October 18, 2010

Early this past weekend, I got an interesting email from a subscriber “Down Under,” in Australia. It seems her niece had a problem with maltracking of her kneecap. That means that the patella doesn’t glide centrally down the front of the knee, as it should. Instead, it pulls off to one side, usually the outside (lateral side) of the knee.

This is usually because the thigh muscles which pull on the kneecap come from an attachment just to the outside of the center line. For that reason, they pull a bit to the outside.  Normally, the single muscle that pulls to the inside (vastus medialis, or VMO) helps balance this, as does the anatomy of the knee joint. There is a groove in the front of the far end of the femur bone that acts like a guiding track for the kneecap. This has a higher ridge on the outside than the inside, to compensate for that lateral muscle pull.

The end result is that the kneecap normally rides up and down centrally, as the knee is bent and straightened. This allows the compression forces to be evenly distributed as the knee functions. As a result, we normally don’t feel pain.

But sometimes, the muscles are imbalanced, or the anatomy is not normal, or the outside capsular tissues become tight and contracted, or there’s been an injury that loosens the inner (medial) tissues. When any of these things happens, then the kneecap can be pulled outside, off track and the forces are deranged, so that there’s too much compression on the underside cartilage of the patella. The result is kneecap pain and sometimes, giving way of the joint.

But this case initially sounded unusual in that the kneecap reportedly pulled off to the INSIDE, not the outside. And her doctor was suggesting an operation called a lateral release, in which the tight outer fibrous tissues around the kneecap are split, or released, to reduce the outer pull on the kneecap. This usually allows the patella to return to a better position within the groove (trochlea) as it moves up and down.

But this seemed counter-intuitive in this case, in which it seemed that the pull was the reverse of what was the normal pattern of lateral tracking. So this procedure would theoretically make things worse, not better. This concerned me quite a bit.

But then, I went back and re-read the description of the niece’s knee and I realized what was going on.

You see, this  girl’s kneecap slipped to the INSIDE, when her knee was STRAIGHTENED, not when it was bent. I missed that, first time through, because when orthopaedists speak of such things, that’s how WE describe them, ie., what path the kneecap takes on bending the knee. My first, fast reading assumed that this was what her aunt was saying.

You know what they say about “assumed,” right? It makes an ASS out of U and ME.

Turns out that she was describing the kneecap moving medially (inside), as the knee was being extended. So, while bent, it WAS indeed being pulled laterally. But as the joint straightened and the kneecap moved upward, it was pulled above the constraining trochlea groove, like a little train that had run out of track, and at that point, the outer pull of the muscles was lessened (as they loosened up) and the inner muscles pulled it a bit medially, causing it to jump inward.

If this all seems confusing, and you’re wondering why I even bother telling you about it, don’t worry, there is a lesson here. The point is that there’s always a good reason for why you’re having pain. Pain is simply a way for the body to let you know something’s wrong. True, it’s unpleasant, but it DOES get your attention, doesn’t it?

Once you (correctly) analyze why you’re having pain, it usually becomes obvious what you need to do to correct the problem.

In this case, the proposed lateral release, which will reduce the outer capsular and muscle pulls on the kneecap, is necessary, because all prior, nonsurgical methods had failed to help. Once those abnormal forces on the patella are reduced, it should return to a central tracking position within its ordained path. And that, in turn, should grant her pain relief and return her to optimal function.

To maintain that position, though, a program of strategic knee pain exercises, like those in my popular and effective PAIN-FREE PROGRAM

http://www.drbillsclinic.com/exercise_eliminate.html

will be needed, both immediately postop and long term, as well.

Now, this is an unusual case. Most cases of knee pain can be healed with exercise alone, or exercise as part of a healing program of non-surgical measures, conventional and alternative.

The point is, that you burn no bridges with exercise. If conservative measures fail to relieve your knee pain, you can still have surgery, if it’s needed. But, as I love to say, you lose nothing by trying. And, if you win, you win BIG!

So, if you or someone you love have knee pain. Do yourself or them a big favor. Click the link above and get your own copy of my PAIN-FREE PROGRAM, RIGHT NOW! Til next time, my friend, be well.

Yours for a pain-free tomorrow and your optimal health,

Dr. Bill

“The Wellness Warrior” ^TM