Correcting lateral movement of patella

[leonidas33]

Been having really bad knee pain for a llloonnnggg time now... especially after playing basketball and when doing squats and leg extensions. I had them x-ray'd and they look ok.. PT told me i have a lateral movement problem with the patella when flexing. The patella moves outwards when flexing or extending knee and this is grinding against the femur. What exercises are good to correct this? What about stance and toe pointing when doing leg presses or squats? Point them in? Unfortunately PTherapist sent me home with a peice of tape on my knee thinking it would hold my patella in, even when i bent and flexed my knee. I havn't been back.

 

[ireekofawesomeness]

You ever try wrapping your knee??

 

[leonidas33]

i havn't... whats the proper way to do that?

 

[leonidas33]

i found this and it looks like it would be great for bball and even weights... would this be better than wrapping?

http://www.jointhealing.net/donjknebrac.html

 

[dopename]

I have the same thing!

My Dr. gave me a sheet that had some exercises and stretches on it. They have seemed to slowly help.

here is the exact handout he gave to me. And the name of the syndrome:

Patellofemoral Pain Syndrome

 

[ireekofawesomeness]

Just a regular ace wrap if you dont want to spend all that money on a fancy shmancy thing. Heres how to wrap.


1. Sit down. You cannot effectively wrap your knees while standing up.

2. Extend the first leg so it's basically straight. Relax the leg.

3. Take the first roll in one hand, and grab the loose end with the
other. Put the loose end behind your knee, just below the joint. One long
side of the wrap should be aligned with the crease in the back of your
knee, so when you bring it around you have covered the lower portion of
your knee.

4. Unroll the wrap around the lower portion of the knee, pulling it
snugly (but not tightly) enough so that it holds the loose end in place.

5. Continue unrolling the wrap around the knee, being careful to wrap
with an even snugness all the way up. You want to stretch the wrap
somewhat - NOT all the way. If you stretch it too much, there won't be
any "give" and you'll strangle your knees. Too little stretch and there
won't be enough support, and the wraps will fall off.

6. Unroll the wrap until it covers the upper part of the knee. You should
"plan" the wrapping so you start at the bottom of the knee and end at the
upper part. You don't need to go too far down on your upper calf, or too
far up on your lower thigh. But this is a matter of individual
preference. Emphasize supporting the kneecap from below and from above.
When you've unrolled all the wrap, tuck the loose end in securely
wherever you can. I wrap in one layer, from bottom to top, but you could
use two layers, bottom to top to bottom if you want to and your wraps are
long enough.

7. Bend your knee a bit. Then stand up and try squatting in place. Your
knee should bend reasonably easily, without restriction. If it feels like
nothing's on, then the wrap is too loose. Rewrap. If you feel the blood
getting cut off to your lower leg, or if you cannot comfortably bend your
knee more than 90 degrees, the wrap is too tight. Rewrap. Again, when
gauging how much to stretch the wrap, pull it to maximum stretch, then
shoot for somewhere halfway between that point and unstretched.

8. Repeat with the other leg, then retest again for proper tension.

9. When you're done, re-roll the wraps so they'll be ready for the next
time. Periodically, bring them home and throw them in the wash. They get
grungy fast but gradually, and after washing them you'll be surprised how
dirty they were.

 

[leonidas33]

Just a regular ace wrap if you dont want to spend all that money on a fancy shmancy thing. Heres how to wrap.


1. Sit down. You cannot effectively wrap your knees while standing up.

2. Extend the first leg so it's basically straight. Relax the leg.

3. Take the first roll in one hand, and grab the loose end with the
other. Put the loose end behind your knee, just below the joint. One long
side of the wrap should be aligned with the crease in the back of your
knee, so when you bring it around you have covered the lower portion of
your knee.

4. Unroll the wrap around the lower portion of the knee, pulling it
snugly (but not tightly) enough so that it holds the loose end in place.

5. Continue unrolling the wrap around the knee, being careful to wrap
with an even snugness all the way up. You want to stretch the wrap
somewhat - NOT all the way. If you stretch it too much, there won't be
any "give" and you'll strangle your knees. Too little stretch and there
won't be enough support, and the wraps will fall off.

6. Unroll the wrap until it covers the upper part of the knee. You should
"plan" the wrapping so you start at the bottom of the knee and end at the
upper part. You don't need to go too far down on your upper calf, or too
far up on your lower thigh. But this is a matter of individual
preference. Emphasize supporting the kneecap from below and from above.
When you've unrolled all the wrap, tuck the loose end in securely
wherever you can. I wrap in one layer, from bottom to top, but you could
use two layers, bottom to top to bottom if you want to and your wraps are
long enough.

7. Bend your knee a bit. Then stand up and try squatting in place. Your
knee should bend reasonably easily, without restriction. If it feels like
nothing's on, then the wrap is too loose. Rewrap. If you feel the blood
getting cut off to your lower leg, or if you cannot comfortably bend your
knee more than 90 degrees, the wrap is too tight. Rewrap. Again, when
gauging how much to stretch the wrap, pull it to maximum stretch, then
shoot for somewhere halfway between that point and unstretched.

8. Repeat with the other leg, then retest again for proper tension.

9. When you're done, re-roll the wraps so they'll be ready for the next
time. Periodically, bring them home and throw them in the wash. They get
grungy fast but gradually, and after washing them you'll be surprised how
dirty they were.

appreciate the good detail.. do you think wrapping would be better than the knee brace i pointed out earlier???

 

[ireekofawesomeness]

Try the ace first. much cheaper than buying a whole brace. Go to CVS or any super market

 

[Gordz24]

Yeah, sounds like your definetly having some patellar tracking issues. Do some research on a procedure called a Lateral Release. There is a ligament complex on the sides of the knee that hold the patella in place, or "on track". I think there are some non surgical ways of retracking the patella. Certain muscles of the quads can be targeted and strengthened. Just out of curiosity, did they apply 3 different pieces of tape, or just one. Anyways, look up patella tracking disorder and lateral release surgery. Retinaculum (sp) is the exact terminology for the ligaments. I'm a human Biology major so I know how some stuff functions. Hopefully this points you in the right direction either finding the problem or eliminating a possibility.

And if it's a patellar tracking disorder, I don't think the ace bandage would help tremendously. If you had a snug ace around the knee and patella, and the knee cap tracks out due to certain movements or lifting, the ace bandage IMO would add to the discomfort and literally help press the knee cap laterally.

Let us know what you find out.

 

[coolcolj]

You have jumpers knee - fix it!

a bit too complicated to explain though, but read some articles
http://www.t-nation.com/readArticle.do?id=1127149

also could be strained/torn meniscus issues, if then stop squatting ASAP. And definitely no leg extensions ever! takes a good few weeks to recover

Do ankle, and hip mobility work. Foam roll the crap out of your IT band and hips. Strenthen your hamstrings and posterior chain, stretch the crap out of your qauds, rectus femoris and hip flexors.

 

[leonidas33]

You have jumpers knee - fix it!

a bit too complicated to explain though, but read some articles
http://www.t-nation.com/readArticle.do?id=1127149

also could be strained/torn meniscus issues, if then stop squatting ASAP. And definitely no leg extensions ever! takes a good few weeks to recover

Do ankle, and hip mobility work. Foam roll the crap out of your IT band and hips. Strenthen your hamstrings and posterior chain, stretch the crap out of your qauds, rectus femoris and hip flexors.

great information here... going to go read through all of it!!! thx

 

[leonidas33]

Yeah, sounds like your definetly having some patellar tracking issues. Do some research on a procedure called a Lateral Release. There is a ligament complex on the sides of the knee that hold the patella in place, or "on track". I think there are some non surgical ways of retracking the patella. Certain muscles of the quads can be targeted and strengthened. Just out of curiosity, did they apply 3 different pieces of tape, or just one. Anyways, look up patella tracking disorder and lateral release surgery. Retinaculum (sp) is the exact terminology for the ligaments. I'm a human Biology major so I know how some stuff functions. Hopefully this points you in the right direction either finding the problem or eliminating a possibility.

And if it's a patellar tracking disorder, I don't think the ace bandage would help tremendously. If you had a snug ace around the knee and patella, and the knee cap tracks out due to certain movements or lifting, the ace bandage IMO would add to the discomfort and literally help press the knee cap laterally.

Let us know what you find out.

good info.. thx! this is why i went ahead and ordered this brace...

http://www.jointhealing.net/donjknebrac.html

it has the built in J bar pad which acts as a speed bump to the lateral tracking of the patella... will see how it works when i get it.

 

[coolcolj]

I would not suggest bracing it, it will make things in the long term

you need rest and rehab

also read up some more here
http://www.ericcressey.com/articles.html

http://www.michaelboyle.biz/joomla/dmdocuments/anterior_knee_pain-9_2006.pdf

 

[coolcolj]

also check if your don't have a stuffed up meniscus. If you do this changes everything!

middle of this topic - seee the youtube video
http://www.t-nation.com/tmagnum/readTopic.do?id=1937847

 

[Gordz24]

I on the otherhand, would suggest bracing it for the time being. Also for the time being, don't do any lunges if that is part of your routine. Also just for grins, go ahead and do a few lunges. Let me know if there is any discomfor towards the end of the lunge (where your knee goes IN FRONT of your foot). I dont think the first part of the lunge will hurt, but the 2nd part might. Also, find some excersizes that target the vastus medialis. (vastus medialis is the medial quad muscle) I have a feeling that might help in securing the patella more medially. Also, u might wanna take either some aleeve or ibuprofen to help keep inflammation down while doing this. Don't exceed 800mg ever 4-6 hours. I would stay in the 400-600 mg range.

 

[coolcolj]

http://www.t-nation.com/article/most_recent/20_things_im_thinking_about

I first started thinking about the role of the psoas after viewing Michael Boyle's "Functional Strength Coach" DVD series. Shirley Sahrmann also states in her Diagnosis and Treatment of Movement Impairment Syndromes that a weak or inhibited psoas can lead to issues with the tensor fascia latae (TFL).

If your primary hip flexor can't do its job (i.e. psoas), then others (like the TFL) are forced to take over. It's very similar to how an athlete can strain their hamstrings or adductors when their glutes aren't firing correctly.

So what does this have to do with anything? Anterior knee pain is a huge cause of concern. I frequently work with people who have soft-tissue problems in their TFL/IT band and their rectus femoris. Want to know what they typically have in common? Their psoas is slacking on the job!

Here's how it looks:

Weak psoas -> overactive TFL -> excessive tension on the IT band -> lateral knee pain

Or...

Weak psoas -> overactive rectus femoris -> excessive tension on the quad tendon/patellar ligament -> anterior knee pain