Damaged patella

January 12, 2014

Richard asked The Guru for the following Physiotherapy Advice:

Hi, I run 3 / 4 times a week and recently completed my first half-marathon but struggle with persistent r-kneecap pain after longer runs. I have taken up Bikram yoga which has helped prevent other injuries but the knee pain remains. Going up stairs is particularly painful. Previously had an MRI and was told there was permanent damage behind the knee cap (probably from heavy squatting when I was a regular in the gym) but no op was required, any ideas?

Thanks Richard

January 12, 2014

Hi Richard

Don’t get too freaked out about what it says on the MRI report – loads of people have this and have no idea they have it until they are scanned. Your pain may, or may not be associated with this change. Certainly stay off the operation table!

What you do need to get is control of the way your kneecap moves on front of your knee. The more control you have the less pain, regardless of the damage.

Your kneecap is the victim of what happens below (feet) and what happens above (hip and pelvic control).

Max out your control settings by making sure that you run in the right shoes – they need to marry with your foot posture and running stylee.

This also bleeds a little into what you wear on your feet in general, and an off the shelf orthotic may be an idea.

Have a good look at how you do a single knee squat on the right (compared to the left). Does your foot roll out? Does your knee roll in? Does your hip drop down? Does your weight get thrown across to the side? Is it painful? If there are any yesses then you need to work on control. Not range or strength but the actual action of doing the SKS correctly.

Taping your patella into better alignment (as long as it’s done by the right person, taping the right thing) is a great pain reliever to allow you to function at a higher level.

I’m (unfortunately) not sure if Bikram will help. You need control not increased flexibility. There is also a time warning on your knee too, as in don’t expect change (less pain) to take place over night if you’ve got poor control or poor kneecap tracking.

Time, control and goals are all on the table……

Guru Responded

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