Aloha Doug,
Mahalo for taking time to answer my quickie of a question. I was out on a long walk a couple of days ago, enjoying the fresh floral fragrance of a miraculous Kauaian day. After an hour or so, my knee started to ache, as it often does. It’s not deep inside the knee, but right underneath the kneecap. I’m very active and strong, and this little twinge is tweaking my giddy-up. Any ideas for a gal who still wants to gallop?
C.C.U. in Kapaa
Aloooooooha! I appreciate your question, but please note that I am not “Dr. Doug.” So, without diagnosing, I’m happy to provide my take, to give you my hope for your health. Please allow me to approach your specific issue in my typical tangential manner.
I’m going to assume that this is an ongoing issue for you, and that your orthopedist has diagnosed it as chondromalacia patellae. Sound familiar? If so, you might experience knee aches, tightness, swelling, and perhaps even a little crepitus (grinding) during knee-straightening motions, squatting, kneeling or even long-distance walking. While I do have a very simple solution, let’s start with my proprietary detour.
Yours is probably a question of muscle balance, something that is important for all of us. While most consider balance to be the kinesthetic keenness of a graceful gymnast or the proprioceptive proclivities of a beautiful ballerina, I defer to differ, using more of a physiological perspective. My apologies. Ha ha.
I look at muscular balance in terms of push versus pull, agonistic versus antagonistic, strength versus endurance, and flexibility versus flex-ability. If you like details, I’ve written about these topics in previous columns. To lead me into your specific knee needs, consider the following.
Our bodies are created for balance … front to back, side to side, top to bottom. Imagine a muscle-head, focused only on what is visible, the “mirror muscles.” I’m sure that you’ve seen the type, all upper body, and gorilla-ish in stance. Their arms are always slightly bent with their shoulders rounded forward. The “visible” muscles are strong and tight; the non-visible are weak and slack. I’m not trying to pick on gym rats, but these guys are often all biceps and chest, because that’s all they can see in the mirror. Moreover, they only train strength, never stretching.
Ideally, the triceps (a three-headed muscle on the back of the arm) is, by design, bigger and stronger than the biceps (the two-headed muscle on the front). This goes for the back muscles (latissimus dorsi) as well, which are supposed to the biggest and strongest in the upper body. A strong back, along with a stretched front, develops a balanced body with perfect posture and a much-reduced potential for injury.
Additionally, the “front muscles” should be stretched after each and workout, helping to prevent walking around like the King Kong of Kauai. Stretch the front. Strengthen the back. Easy peasy!
So, what in the world does this have to do with your particular peculiar patellar issue?
Well, if you have chondromalacia of the knee, it means that your knee cap has probably shifted laterally. Considering that you are active and athletic, you no doubt have stronger muscles on the outside of your kneecap (quadriceps’ vastus lateralis) relative to the inside of your kneecap (quadriceps’ vastus medialis). This is typical for individuals with strong legs, yet haven’t performed targeted isolation exercises. No worries. I’ve got your back!
The following movement should help, and it certainly shouldn’t hurt (if it does, please stop). The simplest solution that has worked for countless clients over the years is a movement called “terminal leg extensions.” In a nutshell, it is the very top of the range of motion during leg extensions with resistance. I will provide some free visuals for you on my website.
Using a desk, table, or side of your bed, sit with your knees bent and your lower legs hanging off the edge. Extend your lower leg, so that your leg is now straight from hip to foot. You can attach an ankle weight for resistance, or just cross one foot over the other.
Perform the top 30 degrees (or so) range of motion … from slightly bent to fully straight. Move super slowly, up and down, for a minute or two, a few times, every other day. This targets the muscle proximal and medial to the kneecap (see my website), gradually bringing your kneecap back into alignment, resulting in more gain with less pain.
