6 Best Exercises For Plica Syndrome

By Dr Ken Nakamura+

Synovial Plica Syndrome Exercises

Do you have knee cap pain?

Knee cap pain or anterior knee pain that is presistent, despite your physiotherapist’s and chiropractor’s best efforts could be Plica Syndrome.

What is Plica Syndrome?

Plica Syndrome: The Mediopatellar Plica Is The Most Common Plica. (medial plica closer to your body midline)
Plica Syndrome: The Mediopatellar Plica Is The Most Common Plica. (medial plica is closer to your body midline) Picture Reference #2.

With Plica Syndrome, your knee cap is painful with clicking, clunking and popping with activities like squatting. You get decreased bending of the knee with intermittent knee cap pain other times with medial knee pain.

See MRI CAT or X-ray which is best

The picture below shows the picture of the medial side of the knee that often hurts with Plica Syndrome.

Plica Syndrome: Most often plica syndrome causes pain at the medial knee.
Plica Syndrome: Most often plica syndrome causes pain at the medial knee. Picture Reference #3

Plica is leftover knee tissue that didn’t reabsorb back into the body since you were a fetus in your mom’s belly. Not everyone has a plica. According to researchers [1] only 50% of us have a plica.

For those 50 % of you with a plica, they are found most often on the medial side of the knee cap.

Plica Syndrome: Synovial Plica Syndrome | Exercises For Synovial Plica Syndrome SPS
Plica Syndrome: Synovial Plica Syndrome | Exercises For Synovial Plica Syndrome SPS. Picture Reference #4

What causes Plica syndrome?

Plica syndrome can be due to injury or overuse. Your plica often gets caught between your femur (thigh bone) and the knee cap (patella) or the femur and Quadriceps tendon.[2]

When you bend your knee between 70-90 degrees that is when it pinches. This can pinch the plica causing pain and inflammation.

For most athletes repeated bending of the knees with sports like running, rowing sports, gymnastics and team sports such as hockey and basketball can irritate the plica.

Symptoms of Plica Syndrome

Knee Pain From Plica Syndrome
Knee Pain From Plica Syndrome
  • More common in female young adults and teenagers. They will often be doing a sport then all of a sudden get progressively worse.
  • Walking up or down stairs, squatting, kneeling or holding your knees bent for long periods will cause dull aching.
  • Symptoms can worsen progressively for only some of you.

Diagnosis Of Plica Syndrome

The problem with Plica syndrome is only considered by your chiropractor or physiotherapist only after treatment of patellofemoral pain has not worked.

It’s not the first thing that most practitioners think of. The problem is there are no specific tests or imaging such as X-ray to rule it out. Even an MRI will have a difficult time showing plica unless there are inflammation and fibrosis.

Meaning, your history and exam are more important than X-rays or MRI.

You likely were doing a lot of strenuous activity like squatting, bending, walking up/down stairs, but also sitting for long periods of time. Pain with prolonged sitting seems to be all the rage among practitioners that diagnose Plica Syndrome. [3]

The more strenuous sporting activity you do the worse it gets until you can’t do your sport.

Palpating Your Plica

Knee Palpation for Plica Syndrome.

Your chiropractor can often palpate the plica on the medial side of the patella (knee cap) right at the joint line .

Very helpful for the diagnosis of Plica Syndrome. Although your chiropractor has to think about the possible diagnosis first.

How long does it take to recover from Plica Syndrome

The severity, skill of your practitioner and your ability to not aggravate your Plica Syndrome will determine how quickly you get better.

As an athlete, if you continue to train your knees as hard as before you will take months or not even get better.

If you decrease your training and cross train by swimming and do upper body training more you will likely get better more quickly and allow your physiotherapist or chiropractor to get you better.

You will likely takes weeks and sometimes months to get better.

Chiropractic Rehabilitation For Plica Syndrome

Ice packs and ice massage to reduce inflammation helps Plica Syndrome. Active release techniques are also helpful to break down scar tissue. Once the inflammation is down quadriceps strengthening and hamstring flexibility is recommended.

#1 Exercise: Foam Roll Knee Extension

Foam roll knee stretch
Foam roll knee stretch. Picture Reference #5

This exercise is a good way to stretch out the back of your knee, and hamstrings.

  • Sit up with your hands supporting you.
  • Put a foam roll under your lower leg.
  • Straighten out your knee and let it relax.
  • Hold for 2-5 minutes to stretch out the back of your knee and hamstring.

For added pressure you can put your leg on top of the other.

#2 Exercise: Straight Leg Raise ITB stretch

ITB / TFL stretch : Iliotibial band (ITB) and Tensor Fascia Lata (TFL) Stretch
ITB / TFL stretch : Iliotibial band (ITB) and Tensor Fascia Lata (TFL) Stretch. Picture Reference #6

An ITB stretch stands for ilial tibial band which is a band of fascia that is on side of your thigh. You are trying to stretch this out to decrease pressure on the medial side of the knee.

  • Lie face up.
  • Put a Theraband or towel around your foot.
  • Keep your knee straight and raise it up.
  • For right knee Plica: Bring your straight leg over your left shin or as far as it will go.
  • Do 2 sets of 8 repetitions.

#3 Exercise: Heel Slide For Plica Syndrome

Your hamstrings will get stronger with this exercise and at the same time help keep joint mobility.

I would do this exercise on hardwood or laminate floor with your socks on to allow your heel to slide easily. Alternatively, you buy a slider for your heel.on carpet or floor, which is the easiest way to do this exercise. Don’t use a yoga mat for this exercise.

Level 1

Heel slides Level 1: While putting pressure on your heel slide your foot towards your buttock. Make sure you wear socks or use a slider.
Heel slides Level 1: While putting pressure on your heel slide your foot towards your buttock. Make sure you wear socks or use a slider. Picture Ref #7
  • Lie down on the floor with your socks on.
  • Both of your legs should be straight.
  • Toes should be bent up towards the ceiling.
  • Bend your painful knee while putting some weight into your heel until your knee is about 90 degrees.
  • If both your knees are painful do both sides.
  • Do 3 sets of 15 repetitions. Start with sets of 10. Hold for 3-seconds.

Level 2

Heel Slides Level 2: One leg is straight while the other leg is bent. Do a bridge then bend the straight leg while sliding the heel across the floor.
Heel Slides Level 2: One leg is straight while the other leg is bent. Do a bridge then bend the straight leg while sliding the heel across the floor. Picture Reference #8
  • Lie down on the floor with your socks on. (The picture above uses a slider)
  • One leg should be straight while the other should be bent like the picture above. Picture A
  • Toes should be bent up towards the ceiling.
  • “Bridge up” so that your hip and buttocks come up so they are in-line with your chest like the picture above.
  • Bend your painful knee until your knee is about 90 degrees. Picture B
  • Do 3 sets of 15 repetitions. Start with sets of 10. Hold for 3-seconds.

#4 Exercise: Straight Leg Raise For Plica Syndrome.

Straight Leg Raise For Plica Syndrome
Straight Leg Raise For Plica Syndrome. Picture Reference #9

Straight Leg Raises starts strengthening the quadriceps muscle that.

  • Lie on your back with one knee straight and the other bent to help protect your lower back.
  • Bring your toes towards you to lock out your knee and keep your knees straight.
  • Slowly raise your leg straight with your leg locked to about 60 -70 degrees. Hold for 1 sec.
  • Slowly lower your leg back down.
  • Do 3 sets of 10 repetitions.

Advanced Straight leg Raise

  • Don’t let your feet rest on the floor.
  • Come down to about 30 cm or 1 foot off the floor then come back up again.
  • Do 3 sets of 15-20.

#5 Exercise Hip Adduction For Plica Syndrome.

Hip Adduction Exercise For Plica Syndrome
Hip Adduction Exercise For Plica Syndrome

You want to strengthen your adductors to help the muscles in that area of your plica.

  • Lie on your side resting on your elbow.
  • Your back leg is bent and your front leg is straight.
  • Bring your back leg to the front if you feel more comfortable.
  • Bring your toes up to lock out your knee.
  • Raise up your straight leg as much as you can. It won’t be very high for most of you.
  • Do 3 sets of 10 repetitions.

#6 Exercise Hip Abduction For Plica Syndrome.

Strengthen the abductors to help balance the muscles out. This exercise is very similar to the above. The main difference is you are raising the top leg this time.

  • Lie on your side resting on your elbow.
  • Your bottom leg is bent.
  • Your top leg is straight.
  • Bring your toes up toward your body to lock out your knee.
  • Raise your straight leg slightly behind your body.
  • Lead with your heel when raising your leg. Meaning the heel should be the highest part of the leg raise.
  • Keep your body in a straight line.
  • Do 3 sets of 10 repetitions.

Picture Reference

  1. Photo by Jon Tyson on Unsplash
  2. https://www.researchgate.net/publication/316099763_Plica_Syndrome_and_its_Embryological_Origins
  3. Photo by Ramesh Iyer on Unsplash
  4. Photo by Marlon Lara on Unsplash
  5. http://www.stretching-exercises-guide.com/calf-stretches.html
  6. https://rollerderbyathletics.com/how-to-tfl-stretch/
  7. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=abj6473
  8. https://www.womenshealthmag.com/health/a20700636/single-leg-valslide-curl/
  9. https://www.performancehealthacademy.com/thera-band-cuff-weight-straight-leg-raise.html

Research

  1. Roofeh. (2008, Juli). The medical plica syndrome can mimic recurring acute haemarthroses. HAEMOPHILIA , pp. 862-862.
  2. Lee, Nixion, Chadratreya, Murray, Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain, The Journal Surgery, 2017 Jan, 3(11); e9-e16.
  3. Chevestick A, Huie G, Kissin Y D, Kelly M A. Anterior knee pain: the pitfalls of plica and chondromalacia patellae. Adv NPs PAs. 2011;2(06):37–39. [PubMed] [Google Scholar]


Author

Dr Ken Nakamura

Who is Dr. Ken? I’m a father, spouse, chiropractor, and I love what I do! I created Bodi Empowerment to bring you and everyone-else safe and effective methods for self-treatment by basing my articles on research to everything I can. Still many parts will be based on 18 years of experience, seminars, and collaboration with other health experts; which means you will get opinions as well. Sometimes my articles won’t agree with what is currently accepted, but I am not here to please everyone. I’m here to empower you through the knowledge that I give you. Dr. Ken works at Rebalance Sports Medicine in downtown, Toronto.

Leave your thoughts to 6 Best Exercises For Plica Syndrome

Leave a Reply

Your email address will not be published. Required fields are marked *

Related Posts


© 2019 Dr. Ken Nakamura Downtown Toronto Chiropractor |Sports Injuries.com. All rights reserved. Reproduction is prohibited without explicit Permission of
Dr. Kenji Nakamura. Use of this web site constitutes acceptance of the BodiEmpowerment.com Terms of Use and Privacy Policy. The material appearing on BodiEmpowerment.com is for educational use only. It should not be used as a substitute for professional medical advice, diagnosis or treatment. BodiEmpowerment is a registered trademark.

Bodi Empowerment is an online health magazine. We are dedicated to empowering people, by guiding their step-by-step self-treatment, in areas of rehabilitation and nutrition. We are headquartered in the financial district of downtown, Toronto.