

If you had a bone-patellar tendon-bone (BTB) graft, your patellar tendon was harvested for the ACL reconstruction. This makes patellar mobilization even more important, but requires extra care:

Start gently: May be more tender initially
Avoid pressing on tendon: Push on patella bone only
Inferior glide important: Prevents tendon from scarring down
Follow PT guidance: Your therapist will guide progression
Kneeling may be limited: This is normal long-term

Scar Tissue Massage

When to Start

Once incisions are fully healed (usually 2-3 weeks)
No open wounds or scabs
Cleared by surgeon or PT

Technique

Apply lotion or vitamin E oil to scar
Use fingers to gently massage scar tissue
Move perpendicular to the scar direction
Apply moderate pressure (uncomfortable but not painful)
Massage for 5-10 minutes
Can also lift and roll the scar between fingers

Why It Helps

Prevents scar from adhering to underlying tissue
Keeps tissue mobile and pliable
May improve cosmetic appearance
Reduces hypersensitivity around scar

Recommended Routine

Technique	Duration	Frequency
Medial/Lateral glides	10-15 reps each direction	3-4x daily
Superior/Inferior glides	10-15 reps each direction	3-4x daily
Circular mobilizations	10 each direction	2-3x daily
Scar massage (when healed)	5-10 minutes	1-2x daily

Total time: 5-10 minutes per session

Duration: Continue for first 8-12 weeks minimum

Common Mistakes

Quad Not Relaxed

Tensing the quad prevents patellar movement. Focus on keeping leg completely relaxed.

Too Aggressive

Pushing too hard can cause pain and swelling. Be firm but gentle.

Skipping Sessions

Inconsistent mobilization allows adhesions to form. Do it multiple times daily.

Stopping Too Early

Thinking it's no longer needed. Continue for several months.