Hypermobile patella exercises

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Non-weight-bearing exercises place less strain on your knees and therefore are a good starting point. Bridges are performed lying on your back with your knees bent and feet on the floor. Slowly lift your hips up off the floor, squeezing your hamstring and gluteus muscles Nonsurgical treatment may include rest, regular stretching and strengthening exercises, taping or bracing the knee, using ice, and short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Quadriceps strengthening is the most commonly prescribed treatment for patellar tracking disorder Kneecap instability (patellar instability) is an incredibly common sign and symptom of a hypermobility-related disorder such as Hypermobile Ehlers-Danlos syndrome (hEDS) or a type of Hypermobility Spectrum Disorder (HSD). This slight structural abnormality appears to stem from the overall laxity of the knee-joint, and it's more common in. The best way to stay fit and healthy is by doing regular exercise that you enjoy. Some of the best things to do if you are hypermobile are to go swimming and/or cycling. These two sports avoid lots of impact through your joints, strengthen your muscles and help your heart and lungs stay healthy

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  1. A 2017 article in the Journal of Education, Health and Sport recommended stabilization exercises for people with hypermobility. These movements rely on closed kinetic chain exercises, which increase muscle awareness and work many joints. Examples include power squats and rowing
  2. sprains, or patella (kneecap) dislocations. Specific exercises prescribed by a physiotherapist can strengthen muscles surrounding the joint to improve joint stability and ease pain. It is important that children with joint hypermobility are physically active for the development of strength and fitness. Low impact sports and activities such a
  3. Knee cap exercises can be really helpful in reducing knee pain. They strengthen the VMO muscles (Vastus Medialis Oblique) around the patella improving how the kneecap moves. The VMO muscles are part of the quadriceps muscles and are found on the inner side of the knee. Their job is to control the kneecap movement, known as patellar tracking
  4. Patellofemoral pain syndrome physical exercise 2: Stretch your quadriceps muscles The second physical exercise is a stretching exercise to reduce the tension in your thigh muscles. Tense thigh muscles cause more pressure on your kneecap and therefore reduce patellar tracking
  5. Early stage exercises for patellar instability. Knee bends. Sit in a chair or lie odwn on your back with your leg straight. Bend your knee as far as comfortable.. Repeat 5-10 times. Do not push through pain. Knee press. Press the back of your knee into the floor and hold for 5 seconds then relax. Repeat 5-10 times
  6. Clinically Relevant Anatomy [edit | edit source]. The patella is the largest sesamoid bone. It is located within the complex of the quadriceps and patellar tendon. Through its articulation with the femoral trochlea, the patellofemoral joint forms a highly complex unit with potential for joint instability. Patellofemoral joint stability is multifactorial and can be categorized into static and.
  7. Orthopaedic surgery in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders A look at the pros and cons of opting for orthopaedic surgery if you have hypermobile Ehlers-Danlos syndrome or a hypermobility spectrum disorder, and a discussion of the special measures that need to be taken

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  1. 8.1. BOER Knee Brace for Women -Adjustable Kneecap Stabilizers Open Patella and Meniscus Support, Suitable Relief for Comfort-Helps with Hypermobility, Ligament Tear, Injuries. Buy Now. 7.7. TechWare Pro Knee Compression Sleeve - Knee Brace for Men & Women with Side Stabilizers & Patella Gel Pads for Knee Support
  2. Famous Physical Therapists Bob Schrupp and Brad Heineck present the Top 3 exercises to be performed for rehabilitation after a patellar dislocation.Make sure..
  3. ant inherited connective tissue disorder described as generalized articular hypermobility, with or without subluxation or dislocation. 1(p586) The primary manifestation is excessive laxity of multiple joints. Hypermobility syndrome is different from localized joint hypermobility and other disorders that have generalized joint hypermobility, such as.
  4. Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain in the outpatient setting. It is caused by imbalances in the forces controlling patellar tracking during knee flexion and.
  5. ant inherited connective tissue disorder described as generalized articular hypermobility, with or.
  6. Exercise regularly: If you have EDS, your connective tissue in your tendons and ligaments may be compromised. Luckily, strong muscles can help pick up some of the slack, stabilize and secure your joints in place, and cut down your chronic pain. Everyone knows that exercise is good for you, but if you have EDS, think of it as daily medicine
  7. Patients with joint hypermobility syndrome of knee are referred to as having double jointed knee which is an inherited condition that occurs when certain genes are passed on to the children by their parents. Know the causes, symptoms, treatment, risk factors and prognosis of joint hypermobility syndrome of knee or double jointed knee

Generalized joint hypermobility (GJH), a requirement for many dance styles, is a common physiological trait of many young dancers [].GJH is characterized by increased joint flexibility, where the joints move beyond the normal limits [].This characteristic has mostly been assessed by the Beighton score [].GJH was reported to be dependent on the age, sex, and maturity of the individuals [] However this brace is designed for people who have suffered one or two subluxations or for those with pain around the knee cap due to Patellofemoral Pain Syndrome. I don't think that this brace will be effective in your case, due to the very severe symptoms and the way that Hypermobility Syndrome is affecting your knees Share your videos with friends, family, and the worl Hypermobile patella. A change to the exercise schedule, including a reduction in the frequency, duration, and distance of running, is a good first step in the treatment of patellofemoral pain. Do Posture Exercises People with hypermobile joints typically have posture issues, according to a 2013 report in the journal Research in Developmental Disabilities. In fact, poor posture is common even in hypermobile people without a genetic condition.Exercises for knee pain: Here are the best and worst exercises for sore, achy knees due to.

exercise. Hold for 5 seconds then slowly lower your knee back to the starting position. Do not roll your body or pelvis backward. Repeat 20-30 times. Wall squat: Stand with your back to the wall and your feet about 12 inches away. Perform a small squat, making sure your knees stay over your ankles. Hold the position for 5-10 seconds. Return t A hypermobile patella does not stay firmly in the femoral groove as the knee straightens and bends so it is at a greater risk of exercises. If one side of the quadriceps muscles pulls harder than the other side, the patella may not glide smoothly and may rub on one side Dancers can strengthen their ankles and the intrinsic muscles in their feet by doing TheraBand exercises, doming and doing a consistent series of gentle rises. They should feel the weight evenly distributed through the metatarsals, so they develop the right alignment, says Glass. Hypermobility needs to be supported, and the strength.

Exercises for Hypermobile Knees Livestrong

Training/exercises - Joint hypermobility can sometimes be developed, for example by gymnasts and athletes, through the training exercises they do. shoulder or the kneecap. Sometimes the soft tissues in and around joints (cartilage, If you do have tendons, ligaments) can tear. symptoms associate Exercises such as Pilates and yoga help to develop muscle control, posture, and flexibility, and are excellent choices for hypermobile individuals. Pilates focuses upon control and muscle strengthening - particularly the strengthening of the core (lower abominable muscles) which are vital to maintaining a correct posture and avoiding back pain the incidence of hypermobility and the incidence of Joint Hypermobility Syndrome, using the Brighton Criteria in both cases. The Brighton Criteria for inclusion in the syndrome takes into account the 9-point Beighton test and history of injury. We found that 74% of girls and 82% of boys in the lower school (11-16 yrs) were hypermobile. Th He now cannot imagine getting back to dancing. We need to explore other avenues of exercise as a preliminary stage. O/E. Obs. Overweight, no effusion. Small patella. Thoughts: small patella can indicate hypermobility. ROM full, 20 degrees hyperextension. Little pain. Beighton score: 9. Palpation. No tender areas. Patella highly mobile

Patellar Tracking Disorder: Exercises Michigan Medicin

Also, specific exercises may help to correct problems with alignment and muscle balance around the knee. For example, you may be taught to do exercises which strengthen the inner side of the quadriceps muscle. Taping of the kneecap (patella) - is a possible treatment which can reduce pain. Adhesive tape is applied over the patella, to alter the. Patellar Dislocation and Instability in Children (Unstable Kneecap) Your child's kneecap (patella) is usually right where it should be—resting in a groove at the end of the thighbone (femur). When the knee bends and straightens, the patella moves straight up and down within the groove. Sometimes, the patella slides too far to one side or the. Patello femoral syndrome is the term used to describe pain in and around the knee cap (patella), Pain is the result of abnormal position and movement of the patella on the thigh bone (femur) during knee flexion (often referred to as maltracking). This movement can lead to damage of the surrounding tissue and cartilage underneath the kneecap

8 Tips for low-impact workouts for Joint Hypermobility

Knee pain in children with Joint Hypermobility Syndrome (JHS) is traditionally managed with exercise, however the supporting evidence for this is scarce. No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes. This study aimed to (i) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is. Typical symptoms include pain behind or around the patella that is increased with running and activities that involve knee flexion. Findings in patients with PFPS range from limited patellar mobility to a hypermobile patella. To confirm the diagnosis, an examination of the knee focusing on the patella and surrounding structures is essential Hypermobility is a certain condition of the joints where the joints stretch a lot farther than they are supposed to. This condition is known under many names, some of which are double jointedness, hypermobility syndrome, benign joint hypermobility syndrome and hyperlaxity. Regular exercise and ether physical therapy or hydrotherapy can aid. There are various treatments available for Hypermobility syndrome and exercise can be one of the most essential parts of the treatment procedure. Physical therapy is one of the best ways to treat hypermobility syndrome. Occupational therapy for hypermobiity syndrome may involve educating the patient with all the alternative ways for carrying out a specific task

Patellofemoral Syndrome Exercises Patella Femoral Syndrome Chondromalacia Patella Exercises Vastus Medialis Exercises Hypermobility Fitness Workouts Sport Fitness Knee Strengthening Exercises Knee Physical Therapy Exercises Perform quadriceps exercises to strengthen the muscles in front of the thigh. If you have flat feet, orthotics can help correct the faulty alignment in your legs. In severe cases of recurrent patellar instability, surgery to stabilise the patella may be required. Recovery time Average recovery time is 4-6 weeks, but recurrences are common Exercises progress from static to weight bearing, and functional activities are encouraged as patients improve'. Physiotherapists, specialising in hypermobility, will often begin by guiding patients towards exercises that concentrate on strengthening their internal core and correcting their posture to improve stability PFP is defined as peri- or retro-patellar pain, exacerbated by activities that increase compressive loads on the patellofemoral joint (PFJ), such as running, navigating stairs and squatting (1). PFP is prevalent in 22.7% of the population and is significantly more common in women Joint hypermobility syndrome, sometimes called benign hypermobility joint syndrome (BHJS), is an inherited connective tissue disorder. It is associated with three classic findings: generalized hypermobility (characterized by greater than average range of mobility in the joints), chronic joint pain, and other neuromuscular signs due to a defect in collagen

Causes of patellar dislocation. Patellar dislocation typically occurs when the forces pushing the knee cap out of its normal position are greater than the quadriceps muscle and patella retinaculum can resist. This typically occurs traumatically due to excessive twisting or jumping forces or due to a direct blow (usually to the inner aspect of the patella) About 10-20% of people are hypermobile and can move their joints beyond the standard range. For most people, if you try to straighten your arm past 90 degrees, you would probably dislocate your elbow. While flexibility through stretching and exercise is possible, that super flexibility in hypermobile people is thought to be genetic Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 22(10): 2264-2274. Tang SF, Chen CK, Hsu R, Chou SW, Hong WH, Lew HL (2001). Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study

The Best & Worst Activities for Hypermobile Joints

The patella, or kneecap, can be a source of knee pain when it fails to function properly. Alignment or overuse problems of the patella can lead to wear and tear of the cartilage behind the patella. Chondromalacia patella is a common knee problem that affects the patella and the groove that the patella slides in over the femur (thigh bone) The joint hypermobility syndrome is a condition in which the joints easily move beyond the normal range expected for a particular joint. The condition tends to run in families. Symptoms of hypermobility syndrome include joint pain. People with hypermobility syndrome are more susceptible to injury, including dislocations and sprains. Anti-inflammatory drugs can help with joint pain. Exercise. A luxating patella, or trick knee in layman's terms, is a condition in which the patella, or kneecap, dislocates or moves out of its normal location. How do you stabilize the patella? Patellar Tracking Disorder: Exercises—Straight-leg raises to the back Lie on your belly Physiotherapy, particularly exercise, is a mainstay of treatment for hypermobility. Including regular strengthening, proprioceptive and stability exercises is the main form of treatment. This includes using a swiss ball to improve your stability and proprioception (awareness of where your joint is positioned), and the use of resistance bands. Proprioception exercises • Juggling • Balance board or wobble board • Stork standing (stand on one leg) • Stand up paddle board (SUP) • Sitting on exercise ball • Exercise in water - walking, treading but NO • Hypermobile patella - unstable knee • Strains the ligaments inside the kne

This exercise prescription case module will describe current ideas behind diagnosing and treating patellar tendinopathy. It will discuss the case study of a basketball player and dive into exercise demonstration videos with examples of regressing and progressing exercises Hypermobility, also known as double-jointedness, describes joints that stretch farther than normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or perform other contortionist tricks. It can affect one or more joints throughout the body Hello zaibss, I too have Hypermobile EDS. For me, consistently doing my EDS-appropriate exercises as described in Kevin Muldowney's Living Life to the Fullest with Ehlers-Danlos Syndrome with the help of my manual PT to put my bones back in pace and alignment as well as doing EDS-appropriate exercise, mostly in a warm pool, helps my loose joints the most Patellofemoral syndrome (PFS) is one of the most common causes of anterior knee pain. It is commonly known as runner's knee, patellofemoral pain syndrome, retropatellar pain syndrome, lateral facet compression syndrome, or idiopathic anterior knee pain. It is a diagnosis of exclusion once another intra-articular and peripatellar pathology has.

Patellar plica syndrome is a common cause of anterior knee pain (Griffith & LaPrade, 2008). Usually reported as an insidious onset of knee pain, patella plica should be considered upon initial presentation of those with anterior knee pain, especially in the setting of known repetitive activities (Al-Hadith et al., 2011; Griffith & LaPrade, 2008) patellar mobility is important ROM should be initiated (0-90°), emphasizing full passive knee extension. Other examples of exercises that may be initiated include quadriceps sets, ankle pumps, straight leg raises, and upper body strengthening Patellar dislocation exercise 1: Increase the mobility of your knee. The first exercise I'm going to show you is designed to increase the movement of your knee again. Because your knee has been bend for so long, the muscles and joint capsule tighten so much that it prevents the full range of motion of your knee

Knee Cap Exercises: Improve Patella Tracking - Knee Pain

It can be useful, especially if the individual is experiencing significant pain, to start with static exercises in the hypermobile range before progressing to dynamic work and then on to resisted work. The exercises may progress from non-weightbearing to weightbearing work and hydrotherapy can be a useful adjunct. Hydrotherapy can also be. People with hypermobility have laxity in knee ligaments and stand in the genu recurvatum posture. The knee is the most painful joint in people with knee hypermobility and patellofemoral pain syndrome is a common problem (Tinkle 2008). Additionally, the normal kinematics of the knee are affected by alteration of tibiofemoral mechanics The prevalence of general hypermobility in the adult population ranges from 10 to 30% (1, 2). Most individuals with general hypermobility remain asymptomatic throughout their lives, but compared to those who are not hypermobile, they have an increased risk of musculoskeletal complaints (2), especially in the neck, back and upper body (1, 2)

3 Responses to 4 Ways Hypermobile Clients Can Improve Their Training Cote Says: January 6th, 2017 at 12:53 pm. Hi, I am extremely hypermobile and my wrists and elbows are the ones that suffer the most when I perform overhead lifts. Even wearing wrist wraps. I even wear double wrist wraps when performing overhead squats because of the pain If you fall into the hypermobile category, lifting heavy twice a week and complimenting your strength work with more stability based exercises might be a good balance. Do lighter stuff on the off days or rehab stuff on the off days, like old school rehab drills for the shoulders and hips, Catherine suggests

Patellofemoral pain syndrome treatment with 5 physical

Patellar Instability - symptoms, causes & best treatmen

• Hypermobility Spectrum Disorder (HSD) is the most common systemic inherited connective tissue disorder in humans - In the UK prevalence of HSD associated with chronic widespread pain or severely disabling pain (Mulvey, et al col for treatment or exercise prescription can be de- veloped for the entire scope of individuals experienc- ing PFPS. Differential diagnosis must consider a range of inflammatory conditions, mechanical prob- lems, and other conditions (eg, tendinitis and bursi- tis, patellar hypermobility, subluxation and disloca

Patellar Tendonitis Exercises. Exercises to relieve Leg Joints' Pain. Saved by Audrey Jenkins. 585. Patellar Tendonitis Exercises Knee Pain Exercises Arthritis Exercises Knee Stretches Knee Surgery Recovery Pilates How To Strengthen Knees Runners Knee Physical Therapy Exercises Double patella-what is that? Hypermobile Patella Broken patella healing Jone's Fracture--when to give up on conservative treatment and have surgery? lis franc fractures anterior pole fracture of patella Recovery time for tibia stress fracture? Broken Femur Jones Fracture Broken patella starting to play up after two years of being fine What causes lateral patellar tilt? It is caused by imbalances in the forces controlling patellar tracking during knee flexion and extension, particularly with overloading of the joint. Risk factors include overuse, trauma, muscle dysfunction, tight lateral restraints, patellar hypermobility, and poor quadriceps flexibility

Symptoms of joint hypermobility syndrome. JHS can cause a wide range of symptoms, including: pain and stiffness in the joints and muscles - particularly towards the end of the day and after physical activity. clicking joints. back and neck pain. fatigue (extreme tiredness) night pains - which can disrupt your sleep Hypermobility syndrome was recognized as a distinct pathology by Kirk et al 1 in 1967. Since then, the syndrome has been identified by a variety of names: hypermobility syndrome (HMS), 2- 9 joint hypermobility syndrome, 10- 13 hypermobile joint syndrome, 14 and benign hypermobile joint syndrome. 15, 16 Other reports do not recognize this disorder as a syndrome, but. Graded exercise progression: Exercising with an underlying hypermobility disorder is a tricky game. It requires a specific gradual exposure and build-up to avoid injury or flare-up of pain symptoms. It may require a guided and individualized approach. See below for some tips on exercise progression for hypermobility Patellar instability is found in in 57%, chronic pain in 85% of the patients. These numbers were similar to earlier research which suggested 81.5% of patients with hEDS reported knee pain and 40% reported patellar dislocations. Patients with EDS were found to have patella maltracking with a relatively large lateral tilt There is a grading system from 1-9 to rate the severity of the hypermobility. Children frequently attend the physiotherapy clinic for treatment of recurrent injuries to a variety of joints and there they will be identified as a systemic hypermobile and a specific exercise program can be designed to deal with this ongoing issue

Patellofemoral Instability - Physiopedi

EDS, Hip Dysplasia, Hypermobility, Cam Impingement, joint subluxation means close attention to exercise and an excellent diet. Hello! I am a 26 y/o female with right hip dysplasia, a left hip cam impingement, and bilateral labral tears. Also I have bilateral joint space narrowing with bone spurs on both my patellas which are very superior. As we do a lot of work with Ehlers-Danlos syndrome hypermobility type, if you are researching knee cap dislocation in children, please see this article Ehlers-Danlos syndrome hypermobility type. Kneecap dislocation occurs when there is an impact injury to the knee significant enough to dislodge the kneecap Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers BMC Musculoskelet Disord . 2021 Feb 9;22(1):161. doi: 10.1186/s12891-021-04023-z medial patellar border to lateral patellar border. If medial border is more anterior, then there is a lateral tilt. • Medial/Lateral Patellar Glide - Noting degree of movement relative to width of patella, > 75% translation is hypermobile. • Patellar Compression/Grind - Direct compression into trochlea, contraction of Quadricep

A dislocated kneecap is a common injury that normally takes about 6 weeks to heal. It's often caused by a blow or a sudden change in direction when the leg is planted on the ground, such as during sports or dancing. The kneecap (patella) normally sits over the front of the knee. It glides over a groove in the joint when you bend or straighten. Fortunately, there's plenty you can do with hypermobile joints to head off pain. By being aware of the symptoms and performing strengthening exercises at home, you can tighten up the best muscles for keeping your joints supported and in line. The best strengthening exercises to counter hypermobility target specific areas around the joint

Managing dislocations and subluxations in hypermobile

Stretching exercises. The aim of stretching is to increase the range of movement at a joint by increasing the flexibility of the soft tissue structures that surround it i.e. muscles, ligaments, and the joint capsule. Stretching exercises are extremely beneficial in rehabilitation but should normally be accompanied by a strengthening program so that instability does not develop around the joint Ottawa Knee Rules. radiographic exam required w/ acute injuries and 1+: -age of 55 or older. -tenderness at head of fibula. -isolated tenderness of patella (only patella) -inability to flex to 90*. -inability to bear weight both immediately and in the ED (4 steps) conditions under mobility deficits. knee OA Patellofemoral pain syndrome (often called anterior knee pain or runner's knee) is the medical term for pain felt under and around your kneecap, where your patella (kneecap) articulates with your thigh bone (femur). This joint is known as your patellofemoral joint (see Figures 1 and 2). Patellofemoral pain syndrome is one of the most common. Genumedi® PT is a brace to influence the glide direction of the kneecap (patella). The integrated silicone pads in the knee support relieve pain and lead to a reduction of swelling (such as oedema or haematomas). The complex pads design positively influences correct patellar guidance by specifically addressing individual muscles

Hypermobile Ehlers-Danlos syndrome (hEDS) is the most common type of EDS affecting around one in 5,000 to one in 20,000 individuals worldwide. It is characterized by symptoms such as soft, smooth, and fragile skin, hypermobile joints, frequent joint dislocations, scoliosis (abnormal curvature of the spine), and osteoarthritis (inflammation of the bones) A person with hypermobility may have problems with floppy heart valves, which cause heart murmurs. Heart palpitations and noticeable extra beats can also be signs. Lung infections - I have always struggled with lung infections but since the age of 38 I have had three serious bouts of pneumonia, which led to a chronic lung condition

Hypermobile Patella Injuries, Fractures and Burns

The purpose of this study was to selectively challenge the vastus medialis oblique muscle in comparison with the vastus lateralis, the vastus intermedius, and the vastus medialis longus muscles by performing nine sets of strengthening exercises Joint hypermobility is one of the hallmarks of Ehlers-Danlos syndrome (EDS), an inherited connective tissue disorder. Knees Patellofemoral pain and patellar instability (subluxation/ dislocation) Strengthening Exercises Patients who have joint hypermobility inherently hav Hypermobile joints, or hypermobility, are joints that are too loose and move excessively. This condition makes your joints less stable. If you're hypermobile, your ligaments are too long/loose (or became overstretched) and your muscles have to take over the job of stabilizing your joints. Sometimes people refer to this as double-jointed Injury Prevention: Patella Dislocation. Knee injuries of all severity are rather common in the sports industry. One that you don't hear quite as often is a patella (kneecap) dislocation. However, for those of us who are LA natives, the name Andrew Bynum may come to mind when you hear patella dislocation. In January of the 2008 season, Bynum.

EDS hypermobility & patellar tendon realignment - Ehlers

Specific exercises and education can be given to prevent injury. In some cases, people may be steered away from particular sports and towards safer activities. Individuals with marked joint hypermobility, JHS, EDS, or Marfan syndrome (Chapter 1) should be screened for cardiorespiratory abnormality before undertaking strenuous physical activity. Chondromalacia Patellae Definition Chondromalacia patellae refers to the progressive erosion of the articular cartilage of the knee joint, that is the cartilage underlying the kneecap (patella) that articulates with the knee joint. Description Chondromalacia patellae (CMP), also known as patello-femoral pain syndrome or patello-femoral stress syndrome. People with hypermobility spectrum disorder (HSD) are in great risk of experiencing shoulder symptoms, but evidence for treatment is sparse. Therefore, the objective was to evaluate the feasibility of 16-week shoulder strengthening programme for improving shoulder strength and function in people with HSD and shoulder symptoms for more than 3 months to inform a future randomised controlled. Chondromalacia patellae (CMP), also known as patello-femoral pain syndrome or patello-femoral stress syndrome, is a syndrome that causes pain/discomfort at the front of the knee. It is associated with irritation or wear on the underside of the kneecap, or patella

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