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BendtheBar 01-11-2013 09:25 AM

Atellar tracking issue
Someone is asking me for help regarding:

"atellar tracking issue, knees appear to be swaying to the lateral side"

Any ideas what weaknesses might be causing this? My research says quads but I wanted to get a second opinion.

MikeM 01-11-2013 01:00 PM

I am interested in this too. I get a shimmy from time to time and assumed it was a balance issue. However, I watched a Poundstone video about Glutes and he said your butt is in control of lateral knee motion. Which would make me think it's a butt issue if your knees move laterally.

Kyle Aaron 01-12-2013 04:20 AM

Short version: when it hurts, rest and ice. When it stops hurting, run less, wide stance squat and foam roll along the side of the thigh.

Long version:

I assume they meant patellar maltracking.

This is a relatively common issue, I have it myself. The physiotherapists tell us that it's caused by an imbalance in the quadriceps. Speaking very roughly, all four quadriceps join together into the patellar tendon which crosses the patella - the kneecap (in fact they don't exactly, but it's a useful approximation). Straighten your leg and squeeze your quads, you can feel just above the kneecap, that's the tendon. This crosses the kneecap, you can feel it just below, too - and then attaches to the front of the tibia or shinbone, it produces knee extension, ie the "kicking someone in the head" movement.

If the quadriceps muscles on the outside of the leg are stronger and tighter and fire quicker than those on the inside, this pulls the kneecap across to the outside. Now, when you bend and straighten the knee, there's a little groove the kneecap is supposed to slide up and down in. If it's pulled across then it goes grind grind grind against other stuff instead, specifically the synovium - the sack of fluid that surrounds the cartilage under your kneecap.

If it grinds away for long enough, the synovium becomes inflamed and the cartilage damaged. At this point, ow. If you just squat or something then it tends not be a problem, you do a little bit of damage, it heals up, and so on. If you run or cycle or walk for miles and miles, then you do a lot of damage, it heals somewhat, you damage it more, etc. Damage is followed by inflammation and pain. Keep poking an inflamed tissue and it keeps hurting, try it with a bruise sometime, preferably someone else's.

Runners, hikers and cyclists get it a lot, pure weightlifters rarely get it. Essentially it's an overuse injury. Even a hardcore squat programme will have perhaps 300 knee flexions and extensions each week, you can do that many in running or cycling in five minutes.

Patellar maltracking often appears in adolescent females - as they go through puberty, their hips expand quickly and the muscles don't catch up, so the outside muscles like vastus lateralis become tight, and the inside muscles like vastus medialis (VMO) become weak. However, others can get it, too.

Along with VMO weakness and VL tightness will be glute weakness, especially gluteus medius, and tightness of the illiotibial band, this ITB as it's known comes down from the tensor fascia latae.

Physiotherapists will typically prescribe exercises designed to isolate the VMO and glute, like half single leg squats, clamshells and so on. These have not been shown to produce any lasting difference in the position of the patella, or any improvement in the firing speed of the VMO. No-one I know has ever found these any use beyond the simple fact of resting.

What I have found works best is the following,
  • when it hurts, stop what you're doing - the hiking, running or cycling
  • rest and ice until the pain stops, then wait as long again as it took to stop (eg if it hurt a week, wait another week again)
  • start doing deep and wide-stance squats, this will strengthen VMO and glutes etc; the weight need not be heavy
  • foam roll ITB - the illiotibial band along the side of the thigh, just foam roll along the side from knee to hip, you'll know the spot when you find it!
  • ease back into the hiking, running or cycling, at some point it'll start hurting again; this is now your limit, you may find you can do 15km a week without trouble, but 20km hurts you; now you know your limit, stay under it!

Short version: when it hurts, rest and ice. When it stops hurting, run less, wide stance squat and foam roll along the side of the thigh.

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