patella maltracking
 

Anyone familiar with this? Today was my lucky day and i happen to get in contact with a sports doctor on the internet. I just sent her an e-mail and asked about patella maltracking. How can i tell if my patella was out of its normal tracking route? She told me it is possible to tell that by looking into MRI, tangential projection of the patella to be more specific. Luckily, i had that from last year. Sent it to her and she told me my patella was shifted laterally and also tilted! Now she told me to do an exercise to fix it back to its normal position. Hopefully it will work and i can get on the saddle for longer and harder rides. If you have that kind of problem and want to add something i'd appreciate.

In 6th grade I went to an orthopedic doctor about my knee because I had dislocated in during gym class. I actually didn't know what had happened I just screamed holy hell and fell onto the floor. I feel bad for my poor gym teacher, he didn't know what the hell was going on.

Anyway, turns out, like my mother, I have luxating patellas (yes, both knees). My knee caps float - which is easily noticed because of how much higher they stick out from my knees than a normal person's. Usually during an activity like running, or twisting, or sometimes just placing my foot wrong and making the muscles twist just so...my knee cap slides to the outside of my leg, giving my leg a nice V shape, and down I go. It happens at the most absolute random times I can never expect it. I've done it slipping on ice, walking, standing and turning wrong. It mostly happens with my right knee - has been doing it since I was in elementary school, and still does it now at 32. My left knee was a little more resilient and has only gone out twice. But both of those have been really, really, really bad.

The first time my left knee went out it was a double. We were walking home one night and my right knee went out - I'm guessing from stepping wrong on a cracked sidewalk, I dunno, -and instinctively I shifted my weight to my left leg as my right leg flailed out. Well, then as I shifted weight my left knee went out and down I went to the ground. I pushed my right knee back in, but since it was new for my left, I couldn't get it to slide back. It was out a good 30 seconds (a goddamn eternity) and all my friends could do was stand over me watching in awe and pain and "tell us what to do Dan!" I was about 10 seconds away from having them call an ambulance when it slid back into place. They had to help me hobble home. The left knee has only gone out one other time, it was bad, but not that bad. It still gives me chills just thinking about it. Ugh.

I went back to the orthopedic doctor after the double knee incident, and they gave me a lot more info than when I was younger. He said the ligaments that go over the patella and attach to the bones on top/bottom of the knee, were not straight. they were off to the side, which was why my kneecaps floated/tended toward the outside of my knees. And why they were so prone to be pulled out. I could have surgery to move the ligament attachment points, but would probably need it more than once, so waiting until i was older and it got to be a problem for my mobility was a better idea.

He also said that as I was sitting there on the exam table, just sitting normally like you would in a chair, with my legs hanging over the side, that my knees were technically dislocated. He said he was surprised I had adapted to walk as I was growing up since the knees have obviously been screwy since. My mom has a similar issue, but mine is much worse.

When people with regular knees straighten their leg, the kneecap basically stays still and maybe sinks into the socket a little. When I straight my leg my kneecap slides to the outside, but is also mobile and I can push it side to side.

I'll take some pics maybe. I always impress/gross out people when I show them :lol:

Specifically what exercise, out of curiosity?

I was told to do exercises that strengthen my interior thigh muscles, so help counteract the tendency for my muscles/ligaments to pull my kneecaps to the outside of my leg. It's extremely hard to try to just use one side of your thigh muscles. I gave up about 20 years ago.

Maybe that question was for me. I have been told to sit on a couch while my legs are straighten. Put a pillow under my heels and press down with my knees for 5 secs. 200 times a day for 3 weeks. Another orthopedist had told me to do this with the pillow under my knees. She told me this is going to make the matter worse. I think what she is trying to achieve here is activating the VMO without activating VML. When the pillow is under my knee and press down with my knees, i can see the muscles contracting on both side. Since my kneecap is shifted outside i have to strengthen inner muscles.

How can you even ride with such an extreme condition? Your kneecaps should be brushing aside way too heavier than me. You know it causes inflammation and it is killing you when it happens. I feel like a disabled person when it happens to me and tell myself i should stop cycling for the good. Do you wear knee braces to keep them in their groove?

Well, first I've like to know what you mean by it's killing me...
Secondly, no doctor has told me I couldn't do anything physical. It's never happened while cycling *knocks on wood* and I'm not sure it would because you never fully extend your leg while pedaling. And pedaling is a consistent, fluid motion - not sudden or jerky or apt to apply weird pressure randomly. I don't wear braces, it most likely wouldn't help anyway.

So your patella is in its normal track during your normal activities. When it goes wrong it totally goes wrong. Mine is not like that. I think it is pushed outside by a small margin and it always gets rubbed to the femur during its activity which causes inflammation afterwards. I can't describe this phase very well. It is not like a headache or something. There is no sharp pain but it is kind of directly affecting your brain chemistry and puts you into a depressive mood. You don't have it so you can't feel it.

no, not entirely. like i said, it floats above the normal groove, and the groove that it floats in is curves up and to the outside of my knee

Here's what I know about patella mal-tracking:
http://www.bikeforums.net/showthread...1#post16081392

I haven't heard about pushing down with the knee before. When I do what I think the OP is describing, neither my VMO nor my VML contracts noticeably.

good for you! glad it hasn't sidelined you, especially at your age. :thumb:

it sounds funny, but, my body has forgotten how to run. i haven't done it in so long because my knees would give out randomly, so i never ran (also not being an active sports guy or anything i never had a need to run). now when i try to run i look like a damn fool, half because i'm afraid to get into a full stride and extend my knee toward straight and make them fly out. i guess its half physical, half psychological

It is also weird for me because this is something against your joint trajectory. You are trying to give a curve to your legs in an unusal way. Anyway, my doctor said it is not about those muscles. She said that i have "functional hyperextension loss" and have to gain it back. I will look into this term now and try to have a sense why i have to do this weird exercise everyday.

Yes. Sounds like isometric exercises for the VMO. IMO, it doesn't much matter where you put the pillow. It's just there to assist you in isolating the VMO rather than complicating things by flexing the hip. As you point out, you can feel the VMO with your fingers and use this to help get the feel of contracting it. IMO 200 times a day is only part of the story. I think you need to tense it hard and repeatedly to the point of fatigue to build strength, as you would in any other strength building exercise. Also, I think pedaling with force more on the balls of your feet than toward the outer edge of the foot is very helpful.

Disclaimer: I'm not a doc, therapist, or anything else....

There are also some taping techniques that can help. Use of kinesiotape is great, as it it flexible and still allows the patella to move, but at the same time restricts it some. Any competent PT can help with this. Quads sets are helpful, but not really going to get a lot of strength by doing isometric exercise unless you are really weak. Might help with the sequencing of the muscle contraction though. Short arc quad contraction can help isolate vmo. Typical would be to use a coffee can, or rolled up pillow/towel to the approximate size of the coffee can. Able to add ankle weights and build strength this way.

My right patella was out of line, and it hurt like crazy but only at a certain point of motion. Unfortunately, that point of motion came into play in almost every sport I play. It took a long time (and a lot of limping about) before I figured out that it was a mal-track.

It was my chiropractor that hit it with his activator a couple of times and fixed it.

It came back out of track about a week later. So I started manipulating it with my hands until it popped back into place. I haven't had a problem with it since then.

I'm not kidding.
Now I play all of my sports at 100%. . . whatever 100% might be for my age.

I have hyperextension loss according to my doctor which i think is causing patella shifting. She didn't explain it in detail but according to her my knee doesn't get completely straight (they were looking straight to me). Now i have to make those exercises every day to be able to reach full extension. Weird thing is my knees also don't have full flexion. I can't sit on my knees in a packed up position. They are kind of locking after a certain degree.