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Patella tracking problem(12 posts)

Patella tracking problemColorado Ron
Oct 24, 2002 3:39 PM
Anyone else ever had to deal with this?
I've done the therapy thing but it did not help. A shields brace helps a little. It seems the next step will be a lateral release. If anyone else has had one of these I'd be interested in knowing if it was at all helpful.
Same problem...AMP
Oct 24, 2002 4:36 PM
I've had the same problem and had limited success with physical therapy. I'm sure that others will agree that surgury should be your last option...

For me it was a combination of a really good PT and Rolfing. I've seen the greatest gains from the Rolfing. If you aren't familiar with the technique.... it's an extremely painful method of re-aligning your muscles and connecting tissue. Do a 'net search for more info. The most important thing (and I can't emphasize this enough) be sure that you find a certified Rolfer who was trained at the Rolf institute (supposedly less than 200 people worldwide have this certification). A massage therapist who is not certified, but claims to "be able to do it" will most likely injure you.

After a couple of sessions I was able to see that my leg was completely un-twisted, with perfect tracking. Now I just go in for a touchup once a month or so. I've also had my hamstrings, calves, quads, etc worked over with some great gains in flexibility.

Please post or email if you would like more info.

Good luck!
-Andrew
Thanks, I checked out the rolfing web siteColorado Ron
Oct 24, 2002 6:45 PM
and found their is an advanced rolfing practicioner in my town. I've already sent him an e-mail. I'll try just about anything at this point to keep away from surgery yet still be able to ride.
re: Patella tracking problemFTMD
Oct 24, 2002 6:50 PM
Ron,

Please, do not have that surgery until you are certain it is your last hope. I have been dealing w/this issue mainly in my left knee for over a year, and to a lesser extent in my right knee.

I could type out my entire story, but I won't. I'll simply say that I went through 3 doctors and 2 PT's before I ever saw any improvement. The first doc said "rest it," the second was talking lateral release w/in 10 minutes of meeting me, and the third finally spoke some sense. My first PT looked at me one day and said he could no longer help me. My third doc hooked me up w/my second PT and he worked wonders. Some docs are good w/knees, some aren't. Same goes for PT's. Find a PT that is athletic him/herself. I couldn't find a cyclist, but I did find a runner.

It's all about the muscle balance in your leg. I began in earnest a lifting program this year on 1/1. By June, I could ride, but not hard and more than likely not on consecutive days. By August, consecutive days were okay, but I had to watch the intensity. Now, I can pretty much do whatever I would like to, but am careful and don't hesitate to shut it down if I feel anything weird. I attribute all of my improvement to the weights and stretching. I never made progress until the PT told me that I simply had to push through discomfort/pain to improve.

Search the net for info on the release. The results are poor. Also search for maltracking. Read everything you can. There's a great site called knee guru or something similar. If I was on my work comp I could give it to you. Great info there. I truly believe that if you arm yourself w/as much info as possible and commit yourself to the rehab, you'll come out of this just fine.

If you would like more info or thoughts, post here and we can email.

FTMD
re: Patella tracking problempp_mcgee
Oct 24, 2002 7:48 PM
Well, it's difficult to be specific without knowing your history of how this presents in your case, but, as a PT myself, I would suggest you find a PT who is a cyclist and possibly also certified as an Athleitc Trainer or has experience in Sports Med. I've seen that AT's are much more willing to do aggressive soft tissue manipulation than most PTs. Also, most patellar tracking is due to an imbalance within the 4 muscles of the Quadriceps Femoris, usually Vastus Medialis or Laterallis. It's also common to have pain caused by tight Iliotibial (IT) bands, which cyclists are notorious for having. But if that were the case, I would hope that this would be treated because it would be very apparent. Without seeing you, I can't reccomend any treatment, other than suggesting to find someone who is a licenced PT and certified AT, who, hopefully, has experience with cycling. It sounds difficult but there are many out there. A Doctor of Osteopathy might be willing to provide a more aggressive, non-invasive interevention, as well. Also, The research on a lateral release is inconclusive. I wouldn't reccomend that at all for someone as active as yourself.
re: Patella tracking problemrrbfun
Oct 24, 2002 9:14 PM
I would concur with all the posts and avoid the lateral release or plan on having it again in 3-5 years. I do't know what your previous PT consisted of and how serious your condition is. Does it hurt with all activity or just cycling? I would add you should have your foot alignment check because poor foot control is overlooked a lot and it can be a major factor in poor tracking. It may be as simply as orthotics. I find about 90% of my patients with poor patellar tracking have poor foot mechanics and when corrected eliminates or decreases symptoms enough to fully strengthen the muscle again without the pain. Good luck
Thanks for all the replies, I guess I should have addedColorado Ron
Oct 25, 2002 5:52 AM
My Knee doc did send me to the podiatrist and he did prescribe orthotics. I've been using them since this spring and wear them every day.
My knee hurts all the time. No specific pain point just a general Aching. It's worse after execise of any kind. My research has shown this to be consistent with patella tracking problems.
I worked with a PT for 3 months this summer in an effort to strengthen the muscles on the inside of the leg but basically saw no improvement.
I also agree regardig the apparently poor success ratio of the lateral release. I guess I'll try a different PT and the Rolfing technique.
re: Patella tracking problemChen2
Oct 25, 2002 6:22 AM
I've had this problem all of my life. After 5 surgeries including 4 retinacular releases I can report mixed results. In addition to the releases I've also had tibial tubercle transfers on both knees, and that is what may be needed to avoid the need for additional releases. A few years ago my right knee got so bad I could barely walk. Four weeks after surgery I did a 250 mile bike tour in northern California. Since then I had the same surgery on the left knee with disappointing results, but this was due mostly to my age 58, and lack of good cartilage. Now that I'm nearly 60 I have quite a bit of pain in one knee but I can still compete on the bike and do well on century rides. For me surgery was the best alternative, but everyone's knees are different. I think Mcgee's post is very good. Physical therapy has helped me alot, especially when recovering from surgery. Even though I was back on the bike and competing within weeks of major surgery it still took a full year to get all of my strength back. Knee surgery in general is a lot easier now than it was a few years ago, much less invasive. With today's technology I could have stopped after 2 surgeries instead of 5.
~Al
Check into Active Release Therapybrider
Oct 25, 2002 7:13 AM
A subset of chiropractic is ART. Many people have had immediate relief through this method (I have no personal experience here, just relating what I've seen a lot of raves about). Check for an ART practitioner in your area at
http://www.activereleasetechnique.com/
or do a web search.

Not necessarily cheap, but it's been effective for a lot of people and might be worth checking out.
I second thatmtber
Oct 25, 2002 9:41 AM
I developed chrondromalacia after overtraining and crappy PT after ACL reconstruction surgery. I had a second (debridement) surgery 1 year later. My knee felt great for 1.5 yrs but the pain started popping up again this past summer. I tried ART and had some IMMEDIATE good results (IMHO the best part of ART is that results are immediate). I cannot say that I achieved 100% recovery but the improvement (Id say 80-90% better) was definitely worth the expense.
One more thing...mtber
Oct 25, 2002 9:43 AM
I didn't notice at first that you are from CO. If you are near Loiusville, the ART guy that I say is Dr Phillip Bammer. Good guy but kind of super-enthusiastic about ART.
I'm up North,Colorado Ron
Oct 25, 2002 10:27 AM
In Loveland, but thanks for the reference. I'm not opposed to driving a little for some relief/help.