Wednesday, 22 July 2020

Consider patella tracking

The kneecap (patella) is a wondrous design that protects the knee joint from damage. An array of tendons and ligaments surround the knee cap. The tendons attach muscles, like the quadriceps, to bone while the ligaments attach bone to bone and serve to hold structures together and keep them stable.

The kneecap sits in a groove in the femur (thigh bone). When you bend your knee, the patella should stay centered, in the femoral groove. If the patella instead moves to the left or to the right - misaligned to the femoral groove - then this is known as patella tracking disorder. Common causes are weak thigh muscles and imbalances in lateral and medial muscles. Also tendons, ligaments, or muscles in the leg that are too tight or too loose. Of course, activities that stress the knee again and again, especially those with twisting motion (think quick direction-change sports like soccer and ultimate frisbee), can cause patella tracking disorder.

The pain / discomfort is felt around the kneecap.

This is relatively easy to correct long-term through a variety of stability and strengthening exercises like squats and leg raises. Taping and knee braces are bandaids that provide structural support to keep the knee cap aligned. 

I have another 'cause' to add to the list: restrictive clothing. Clothing that covers your knee can mess with how your knee cap tracks.

I have three examples.

I had a pair of tights that ended just below my knees. Every time I wore them, I developed a sore left knee. The pain and discomfort would sometimes disappear over night, or it would last for a few days. It took me a while to identify the tights as the cause. Stop wearing the tights = stop getting a sore knee. This was the first of two pairs of tights where I had this problem. With the second pair I cut I fabric to loosen the tension over my knee and the problem was solved.

In 2012, I had the pleasure of participating in a 24-hour rogaining event in Ireland. Before the race I bought a pair of really good waterproof pants. Berghaus. They have those pouches for your knee to bend. As it turns out, I found the crotch-to-waist length a bit too long for me and so I had to roll the top to get them to sit right and to ensure that the knee-bending pouch was correctly placed. After hours and hours of my knee hitting the seam, I developed a sore knee that I totally put down to patella tracking - where the lie of the fabric prevented my patella from tracking in its normal alignment and as a result caused increasing pain and discomfort. After the race I took the pants off and never had another problem. I've only worn them for short periods subsequently and have made sure to tuck them so that the pouch is properly over my knee.

Last week I developed a sore right knee - from doing not very much. And I put it down to the tight 'skinny' jeans that I was wearing most days. I spent most of my time sitting at my desk working. tight jeans, pulling over my knee, squishing my kneecap out of alignment... sore knee. I did a few nights of anti-inflams, stopped wearing those jeans and my knee is right as rain again.

I wa discussing this with a running friend this evening. His daughter wears knee-high compression socks that come just under her knees. If they are too high (like just under), she gets a sore knee. My 'diagnosis' is that the tightness of the top of the socks compresses the tendons and ligaments below the kneecap which alters how they pull on the kneecap to cause pain and discomfort. To remedy this, she makes sure that the top of the socks sits lower below her knee.

So, if you develop a spot of knee pain for no particular reason, consider what you are wearing. The type of fabric will have an effect - even stretchy fabrics - as illustrated above - can influence knee movement.  And, remember that weight gain and weight loss can change how clothing interacts with your knee movement. Clothing doesn't have to be tight; incorrect positioning of loose clothing (like my rain pants) can have as much of an effect.

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