KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: CARLB3 on March 08, 2011, 08:36:40 PM

Title: Patella maltracking-VMO exercise advice
Post by: CARLB3 on March 08, 2011, 08:36:40 PM
Hi, Has anyone rectified maltracking by VMO strengthening? Been nearly a year now and still cant ride my bike after physio gave me these exercises and then gave up on me after 6months. Now waiting for ortho appointment, don't want arthoscopy if i can help it, MRI last September suggested nothing out of order. Done hamstring stretches, ITB, and hip flexes. Can do less and less as weeks go by, stretches, walking seem to flare knee up. I get pain to innner underside of left knee and general niggling pain under front. Thanks
Title: Re: Patella maltracking-VMO exercise advice
Post by: smillie on March 08, 2011, 10:38:28 PM
Didn't work for me...
Title: Re: Patella maltracking-VMO exercise advice
Post by: KW on March 08, 2011, 10:56:10 PM
If there are no structural defects and the issue is purely a muscle imbalance then it is possible that exercise will help.  A MRI is not going to show structural defects that would cause maltracking...you need specific x-rays and ct scans.
Title: Re: Patella maltracking-VMO exercise advice
Post by: Snowy on March 09, 2011, 12:34:24 AM
I was able to pretty much resolve my maltracking problems with a combination of VMO strengthening, IMS and foam rolling to release tight muscles, and custom orthotics to correct overpronation in the feet. Before starting on this program with my current PT I was reliant on bracing and/or taping to stop my kneecaps maltracking, and even so they occasionally flared up.

My PT stopped me doing everything that hurt (so for a while I was just cycling and swimming) and then started me on a very gentle program that began with a couple of weeks of simple quad flexes, then began incorporating gentle VMO exercises (towel between knees, single leg dips) and worked up to more aggressive strengthening (leg press and squats with toes turned out, etc). In the meantime he also used IMS (intramuscular stimulation) on my IT band as it was tightening up and countering the action of the VMO, and got me a set of custom orthotics. After a couple of months I noticed a huge improvement in the tracking and associated pain, and was able to discontinue use of the rather clunky braces I'd been relying on before.

Unfortunately right around that time I ruptured my ACL and embarked on a whole different knee adventure, but that's another story.

As KW says, if it's purely a muscular or gait imbalance then it's possible to correct maltracking with a program like the one I followed. If you have a structural problem in the knee joint, it may not be that simple. Your OS should be looking at CT scans to figure out what's causing the problems before they go inside your knee - maltracking is a symptom rather than a cause, and before embarking on any surgical treatment you need to know why things aren't moving right.
Title: Re: Patella maltracking-VMO exercise advice
Post by: Snowy on March 09, 2011, 12:37:51 AM
I should probably add that I'd tried strengthening exercises in isolation before and they didn't help - I think for two reasons. One was that my kneecaps were already badly inflamed, and because the exercises involved putting quite a lot of force through the kneecap they exacerbated the pain and did as much harm as good. That was my current PT's rationale for going right back to square one this time; he wanted to let the kneecaps settle down completely, and build up exercise very gradually to avoid setting off another cycle of inflammation. The other was that strengthening alone didn't address the other issues, which were a gait problem and IT band tightness. Unfortunately these things usually don't have one single cause, and it can take a variety of approaches to address all the contributing factors.
Title: Re: Patella maltracking-VMO exercise advice
Post by: smillie on March 09, 2011, 04:05:41 PM
I'll expand on my rather short reply earlier. KW and Snowy explained it well and the reason it didn't work for me is because I had structural problems that would need to be addressed before any strengthening would help. But when I went to the OS, the first thing he had me try was strengthening to see if it would work. When it didn't, then we tried other things.

Snowy, your PT is awesome.
Title: Re: Patella maltracking-VMO exercise advice
Post by: kscope09 on March 09, 2011, 11:11:42 PM
I had good results with taping, has anyone suggested giving it a try?
Title: Re: Patella maltracking-VMO exercise advice
Post by: Oasis88 on March 10, 2011, 12:12:34 PM
kscope09, I'd be really interested to see what your taping procedure/method was like. Would you care to explain it a little? I just got some tape and have began experimenting to give me some relief from my maltracking and a chance to build up my legs without having them flare up.
Title: Re: Patella maltracking-VMO exercise advice
Post by: Lottiefox on March 10, 2011, 12:38:46 PM
McConnell taping is the usual method but you need a Phsyio to assess you and tape first before trying something yourself. If you tape incorrectly, you'll simply shift load onto the wrong area. Taping can try and shift the patella, or unload areas such as the patella tendon. Never did anything for me, and one attempt actually made my pain way worse for about a week...... :-\
Title: Re: Patella maltracking-VMO exercise advice
Post by: kscope09 on March 10, 2011, 12:41:51 PM
I've never applied it myself,I don't have a clue how.  I think it was called McConnel named after Jenny McConnel who came up with vmo exercises, though she's thought to be a bit dated now but the taping worked for me.  basically what happenned was the pt put the tape on my knee and I ahd to leave it there about 3-4 days and then I would take it off, then the next time I saw her she put some more tape on and I think we did this about 3 or 4 times until it was tracking normally again.

While I was doing this I was also doing some light cycling and squeexing a ball between my knees while sat on a high chair so that my legs dangled and would press the heal of my right foot (affected leg) into the sole of my left foot and then would squeeze my vmo's together.  This gave me a huge vmo and was very god for the hip abductors as well.
Title: Re: Patella maltracking-VMO exercise advice
Post by: CARLB3 on March 11, 2011, 09:20:07 PM
Thanks for advice. Struggling to rest my knee fully though to get the inflam or whatever it is out, seems even climbing stairs triggers a week or two of pain. Would like to find true cause so i can focus on the correct remedies. Will ask about a CT scan if they try to fob me off with more VMO work next week.
Title: Re: Patella maltracking-VMO exercise advice
Post by: kscope09 on March 11, 2011, 11:31:18 PM
don't let them fob you off about the vmo.  Youc an have a vmo like Arnold schwarzenegger and still ahve knee problems, it isn't a magical remedy.  The physio here in the UK is very antiquated in that it concentrates on getting one of the quadrocep muscles to pull agaisnt the others.  You also need to work on glutes and hip abductors as well.
Title: Re: Patella maltracking-VMO exercise advice
Post by: CARLB3 on March 13, 2011, 08:47:20 PM
Can't make out why the maltracking began. Been cycling since i was 7 years old, 43 now, riding/racing mountain bikes over last 15 years without any knee trouble even ran 3hr marathon 2009, ride 5mile commute daily, then this starts after returning to running end of 2009. I thought laying off the running would have sorted it but as I said it has now stopped me riding altogether. Is this the usual progress of patella maltracking?
Title: Re: Patella maltracking-VMO exercise advice
Post by: smillie on March 13, 2011, 09:48:00 PM
Sometimes it can seem like a sudden onset of pain. I had trouble with mine a long time ago but this recent bout of trouble came on quickly. I also know that my other knee has the same problem, but it hasn't been painful very often at all. It is acting like it's about to kick in, though. So, yes, it can be a sudden thing sometimes.
Title: Re: Patella maltracking-VMO exercise advice
Post by: CARLB3 on March 16, 2011, 09:00:30 PM
Had consultation with knee surgeon today, he told me my knee wasn't maltracking (as phyio had previously said) and MRI of last August suggested nothing wrong so to go away and rest. He said the pain under medial side of knee cap was overuse irritation.....even though I havent run in a year or ridden  bike for over 1 month (and that was very easy gear 4miles) Something must be causing irritation to last this long if not maltracking. Any suggestions or advice what to try next, just don't feel rest will ever fix it?