The patello-femoral joint :

what more could I be doing to improve?.... - - Posted by 3of3 (3of3), 15 January 2005

I've had PFS since August, following a 9 mile run too early in the training cycle. So, I've gotten PT and have dutifully done my exercises. It seems that my VMO's, though well developed, are still not good enough, though! My Vastus Laterali are still hypertrophied and seem to stay that way no matter what. My patellae are now in the habit of "cracking" much like how one cracks one's knuckles. They seem to do this when they aren't centered in the trochlea; after the "crack", they seem to track correctly. I am getting a distinct "pressure" feeling on the lateral sides of the back of both patellae and it seems obvious to me that they are still tracking laterally.

I sooooooooooo don't want chondromalacia and as I understand it, it can develop when patellae have been tracking laterally for too long, and I've had this for 4 months! How do I avoid chondromalacia

What more could I do to get my patella to stop tracking laterally? Massage therapy for the VL's & ITB's? Wear a brace to keep the patellae from tracking laterally? Get more aggressive orthotics

What would you do if you were me?
Posted by PattiAnn237 (PattiAnn237), 15 January 2005

Well I actually have been you.  I have PFS too, and when it started the OS though it was from a tilted kneecap.  It turns out it was tracking laterally, so when I had a lateral release (which will not correct tracking) it only made my knee pain worse.  

As for the chondromalacia, I have that on the area of my knee that is rubbing.  You could try taking glucosomine, I haven't noticed a differce with it, but some people have said its helped.  

You could try wearing a brace as well, I have a J-strap brace, which pulls my kneecap medially.  However, my OS doesn't like me wearing a brace all the time, because it does tend to weaken the muscles, so thats something to think about as well.

If I were you just try everything you can, if your not seeing  a specialist, you should.  PTs are good, but they are limited what they can do.

Good luck, and take care, ~Patti
Posted by Linds (Linds), 15 January 2005

It is possible that your patellae have been tracking laterally for quite a while longer then you've had symptoms.  My knees also maltrack but have done so my entire life.  But I didn't have symptoms til I started intense distance training when I was about 9 years old.   I have had chronic problems since.
Anyway...
What sorts of things are you doing in Physio to try and build up your quads, especially VMO's?  Did the try using an e-stim to help the muscle fire?  Have you tried McConnell taping or a Patella brace? Might be worth a try.  Use lot's of ice and don't over due it.. but strengthening and stretching are so important.  Keep up the good work, you might think about taking a Glucosamine/MSM/Chondroiton supplement, it may not help, but it won't hurt.

Well, I've had my patellae taped for the past 4 hours at work (I work in a footwear dept) and when I'd bend my knees to get something, I'd get a mild inflammation sensation, in both patellae. Taping may not be for me, but I'll try it again.

Patti,
which "j" brace are you using? Are your vastus laterali hypertrophied? Mine are and I find it hard to imagine that the traction of my VL's  could be countered by a brace but I'm open-minded and I'm willing to try it.

In my frustration I've wondered if I should have a LR. When I saw my skyline view xray, my patellae looked laterally tilted to me but the orthopedist said that they looked normal. I wonder if that's true; maybe I should get another opinion.

Linds,
Thanks for giving me a response again. I'll bet my patellae have tracked laterally for some time now and it was the running that aggravated them . They were fine before!!!! I used to weight train my legs (barbell squats, lunges) and hike all the time, without consequence.

The PT ex's that I'm doing are:
1. lunges, both traditional & stationary- I've only recently started doing this and they do indeed load the PF joint, but they seem less stressful on the joint than the step downs I was doing and I do get a good burn in both my VMO and my adductors in my trailing leg.
2. side kicks- stand and kick accross my body as if I was kicking a soccer ball. Supposed to develop the adductors & abductors.
3. arches- lay on my upper back, one leg bent at 90* and foot on the floor, other leg straight and raised up and down (basically a leg raise). Should develop the gluts (maximii & medii), among other muscles.

Stretches:
ITB
quads
hamstrings
gluteus maximi
gluteus medii
achilles tendons

I've been icing at night. I've been taking glucosamine for about a month, I think. I need to double check.

I haven't tried e-stim, and while I've been tempted, I don't know if it would help as my VMO does fire before my VL. It just gets overpowered by the VL once the VL fires. My PT calls this a "hook".

This is all I can type now. Lunch hour is almost over .

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.

Hunting for information is a slow process. browsing through these topics will probably raise a lot of questions in your mind. Don't forget that there is a whole site behind these forums - just click the 'KNEEguru' home button at the top left of your page when you are ready to access it.