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What are the symptoms of Patella Tracking Dysfunction?
Pain in front of the knee.
Crunching in the knee and under the knee.
Swelling in the knee.
Symptoms will increase with many daily activities such as stair climbing, cycling, walking, aerobic activities and sitting for prolonged periods of time.
What is Patella Tracking Dysfunction?
The patella glides in the groove of the femur and “tracks” with the bone as a person flexes or extends the knee joint. The patella is a small bone in the front of the knee that is embedded in the patella tendon of the quadricep muscles.
Since the patella floats and should track down the middle of the femoral groove, proper tracking is essential to remain pain free. If some force pulls the patella out of this track, the patient will experience pain. When this force continues to pull the patella out of its track for a long period of time, the patient will develop Chondromalacia Patella.
This condition is caused by a break down of the cartilage under the patella and is very common in athletes who do a lot of running and jumping. If left untreated little fragments of the cartilage will begin to break off. Chondromalacia will eventually result in a complete loss of the cartilage lining beneath the patella. In severe cases surgery is necessary to remove the fragments of cartilage.
What is this force that pulls the patella out if its track? One must look at and understand the anatomy of the leg and knee to discover the proper treatment of this dysfunction. There are four quadricep muscles. They are:
Rectus Femoris
Vastus Lateralis
Vastus Intermedias
Vastus Medialis
As a group, the quadricep muscles are the strongest muscles in the body. All four muscles connect to the patella tendon. This tendon goes over the top of the patella. When one of these muscles becomes too tight, it will pull the patella out of its track. Many health care professionals view this as an imbalance in the muscles.
In other words, they consider one muscle to be strong and another muscle to be weak. The rectus femoris, vastus lateralis and vastus intermedius pull laterally on the patella. Most often this is the reason the patella is pulled out of its track. The only quadricep muscle that has a medial pull on the knee is the vastus mediallis.
It is no surprise that almost all patella-tracking problems occur laterally rather than medially. This is due to the fact that there are three muscles pulling against one.
Most health care professionals are trained to believe that this imbalance means that the vastus medialis is weak and needs to be strengthened in order to correct the problem. Many times when the vastus medialis is strengthened, the patella goes back into its track and the pain disappears.
This seems simple enough and tends to make sense. However, the problem with this is that the patient then determines that strength work will keep him out of pain. We all learn that strength work will shorten a muscle.
If the patient continues with the strength work on his quads, the four quad muscles will all shorten causing the patella to track high. This results from the tight muscles pulling the patella in that direction. Similarly the three lateral quads can pull the patella out of its track, as mentioned above. One should not assume that a short, tight rectus femoris muscle means that the vastus medialis muscle is weak and requires strengthening.
It has been my experience that patella-tracking problems are caused when the quadricep muscles are overworked. When a person overworks (or over strengthens) a muscle, the result is a hypertonic muscle. It says in the Whartons’ Stretch Book1, "There is a big difference between a strong muscle and a tight one.
A tight muscle can be very weak and offer virtually no protection for a joint. Tightness doesn’t help–in fact, it hurts." Over-strengthening a muscle will not only make the muscle hypertonic; it will also make the muscle weak. This weakening is due to the fact that a lot of the strength in a muscle comes from the contractile range of the muscle fibers.
If the muscle is 75% short, it can only contract 25%. If only makes sense that a short, tight muscle will be weak. Most rehabilitation therapists conduct tests on the short, weak muscles and determine that the muscles need strengthening. The hypertonic muscles pull bones out of alignment, entrap nerves and restrict circulation. They will also pull the patella out of its alignment.