Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better

Captain Scott, pilot, athlete, all around good reader, asked about knee pain when the kneecap (patella) "slides to the outside due to tightness in the tendons and muscles on the outside of the knee." His physician recommended surgery to cut the tight area. Is this needed?

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."

1. 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.


2. 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.


3. 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.


4. 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
  

Related Drug Pain Fitness Fixer:

• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
• FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others

Random Unrelated Fitness Fixer:

• Rocky Movie Computer Fight Simulation

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.

Labels: fix pain, forensic, knee, surgery

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Body Farm Not Just For Halloween

The Anthropological Research Facility in Tennessee studies decomposition of human corpses. Their informal name is The Body Farm. The bodies are real and donated to forensic science by willing donors, or are bodies unclaimed at a medical examiner's office.

At a body farm, dead human bodies are left lying in various environments, such as a wooded area, a pool of water, in a garbage bag, a roll of carpet, the trunk of a car, or tied to a tree. They may be buried shallowly or deeply, entombed or left exposed. The purpose is to study key forensic identifiers as time of death, insect colonization changes with environment and temperature, interpretation of insect evidence, and various changes related to whether a body has been moved from one location to another. Information gained helps the science and technology of forensics, forensic anthropology, entomology (study of insects), law enforcement, and others.

Some of the research goes toward determining causes and time of death. Previous assumptions for determining time of death from cooling or insect colonization have been found to be in error and in need of restudy. Another line of study is to develop identification technology to "sniff" and find a concealed body, creating an electronic version of a cadaver dog. It has been found that different conditions and geographic locations create different decomposition chemicals. A dog or machine calibrated to one area may be ineffective in another

There are three facilities in the United States (so far) that study the science of changes in a body after death. The University of Tennessee facility is the first body farm. Another facility is part of the Forensic Anthropology Center at Texas State (F.A.C.T.S.) A third opened through the Western Carolina University Forensic Anthropology program in 2006.

More Fitness Forensics:

• Time of Death From Body Temperature?
• Forensic Anthropology and Bone Density
• Forensic Science
• Forensic myths, body and fitness myths, and how to change exercises that were never healthy: Health & Fitness In Plain English English THIRD edition - How to be Healthy, Happy, and Fit For The Rest of Your Life.

Fitness Fixer Articles for Halloween:

• Happy Birthday Happy Halloween
• Exercise Common Sense Discipline - Turn Down Halloween Junk Food
• Is Your Health Food Unhealthful
• Mischief is Not Good Exercise - Halloween Ahimsa

Labels: forensic, holiday

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Time of Death From Body Temperature?

Television crime dramas often include a scene where time of death is predicted based on body temperature and cooling rates. Is this an accurate method?

After death, metabolic processes that make heat in the body stop. The body begins cooling. Cooling and cooling rates were first recorded in 1710, when English physician John Davey first used the new invention of the thermometer in a human body at autopsy. Davey’s experiments took place in the high heat of Malta, rendering measurements only good for that environment. Later pathologists who followed Davey’s published descriptions did not place the thermometer inside the body, but in the armpit. Publications of their inaccurate information of cooling became widely popularized and passed from school to school.

Cooling does not follow predictable time intervals as once thought. Cooling is often too imprecise to estimate time since death. It turns out that the widely held dogma that body temperature drops at a precise and steady rate of 1.6 degrees an hour (later rounded to 1.5 for ease of calculation) was never the case.

Inaccuracies and things that were never true have been found to be printed and reprinted in medical books, repeated by instructors who heard it from their teachers. Be careful of medical "facts" learned in school untested.

More forensics posts on Fitness Fixer:

• Forensic Anthropology and Bone Density
• Forensic Science

For all movie and TV health posts on Fitness Fixer so far:

• Click the label "movie/media fitness" under this post.

For more on "the chill of death" (algor mortis), more forensic myths, more body and fitness myths, how to change unhealthy exercises that were never healthy, and how to have healthy activity as a natural part of your day:

• Health & Fitness In Plain English English THIRD edition - How to be Healthy, Happy, and Fit For The Rest of Your Life.

Labels: forensic, movie/media fitness, myths

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Forensic Anthropology and Bone Density

A few weeks ago, I attended a lecture on forensic anthropology. In general, this is the study of things you can tell from human bones in a crime setting. How old was the person? Were they male or female? How big were they? What was their probable race or ancestry?

Why was I there when my work is with the living? Two main reasons. I am the science officer for the Vidocq Society, an international forensic society. I might evaluate data, for example in an aviation disaster, whether someone might have been conscious at each point when undergoing G-forces or different temperatures and amounts of oxygen after a depressurization at various altitudes. In a scuba death, I might advise on physical changes that occur with different situations. The second reason was to learn more about bones. Bones are remarkable. Your bones know a lot about you. What was your health like? Were you active? What kind of activity did you do? When I was small, I read about an archaeological dig in ancient Rome. The bones of a girl were recovered. The account stated they could tell she carried loads too heavy for her, and was therefore (in conjunction with other evidence) probably a servant or slave. I was riveted. How could they know that? I spent years after that learning more about telling how someone moved from looking at their bones.

Throughout your entire life, when you exercise you stimulate growth of new bone cells. The physical pull of muscles thickens your bones where the muscles attach. Using your arm muscles thickens arm bones. Using your legs strengthens leg bones, and so on. This is a main mechanism of how exercise prevents osteoporosis. Without exercise, you don't stimulate enough new cells to counter the normal loss as old ones break down. Your bones thin no matter how much calcium you eat. The post Exercise is More Important Than Calcium Supplements for Bones tells more about this. Bone demineralization is rapid and serious in astronauts in microgravity (Collapsing Astronaut Gives Healthy Reminder).

How you use your muscles causes them to pull differently, giving evidence about the kind of habitual motion. More interesting is that when you are active, your bones grow and shape themselves to facilitate your motion. An example of interest to readers following the posts on squatting is that people who habitually sit for normal daily life in full squat grow "squatting facets" on their lower leg bones. These are small areas on the bone that quickly grow to make squatting more comfortable. At one point, it was a debate in anthropology that squatting facets were a marker of someone of Asian ancestry, until it was found that others who squat also grow them, and that squatting facets disappear when the person adopts a Western sitting habit of chairs and no longer squats. Babies of all races can have them.

Someone who habitually slouches can change the shape of their bones, eventually deforming them. This can occur in the spine, knees, hips, ankles, shoulders, feet, toes - everywhere you pressure your bones. Changing positioning habits to healthier ones can, in many cases, reshape the bones back to healthier shape. Think of braces on your teeth. It's human bonsai. In cases of extreme dystrophies of the muscles, someone who sits without function of their trunk muscles to hold the spine upright, can eventually deform their spine until their ribs sit on their hip bones. How are you sitting right now? The recent post What Does Stretching Do? explained a bit of why stretching isn't reducing injuries. People are stretching, then exercising and going about daily life in bent over positions that rub and grind the joints and soft tissue.

You literally shape your own health. Use the posts throughout this Fitness Fixer blog to do healthy exercise in healthful positioning so that your bones will only tell good tales about you.

Labels: achilles stretch, aerospace, ankle, arm, feet, forensic, injury, leg stretch, osteoporosis, posture, scuba, sitting, squat, toes

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Fixing Fitness Myths

"The public has an insatiable curiosity to know everything, except which is worth knowing." - Oscar Wild

April 1 seems to be a day to notice, more than usual, if things in the news are not facts but April Fool. On other days, urban legends and other stories are still popular, sometimes more popular than what is really going on.

The observation that the Earth is flat seemed obviously true at one time until we had more information. It used to be a taught as a medical fact that the cause of epilepsy was masturbation. When I was in school, one of my medical books stated that you don't need to eat calcium since you can "get all you need from your bones." It is true that you pull calcium from your bones when you don't eat enough, although with unhealthy results.

The post Forensic Science told of two crime-science myths, often still taught in forensic books and popularized in television shows, which were never true. Following are more posts hoping to replace myth with information, so that you can get stronger and do more, without the injuries or restrictions in activity that are part of many fitness or injury rehab practices.

Feet and Ankles

Myth - You need tight shoes for support. Fact - tight shoes can deform toes and prevent healthy muscle use:
Are Your Shoes Too Tight?
and Healthy Toe Stretches.

Myth - All ankle stretches prevent sprains. Fact - Some may enhance predisposition to ankle sprains:
Unhealthy Yoga Ankles.

Myth - Following an ankle sprain, bracing must be continuous since no exercise can restore the area. Here is another way -
How To Treat Ankle Sprains and Prevent Them
and
No More Ankle Sprains Part II.

Dispelling Myths of Orthotics Use:

Myth - Only orthotics can place your arches in neutral position. Fact - your own muscles can often do the same:
Arch Support Is Not From Shoes
and
Which Shoes Help Exercise, Fall Prevention, and Ankles?

Dispelling Aging Myths - That respiratory function only declines with age:

Do Breathing Exercises Work?

Dispelling Aging Myths - That you only get weaker with aging:

Getting Stronger is for Everyone
What I Learned at the Aging Conference
Better Balance by Christmas
Conference on Aging Dec 2, 2006 in Midtown New York.

Dispelling Nutrition for Exercise Myths:

That weight gain with aging is primarily lower metabolism: Metabolism - How to Lose Weight and Save Money

or that Healthy eating is difficult or expensive:
What Medical Students Told Me About Nutrition.

Myth that you must eat much protein to get muscles:
Get Muscles for Christmas

Myth that acid prevention drugs are harmless:
Stomach Acid Drugs May Increase Osteoporosis and Hip Fractures

Myth that food marked "Health Food" means it has to be healthy:
Is Your Health Food Unhealthy
and Exercise Common Sense Discipline - Turn Down Halloween Junk Food

and the myth that it's healthy for children to eat junk food:
A Little Good Exercise, a Lot of Bad Food - Overweight Still No Mystery.

Myths that only gyms and weights can improve your strength:

How to get natural exercise is in Rocky IV and Healthier Exercise,
Getting Stronger Without a Gym
Exercising With A Friend - Partner Leg Press
Don't Confuse Exercise With Real Fitness
Healthy Toe Stretches
Quick and Fun Arm and Body Strengthener
and Quick and Easy Strength and Balance Exercise.

More to come for smart, fun, healthier ways to get exercise.

Labels: aging, ankle, arches, arm, balance, breathing, feet, fix pain, forensic, holiday, leg stretch, myths, nutrition, osteoporosis, partner exercise, shoes, sprain, strength, toes, yoga

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Forensic Science

Last weekend we visited the Siriraj Forensic Science museum in Bangkok (pronounced Silly-lot). Forensics is the science of crime. Why are we here?

I am the science officer for the Vidocq Society (pronounced Vee-doc), an international forensic think-tank for solving cold case murders. The Vidocq Society is named after the eighteenth century French detective Eugène François Vidocq, who is considered the founder of modern criminology. Vidocq was a former fugitive and police informant, and expert in surveillance and disguise. In his career-reversal, working in crime prevention, Vidocq was the first to make plaster casts of foot and shoe impressions, and introduced record-keeping and the study of ballistics into police work.

The Vidocq Society allows 82 members by invitation only. As the science officer for the Vidocq Society, my job is to make sense of some of the physiology and facts about the body used (and often not used) in forensic investigations. Real forensics is not like television forensics and often techniques shown on television are exaggerated, applied incorrectly, interpreted badly, or just false. Part of my job is to learn enough to help make sure we don’t do the same in real life.

It is important to check things, even if accepted as fact. For example it is not true that you can tell when someone died from their body temperature or stiffness. You can’t just check the books. Many of the most held old fallacies, were things we learned in school and from forensic books. Health and fitness is like that too. We just need to look a little further to learn how things really work.

Photo by 13bobby

Labels: forensic, injury

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