[Closed] Patella tracking problems

Me! And it’s ok now, so don’t give up hope.

I’m not sure exactly what’s solved it, as there are quite a few factors - the NHS physios certainly didn’t get anywhere. But a few years back I started going to the gym doing powerlifting based training and also started seeing a very good sports chiro.

He seems to have a far deeper understanding of what’s going on (not flowery hippy stuff, he’s also got a physics degree and he talks about things like an expert physio) and has lots of techniques for treating problems. Plus he worked as a PT whilst training as a chiro and is into giving suitable exercises, and is useful for bouncing training ideas off.

Mine was caused by a badly broken ankle which was misaligned when pinned back together. I had to do a lot of mobility work when I started lifting, it took me about a year to get my squat to below parallel and it’s still a technical challenge.

Anyone suggested developing the vastus mediallis? Stretching the ITB and building the VM was what I was told. There are different opinions on how to strengthen or preferentially activate the VM. Extensions with outward rotation of the foot, deep squats, that kind of thing worked for me.

Hi Vacant, are you saying that your kneecap is actually subluxing ("jumping back into alignment").
I've had major issues with kneecaps and surgery was the only route in the end, you may have to see a knee consultant and get some mri's done and an xray to see if you have an underlying bony problem. I spent hundreds, probably thousands on physio, and it turned out that was all wasted money as the underlying condition I had was a bony one not a muscle imbalance.

I don't think its subluxing, in a bent position the patella feels ok but without imaging it's hard to say.
But when I extend my knee there's an audible crack as if its off alignment and catching the edge of the groove.
I have read about vmo strengthening and am trying to do that but imho my vmo isn't particularly weak.
It isn't painful when it happens but over time I don't know what damage I'm doing.

If you're in a position to do so I'd highly recommend seeing a knee orthopaedic consultant privately. That couple of hundred quid will give you a diagnosis and take away the stress of not knowing the issue.

If surgery is then needed having a letter from the consultant will massively accelerate the nhs process.

Do you have any idea what caused this? Any external factors (injury, job, hobbies, etc)?

I broke my ankle at the end of 2010 and it took quite a few years before that misalignment started to cause knee problems. I still have to be careful wearing anything tight over the knee.

Hi Vacant, that sounds like could be a minor subluxation at the end of the extension - not necessarily doing you any damage but you do need to see a knee specialist.
If as you say your VMO is ok then it could be an underlying bony issue. I went through the same regressive state as you describe - I'd had a couple of patella dislocations when young, then gave up all field sports, but it didn't affect my walking or cycling until around five years ago. I'd booked a mountain biking holiday to Portugal but had to fly back after 2 days due to the knee flaring up; four years later I was having trouble walking and the pain the next day would keep me in bed.
As Enigmas says, it could be the best £200 you've ever spent - go to see one with a focus on patellafemoral issues. I can DM you the details of my consultant if you are interested - he's one of the best for this, based in the Midlands.
It could be something else entirely like something to do with your hips or ankles but the minor subluxation (if that is what it is) could suggest something like trochlear dysplasia/patella alta.

Mine was diagnosed as patella tracking. Mostly pain when bending at knee with your arse back (squat?) ie lifting arse out of saddle whilst standing on peddles type position. Walking up / down stairs, climbing ladders, stepping down off things, hill walking on the scramble bits where you're lifting your bodyweight (I often compensate by deliberately leading with the other leg).

I did a course of exercise to the muscles around the knee to pull the patella back into alignment and once I actually took it seriously it was fixed in about a month of doing every day and upping the reps etc. now I've stopped the exercise I've gone back to having a slight issue on ladders and scrambly sections on hill walks and my one legged squat isn't as low as on the other leg, but I can peddle a bike again and raise my bum out of the saddle in attack position.

Having said all that, your issue reads a bit more serious or extreme than just a slight misalignment causing a bit of inflammation to the fatty tissue, as others have alluded to.

I wish I knew the cause!
I have had problems with my right knee for years but never too bad to prevent cycling, but then overnight my left knee started doing the same thing but to a worse extent. Before that I had not had a single problem with it.
At the time I was doing some strength and conditioning work to try and help solve my right knee problems. I have wondered if this contributed, as I was told to do wide legged squats with toes pointed out and I sometimes wonder whether strengthening quads in a position that isn't a normal movement pattern would have caused issues with the lateral structures. But that's just one theory.
I am trying to get a referral through GP as can't really afford to go privately at the moment but if you could recommend a specialist please do DM me.

Thanks

Hi Vacant, I've sent a DM to you.
I paid for a private consultancy of £200 but then was put on the surgeon's NHS waiting list so that's all I paid in the end.
Hope it all works out!
Squats were a major factor in my knee problems - I'd joined a crossfit gym before the above mentioned holiday and the squats made the condition a lot worse in just a matter of weeks. The gym instructors said I just needed to do more muscle strengthening when I complained of pain; in retrospect I should have stopped right there and then and seen a specialist.

I suffured with Patellar Tendonitis a few years ago - which was being exacerbated whilst snowboarding due to not tracking correctly.

I was doing a long winter trip to British Columbia so saw a local Physio who was used to treating winter sports injuries etc and she got me sorted.

Likely cause was a torn MCL in the same knee about 7 years earlier and possibly a badly sprained ankle. As is so often the case, once injured the body tries to 'protect' the injury by reducing load on the area injured and favouring the other side - this led to a number of things including underdeveloped quad muscle, tight ITB etc resulting in the patella no longer tracking but also having inflammation & scar tissue.

Recommendation was for foam-roller/lacrosse ball for tissue massage, stretching, proprioception exercises, squats (in line with *your* body's own bio-mechanics), dips, hip flexibility excercises, core strengthening exercises ...

I stuck with the program which not only allowed me to continue snowboarding (with reduced pain) but also eventually sorted the tendonitis.

Knowing the cause may only be useful if you are wishing to avoid it happening again, but irrespective of the cause my advice would be to see a good *sports* physio and stick with the recommended exercises etc ...

Have seen two sports physios. One suggested foam rolling, hip mobility. The other suggested that would be a waste of time and to strengthen vmo/medial hamstring.

Very lost in the system so I will endeavour to get to see a specialist.

I had patella tracking problems on and off for a few years. Went to a few GPs and physios and was recommended to strap the kneecap with tape (i.e. pulling it back into the centre where it's supposed to be). Bizarrely the most effective solution in my case was skiing - I had knee pain immediately prior to going on a skiing holiday and was anticipating a couple of half days on the slopes. I ended up skiing for a full six days and the pain disappeared for several months. I started getting the pains again, though much less intense, and again a weeks skiing resolved the pain and I have been pain free in the kneecap area since. It would appear that skiing strengthens the Vastus Medialis muscle on the inside just above the knee in a way that squats etc don't.

Does your patella go outwards when it’s mistracking? (Can even they mistrack inwards?)