Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
Tuesday, October 06, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Tracking problems have several names: Lateral Facet Syndrome, Chondromalacia, Anterior Patello-Femoral Pain Syndrome, Lateral Pressure Syndrome, Malalignment Syndrome, Maltracking Syndrome, Patello-femoral Degenerative Arthritis, and other scary names. It is not a disease or a syndrome or that you are doomed to arthritis, but usually a simple injury process that can be stopped.
Instead of surgery, you can stretch the tight side area and retrain the weak area, so the kneecap slides normally instead of grinding sideways in its channel. Stopping causes stops need for surgery, bracing and pain pills. The knees heal and you go back to all you want to do, using the new healthy mechanics.
What can you do when pain continues after physical retraining? Captain Scott wrote that he had been to physical therapy for his knees "for a few months without much success." He had previously endured ongoing treatments for back pain, then discovered Fitness Fixer methods and resolved the pain. He came back to see if he could do the same for his knees.
Kneecap tracking should begin normalizing within days of stopping causes - far sooner than "a few months." If not, one obvious thing to check is if you have the right re-tracking stretches, exercises, and functional retraining. After that, here are four common reasons when PT does not "work."
- Tracking Exercises That Don't Fix Tracking. A common PT scenario is doing 10 (or however many) repetitions of straightening the knee against resistance of a stretchy band, called "terminal extensions," "setting" exercises such as squeezing things between the knees, stretching the lateral (side structures), and small leg lifts with ankle weights to strengthen inner thigh muscles (VMO)s. Without retraining gait and knee use during real life movement, the person often gets up from the PT session and walks away and goes back to their activities with the same poor tracking. PT needs to look at and fix specific use during real life activity - do you turn your knee inward or your feet outward, do you let your foot flatten, do you let your upper leg bone rotate. Also, weight or resistance used is often far less than what the knee encounters when the person stands up and uses their knees to walk away from their exercise session. Tracking angles should monitored during rehab. Not just during standing or during leg lifts, but during the patient's customary activities. If they are not changing, and they are the confirmed cause, then you may not be changing tracking.
- Are You Sure It's a Tracking Problem. Knees can hurt for other reasons. You can go for the best re-tracking programs, but if your knee does not have an actual tracking problem, it is no mystery when tracking exercises do not help. You have not spent time fixing the cause. Make sure that tracking is the reason before treating for tracking. Tracking can be identified with specific patellar x-rays or other scans that can clearly include position during several points of motion. Tracking also can be visualized - look at kneecap path during quadriceps use during several kinds of movement. The kneecap slides up and down obviously under the skin at the knee during use. There is a variable degree of normal angle at the knee. Human legs are not straight from upper to lower leg. That angle at the knee allows us to walk upright on two legs in a smooth gait. The angled knee is one of many markers that tell forensic scientists and anatomists if the leg bones they are looking at are human. Sometimes a normally tilted kneecap slide is misidentified as a tracking problem when it is a normal angle in line with the joint.
- Multiple Causes. Sometimes tracking mal-alignment is confirmed and rehab done. The patella tracks normally and stops wearing the area, but pain continues from other causes. No mystery. Check for other poor knee mechanics that cause injury. Check if your shoes are too hard. Many people paying for "good supportive shoes" get knee pain from the hard shoe. Often the pain from bad shoes is sharply outlined around the kneecap with deeper aching. Check your bending. If you have pain with knee bending (squatting), fix that. Fitness Fixer articles summarize and my books detail more.
- Medicines that Cause Pain. Whether you have tracking problems or not, common prescription medicines cause pain that does not respond to PT. Look into stopping reasons you need the medicines in the first place, and save yourself time, money and pain.
My idea of health care is a quick, straightforward assessment of causes and intelligently addressing them. That beats having someone stick a knife in your knee and charging you for it.
Related Knee Fitness Fixer:
- Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
- Hamstring to Quadriceps Ratios Not the Answer in Knee Injury
- Fast Fitness - Great Hip, Side, Leg, and I.T. Stretch
- Instantly Better Hip and Quadriceps Stretch
- Surgery for Knee Arthritis, Meniscus, Unnecessary
- What Works Better Than Knee Surgery?
- Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
- Daughter's Love Saves Parent's Knees
- Prevent Knee Pain When Rowing
- Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
- FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others
Books To Fix Knee Pain:
- Fix Your Pain Without Drugs or Surgery
- Health&Fitness in Plain English THIRD edition - How to Be Healthy, Happy, and Fit for the Rest of Your Life. Both available from www.DrBookspan.com/books.
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Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" (under trumpet) upper right.
For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" (under trumpet) upper right.
For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
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9 Comments:
At Wednesday, October 07, 2009 5:39:00 AM,
Poleminx said…
Hello, great material on your website. Do you have any advice for 'golfers elbow' - prevention and rehab?
Thank you, I use the stretches in your 'Stretching smarter' book practically every day, with great results. If only your classes were available in UK!
At Wednesday, October 07, 2009 9:09:00 AM,
Anonymous said…
What about myofascial release of the IT band? Trigger points in the TFL and vastus lateralis often contribute to patella tracking issues, no?
At Thursday, October 08, 2009 3:20:00 AM,
Anonymous said…
I don't know if you've ever studied it, but I found belly dancing fixed my kneecap tracking problems. I'd had them for a decade, but just six months into weekly belly dance lessons, they went away.
All the shimmying seems to loosen the tight bits and strengthen the weak bits in a really good way.
Do be warned, though: I haven't done belly dancing in five years now, and I still shimmy whenever I go out clubbing, because it's turned into a default.
At Monday, October 12, 2009 1:09:00 PM,
Scott said…
Thanks Dr. Bookspan for your research on this. I found this website on the subject and am currently doing the suggested exercises to correct my knee problem.
http://www.sports-injury-info.com/patella-femoral-syndrome.html
Barton Anderson has an e-book that I downloaded with exercises that improve flexibility and strength in the hip and leg areas so that the femur and Patella track more normally. I really like the exercises, except for one that has you bend over to stretch the hamstrings - knew better than to do that one because of your help.
Let me know if you would like more info about the exercises. I have seen improvement in tracking of the patella and less soreness in the knee as a result.
Thanks again for all of your help.
Scott
At Monday, October 12, 2009 8:56:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
For Poleminx, You are the third pole dancer this month contacting me about elbow pain. Must be interesting forces from twisting on the pole. I have not personally done lab studies on elbows, as for other parts, so must reserve comment. I would only be able to repeat what I have heard other say, right or wrong. Keep me posted how standard (or other) treatment helps. Maybe we can figure, along with the others, what is particular about the pole. Thank you for making smart gains with my Stretching Smarter book. Send in your successes with it. How do the forward and wrist stretches from the book feel on the sore elbow?
To Anonymous, Right, IT band stretch is part of stretching the side areas, as in the article above. Two of the related links give ways to stretch the area on your own.
To Anonymous Belly Dancer, Was tracking the confirmed event - faulty before and normalized after? Sometimes people with knee pain are told they have tracking problems whether they do or not. Random events are attributed to fixing. Glad you "loosened the tight bits and strengthened the weak bits in a really good way." Belly Dance story in What I Learned at the Aging Conference.
Capt Scott, Are these new exercises you mention different from those you were given when you thought you were going for tracking PT those months? Good thing not to cut muscles that just need some re-training. Good bending, an important part of knee rehab is for all bending. Funny, as you point out, that the new place would have you do lunges (good bending) then bend wrong as a stretch, not incorporating the lunge as a real life function. My books give knee rehab retraining as well as much for hip and leg, which go along with it, both strength, stretch, and positioning. Check your arches too. Not pronating, not letting the knee turn or rotate, and so on. For long term results, use my specific functional methods, where your real life standing, bending, moving, sitting, biking, are all beneficial to reversing sources and incorporating specific movement needed. How would belly dancing go over in the cockpit?
At Monday, October 12, 2009 9:09:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Poleminx, that should read, "forearm and wrist stretches." They should feel good along the forearm and elbow.
At Tuesday, October 13, 2009 5:25:00 AM,
Poleminx said…
Hello, thank you for replying. The forearm and wrist stretches are great, I do them daily and incorporate them into the cool downs for students at end of class. Along with the lovely shoulder, pec, upper back stretches. Not too mention the hamstring stretches which have given amazing results towards goal of doing the splits :-)
At Sunday, November 01, 2009 9:08:00 PM,
Scott said…
I'm not sure belly dancing would go well in the cockpit. Glad the other reader found success though!!
I tried the exercises from the link I recently posted and found them to cause more pain than before, so I'm going to put more focus on your suggestions for resolving my knee tracking problem. I stretch daily and am going to work on strengthening the VMO to see if that helps.
I tried to get back into my normal routine of swimming, biking and running, but found that to be too much at this point. I need to solve my tracking problem before going back to my full training routine; otherwise, I just end up sore and frustrated.
Thanks for all of your help Dr. Bookspan and for the comments of other readers. I'm glad we're all working towards a healthier lifestyle.
Scott
At Monday, November 02, 2009 1:19:00 PM,
Anonymous said…
Hello,
I have been reading the fitness fixer for quite some time.
I completely agree on what you say. For one, exercises in a rehab setting, especially for legs, are usually less resistance then your legs need to simply sit, squat, and stand right? How the thinking that a bands small resistance crosses over to functional life, or is believed so, is beyond me.
I have been squating for a few years now after reading your "free" articles and I say with confidence that my knee problems have vanished. This I believe is a simple result of being more aware of bending and keeping the wieght on the muslces and not over the knees or as you say "on the joint".
It took time as I had to slowly build up strength. I never used bands or setting or anything. I started squating and stretching. That is it.
Ironically, I have a friend whose doctor told him not to squat to save his knees! What is going on with our society? One of the funniest concepts I constantly see is "stop doing activities that use that joint". To me this is kinda like saying if you don't use it at all, you may as well not have it anyway. Like owning a stereo but never turning it on.
Thank you DR Bookspan
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