/ Patella Maltracking and Knee Pain

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improveonsilence - on 12 Feb 2013
I have this. I cannot find a decent physio to help. It clicks with every extension. It hurts when I do anything, running or cycling for 10 mins and then hurts when I sit still afterward. A dull ache.

Has anyone had this? Had an MRI and nothing clinically wrong just the maltracking. Its depressing! Thanks
Paul Hy - on 12 Feb 2013
In reply to improveonsilence: oh yes, about 6 years ago, in fact it was the physio who diagnosed it as such. a couple of sessions with the ultrasound and about 2 months of gradual exercise sorted it.
In reply to improveonsilence: I had it and a few knee extensions sorted it out - I think it's because your quads are imbalanced.

I'm sure someone will be along soon to tell me I'm wrong.
mattking_109 - on 12 Feb 2013
In reply to improveonsilence: I had knee pain last year, also patellar tracking - I know your pain.

In my case it was a muscle imbalance between the different parts of the quadriceps muscles - the medial portion (called the VMO) was weak relative to the lateral section - causing the patellar to be pulled laterally and rub against the edge of the femoral groove, in which it usually slides up and down smoothly. Also needed to strengthen my glutes.

This was relatively easy to fix: I went to the physio and after doing the following programme twice a day for a few weeks it was problem solved:

Quads stretch 30s each leg
Hamstirng/glutes stretch 30s
20x squats
20s Bridge static hold
20x lunges
20x single leg squats, each leg
10s single leg bridge static hold, each leg
20x step downs, each leg

After this got easy I added in a dumbell and started doing single legged squat jumps - definitely targeted the VMO well.

Obviously I don't know precisely what's wrong in your case, but the majority of tracking problems are due to a muscle imbalance, so you just need to find out which areas are weak and build them up.
In reply to mattking_109: Bloomin' hell - agreement!
Welsh Kate - on 12 Feb 2013
In reply to Submit to Gravity:
ditto!
Though I managed to get away with just doing the single leg squats.
Lukas V-L - on 12 Feb 2013
In reply to improveonsilence:

Ive go this at the moment and its an absolute arsehole. My physio regime is pretty similar to the above. It seems to hurt more now though than when I started which sucks. Ive had an MRI which confirmed theres no cartilage or bone damage so thats a plus. Tried Acupuncture but zero joy there either.

Good luck dude.
Tall Clare - on 12 Feb 2013
In reply to Submit to Gravity:

I had leg extensions prescribed in the gym, along with lunges and single leg squats. Took a while but worked a treat. I need to start doing all that again...
russtyg - on 13 Feb 2013
In reply to improveonsilence:

I've also had patella femoral syndrome. Completely agree with the above suggestions.

I think generally being flexible solves many issues. More stretching is good!

Good luck!
SteveRi - on 13 Feb 2013
In reply to improveonsilence:
'I have this. I cannot find a decent physio to help...'
Ask around for a different recommendation. It may well be easily fixable. Have you got any contacts with a local running club or similar?
mountain_bikerider - on 14 Feb 2013
In reply to improveonsilence: I seem to be prone to knee pain brought on by an imbalance of my ITB and muscles in my quads. My physio has recommended exercises similar to those mentioned already plus lots of stretching. The other thing she has recommended is using a foam roller to self massage my ITB to relax it. Then when I see her I go through the hideous pain of her stripping my ITB and other deep tissue massage. However I have gone from pain constantly to no pain even when running as long as I keep up the massage and stretching.
wkrzys - on 14 Feb 2013
In reply to mountain_bikerider: Same here - suffered from the same. Key was a frequent variety of knee strengthening exercises (as mentioned above).

Plenty of foam roller self massage on the ITB, and all around the knee and it was resolved in about 6 weeks. Got to keep it up for a while afterwards until the muscles strengthen and the imbalance sorts itself out!
gingerwolf - on 14 Feb 2013
In reply to improveonsilence:
VMO strengthening is normally the key - squats while squeezing a ball between your legs targets it pretty well - lots of vids on youtube if you're unsure
Also recommend ITB stretch too

If required for a short term fix if doing something sport specific, you could try taping it.
GeoffRadcliffe - on 14 Feb 2013
In reply to improveonsilence: I am surprised that nobody has mentioned the clam exercise which was recommended to me by a physio (in addition to many of the above stretches and strength exercises) for a problem with my knee. Also, she showed me some patella manipulation exercises.
trish1968 - on 14 Feb 2013
In reply to improveonsilence:
yep I've had this problem for years. I had physio and was shown how to tape it up when I did exercise which helped for a couple of years then I had a scan couldn't see anything had an xray looking up at my knee caps. I'd worn both knees to points hence the pain. Since I've had lateral knee releases which involve the cartalidge being trimmed (not cut which some gun ho surgeons recommend)it involved partial key hole part open surgery. It was about 6 week recovery for each knee. It was worth it. My knees still crunch but a lot less pain and if it gets sore again I can have them trimmed again.
Pero - on 14 Feb 2013
In reply to improveonsilence: If you're in London, try Ciaran McCoole:

http://injuryrehab.co.uk/
I'd rather be climbing - on 14 Feb 2013
In reply to improveonsilence: My muscle imbalance was caused by me beingh slightly flat footed, nd rolling in on my ankles when I walk. the exercises I did were focused around keeping my toes pointing slightly sideways whilst leg curling/squatting etc. I also had orthopaedic implants in my shoes (little gel things) that were sloped to stop me rolling in.

Another thing my physio suggested was more climbing. Do routes with big holds so you can have your instep on the holds all the time.

I still have the cracking when I crouch down, but the pain is pretty much gone.
JD84 - on 14 Feb 2013
wendys - on 21 Feb 2013
In reply to improveonsilence:

have you tried the NHS for a physio?

just had my first physio appointment today and have been given my first round of exercises. my problem has arisen from a tib and fib fracture a few years back. bad, or should i say a lack of advice on appropriate rehab at the time has apparently left me with weak glute and quad muscles and a soleus muscle a few inches shorter than the other leg which is pulling all the leg out of line.

I have to say the NHS guys i've seen this time round have spotted the problems almost immediately. been given some very basic stretches to do several times a day, every day, for what sounds like a very long period of time, but hopefully there is a light at the end of the tunnel.
ads.ukclimbing.com
lost1977 - on 21 Feb 2013
In reply to improveonsilence:

the VMO is a weak link in the quads and has a tendency to be lazy so if you do exercises for the quads make sure the VMO is firing well

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