Can PT fix genetically tight retinaculum that causes knee maltracking?

[inpaingirl]

Hi, I had knee problems for 2 years now im getting worse and worse. I tried PT and it didn't seem to do much for me, I feel like something is stuck on the outside of my left knee and the right knee just aches. Surgeon offered LR but he didn't seem to be enthusiastic about it. I cannot be in pain anymore im tired of it and frustrated with PT. My question is if I had a tight retinaculum in both of my knees and my knees are tilted how is PT going to correct the problem forever? It seems like stretching IT band helps a tad my knees are constantly sore and ache, and I hear grinding when i move my legs, i got 2 cortisone shots which only helped a tad. Im  24 years old and my doc pretty much gave up on me. To be honest I wasn't consitant with PT because its hard for me to be doing painful exercies when I am already in bad pain Anyone has PT success stories for maltracking knees?

[lululocket]

Hi there,

Maltracking can cause loads of pain, you have my sympathy. However, if your doctor can't find anything wrong with the underlying anatomy (assuming he is correct), it may be muscle imbalances which are pulling things unevenly. The fact you say that something seems tight on the outside (lateral side) is what leads me to say this, as well as the fact that ITB stretches give some relief.

I know that PT can be really difficult to stick with in a meaningful way. If it hurts, and you don't see results, it basically impossible to stick with! I wonder if maybe you need to vary what you're doing a bit. In particular, I think trigger points in your IT band may be an issue.

On stretching the IT band - what method are you using? My physio wanted me to do it like this:

However, I struggled because my muscles were so weak, and the best I could manage frequently was more like this:


This helped a little bit, but I still had plenty of pain. As it turns out, I had more serious issues with bones being poorly arranged and causing the maltracking, rather than just muscle imbalances. However, I did want to learn more about why I found it so difficult to lengthen the IT band, when its tightness was making things even worse!

I started trying some different types of stretches. The first proper relief I got from pain (whilst I was awaiting surgery to deal with my bone issues), was using a foam roller. It was really effective at loosening the IT band and getting me walking better.


I didn't really understand why this worked so much better than just stretching, until I understood about trigger points. I found that my abnormal anatomy and subsequent poor walking habits had set up chains of trigger points which caused the tight IT band and plenty of other problems. I only realised how big the problem was when I had surgery on one leg, and could witness the difference between a fixed leg, and one which still had chains of trigger points (which I could only ever get rid of temporarily because of the bone issues).

Trigger points develop in muscles as tight little points of contraction, which then leave the rest of that muscle stretched very thinly. This can cause pain in the joints which that muscle attaches to. It also makes it very difficult to strengthen that muscle, because it's pulled tight and can't contract properly. Just stretching won't get rid of trigger points - you need to massage them to get rid of the chemicals causing the localised contraction. You could have trigger points in your quads and along your IT band, which would then be tight and pulling on your kneecap. A foam roller is imprecise but nonetheless an excellent start at getting rid of them. For better understanding, and more precise work to get rid of them, this book is great.
http://books.google.co.uk/books/about/The_Trigger_Point_Therapy_Workbook.html?id=IYqqY5Ae_VoC

Just to offer you some hope - in between the two surgeries I needed to deal with my more substantial issues, I was in loads of pain from this problem. I found a great massage therapist who specialised in trigger point therapy, and within three weeks of her working on my bad leg, I was walking without pain for the first time in years. It made a phenomenal difference, although it took a bit of studying that book to understand what was going on.

Before the pain, were you doing any exercise like running? Or did you have any injuries?

[kneepaincure]

Yup I have the maltracking knees too, but have a huge aversion to anything to with surgery, so I went the PT route and it's helped a lot. It's not resulted in pain free knees, but much better than before. I still have to think twice before taking part in high impact activities though.

My main problem was quad strength which I worked on by doing leg extensions (among other things). Of course it was under the guidance of a great physical therapist, so I wouldn't recommend you start doing them without consulting one first.

What kind of exercises have you been doing in PT?

[aaa]

Just wanted to add one stretch - it is very important and can help if there is some infrapatellar contracture.  Try heel to butt stretch lying prone.

Just like here: http://www.exrx.net/Stretches/Quadriceps/ProneLying.html

If this is difficult, you can use a long rope or towel around the ankle, or a stretch strap like http://www.thera-band.com/store/products.php?ProductID=74 ... but it is still exactly the same stretch pictured above.  It is important to try this stretch laying prone, rather than standing up.  I always found the stretch straps, etc. difficult to use so I would have someone - who knew what they were doing - gently help push the leg down for me.

As other posters metnioned, there may be other issues going on, rotational issues, etc.  If your current surgeon recommends a lateral release and is also not confident it will help - then it probably won't.

There is a list of Surgeons on this site with special interest in patellofemoral disorders,

http://www.kneeguru.co.uk/KNEEnotes/node/1725

I'm also a big fan of Dr. Robert Teitge, who is missing from that list.

[Tinkerbell11]

Hey sorry to hear ur problems I had a tilt done physio for 6 months and seen a private physio including going to gym and stretching myself I also had problems and very sore it band but decided on the lr knee was getting so bad couldn't do anything even bending to sit down was agony ! The lr should be a last resort my os waited years before he operated ! And was basically at his clinic every week in tears with the pain I have no regrets with the lr for me knee is so much better muscles are weak but getting there stick with pt cause there is so many horror stories and risks with the lr have u tried the taping on ur knee. ? Can't remember correct name my physio done that with me and found it really helped pain levels ! I really hope physio does help u and think it does help for muscle imbalance ! My tilt was so bad have tilt in other knee aswell u can spot the difference 2 knees look completly different haha good luck with the pt and hope it sorts the knee at 20 its rubbish been young and having bad knees but young enough to bounce back up keep me posted all the best xx

[inpaingirl]

Thank you so much to everyone who replied I aprriciate your tips. I am still in pain but much less because I quit my standing job. Unforutunately it didn't fix the problem, I am doing PT the surgeon still strongly advises not to do surgery becuase I have slight tilt in both knees,he said surgery will help 20% he said he almost never operates on cases like mine. He is probably the best doctor I have ever been to, he is very sincere and honest. Basically he said "if you were my daughter I would never let you do surgery". I don't know how much longer I can tolerate this pain, the only time Im not in pain is when I do nothing all day, meaning barely walking. As far as sports I can forget all about it...even though I want to be active My sisters ages 11 and 14 are starting to have similar knee problems. In my case its genetic, what can I do... now its winter and pain is 5 times worse, just doing stretches/strengthenig. I walk about hour and a half a day...I walk my german shepherd, afterwards pain lasts for hours sometimes without stopping until next day. I am 25 years old, I can only imagine what it will be like when im older. But I am staying hopeful and committing to doing PT every single day...

[newyorkcityknees]

All I can do is share the words of an excellent Physical Medican Doctor, who told me that when doing PT noever push it beyond the point of bad pain.  He is correct in saying that pain is your body's way of saying enough is enough, if you try to push knee joints beyond the mid numbered pain level say a 6 or 7 on a 10 sscale you can do more harm than good.