Patellar Pain and Dysfunction

If you have ever gone to your doctor because of knee pain you may have heard that you had a patella maltracking issue. It basically means that your knee cap (patella) does not track properly when your knee is extended or flexed. Your doctor's suggestions may have ranged from seeing a physical therapist for VMO strengthening to old school thinking of a lateral release to simply resting. The lateral release surgery option is rarely performed anymore because they figured out that it did not work. The suggestion of having a physical therapist strengthen your VMO muscle is one that baffles me. What they basically mean is to strengthen the inside thigh muscle (vastus medialis-quadriceps muscle). Let me explain in more detail why this suggestion is short sighted and why it does not work.

First you can not isolate your VMO muscle. Your VMO muscle will not pull the knee cap over so it tracks properly. If you try to isolate that muscle by using a leg extension machine you are wasting your time and potentially causing more injury to the knee. If you think about it when do you ever extend your knee like you do on the leg extension machine? Your knee and leg never function in this capacity. Instead you or your health practitioner should be looking at your hip and foot. Yes your hip and foot. Let me give a quick, basic anatomy lesson. Your thigh bone (femur) attaches to the pelvis to form you hip joint. The hip can rotate in and out as well as flex and extend. The femur extends down and attaches to the lower leg bone (tibia) to form your knee. The patella is the bone that tracks over the femur and tibia in a grove. Your knee can flex and extend and does have the capability to rotate in and out but much less than the hip. Your tibia attaches to the talus and calcaneus (ankle bones). The tibia can rotate in and out and the ankle can pronate (collapse in) or supinate (arch up). All of these structures have to work in unison as you move to help decrease the loads you are placing on your body. So it is not a wise decision to only focus on one part (muscle ? VMO). How could you and why would you try to strengthen the VMO muscle when the hip and ankle have a direct impact on the position and function of the knee?

Rachel Jenkins