As a sports rehabilitation doctor, I get the benefit of seeing all types of sports injuries. One of more common injuries I see is a ‘knee tracking’ issue. I’ll go as far as saying about 75% of all people presenting with knee pain have this condition as either a primary issue or issue that is causing a more serious situation. So, what exactly is this funny sounding condition?
As humans, we are the ONLY animal to be upright and on two legs as a primary means of ambulation. Although our evolution has allowed us to do this, it is not without issues. It just so happens that the muscles on the outside of the thigh tend to get stronger/tighter than the muscles on the inside. Now, it’s a bit more complex than this but this should help give us a general idea of what is occurring.
When the outside muscles are too tight, they tend to exert a lateral draw, or pull, if you will, on the patella (that round bone on your knee that moves around a lot). As the patella pulls outward with every step and more-so with anything sports related, it gets rubbed across the patellar groove that it is supposed to be going in. This creates ‘rubbing out’ of the cartilage on the underside of the patella (kneecap), and this condition is called chondromalacia (chondro = cartilage, malacia = softening) patella. This condition can be quite painful and certainly correction is needed. All too many times, this condition is just a sign of more things to come.
If we fail to attend to early knee tracking issues, the injury will get far worse over time.
What makes this condition so important to address quickly is that like many conditions, if it is not treated, it will only get worse. Why is this? It’s called arthrogenic inhibition. When there is musculoskeletal injury in a region of your body, the adjacent tissues stop working properly and imbalances ensue. In this case, when the patella is being pulled outward, that injury process further weakens the muscles on the inside of the knee…and these are the muscles we really need to get going. The injury just continues to get worse until further damage is caused, such as lateral meniscal tearing or medial compartment knee injury due to the gapping on the medial side. This condition also goes along with what many people call ‘iliotibial band syndrome.’ This is not really a ‘syndrome’ at all…it’s your body’s reaction to an imbalance…again, a lateral vs. medial thigh/knee muscle imbalance.
Before I go further, I will say that there are people who do have medial tracking issues, but that number is very low…the overwhelming amount of people with knee tracking issues have the lateral form. This condition actually has a name: Excessive Lateral Pressure Syndrome* (ELPS*). People who suffer with this condition tend to have more pain walking down hill or going down stairs. They will get pain in the lateral knee (like an ice pick) when they are running or shortly thereafter. It is important to note that you can have medial knee pain (from gapping of the medial knee), lateral knee pain (mostly from compression of the lateral capsule), or really pain anywhere around the knee.
Again, the culprit is an imbalance in the medial and lateral knee musculature.
So, what do we do about it? Well, it’s not as simple as just working on the medial side muscles because as soon as you walk or partake in sport, you go right back to strengthening the lateral muscles. Remember, arthrogenic inhibition is at play. What needs to be done is changing the brain’s perception of what is going on in the region and this is accomplished with a multi-faceted approach. We need to eliminate the arthrogenic inhibition before we get the muscles to function properly and this sometimes requires a few different approaches.
Knee tracking issues can be treated with great success if the proper treatment is administered. If it is not, the condition will get worse and create more problems down the road. If you have, or think you might have, a knee tracking issue, do not wait to have it looked at. The sooner the problem is addressed, the sooner you can feel better and get back to your activity!
