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Now that we are into 2017 and the Chinese New Year over, everyone is back in the swing of things and a lot of people have started getting back into their fitness routines with more intensity. With a handful of competitions approaching, I have recently been getting a lot of clients complaining of knee pain whilst doing anything involving a weighed squat. I would always examine their squatting technique and almost all the time I would have to correct their form.

Most beginners would usually start off by bending their knees first then their hips in which the knees would do more work than the hips. Learning how to utilize the hips during a squat is important if you want to make them more joint-friendly. Also, making sure they put the weight on their heels rather than their toes to avoid excessive knee flexion just like when you sit down onto a chair. Enclosed is a feature image depicting this

It was only recently that I myself started developing RIGHT kneecap pain that put me out of participating in a competition, even though my squatting technique was reasonably sound. Being a chiropractor I started to analyse in further detail what was causing it. Perhaps this can relate to some of you too!

As I started observing my squat, my technique was correct in all aspects however I noticed a slight imbalance or “early firing” on my RIGHT side. It was then I realized what I had and dreaded to have: Patella femoral Pain Syndrome. There was no problem with the knee itself but an issue elsewhere that was causing my patella (kneecap) to not glide smoothly in its groove. When the patella doesn’t glide properly, this causes inflammation in the knee area and accelerates knee cap degeneration and pain on weighted squatting

Most athletes would give it the quick fix by wearing knee sleeves to clamp the kneecap down but this would only be a temporary measure. I had to get my pelvis checked for misalignment issues and also check imbalances in the muscles surrounding the knee joint: ITB band and Inner quadriceps

Solution

  1. I got my pelvis adjusted by a chiropractor. Everything functions better when it is balanced. I hadn’t been adjusted in a while due to the festive season and time off. As an athlete, I regularly get adjusted on a weekly basis to keep my body functioning optimally and free from joint restrictions
  2. Started foam rolling my ITB band. This is common amongst cross-fitters as most of the squats we do are usually wide stanced. Wide stanced squats develop the outer part of our quads which is why some cross-fitters have overly developed outer quads and ITB tightness rendering the inner quad weaker. This in turn pulls the kneecap towards the outer side thus giving rise to tracking issues. Stretching and rolling the ITB helped to decreased the tightness.
  3. In combination with (2) I also started doing wall sits and working on my inner quad with close stance leg presses and leg extension work. Wall sits to the quads are like planking for the abs! This helped to create an even balance of muscle pull on either side of the knee thus helping the knee to track properly in its groove
  4. Usually with tight ITB band, the glut medius (outer hip muscle) is also weakened due to the ITB doing all the work. By doing hip abduction movements helped to activate and fire the glut medius muscle. One would usually feel the burn if your glut medius muscle is underutilised.

I wore a knee sleeve at the start and slowly started to rely less on it as I started feeling less pain. In my spare time, I did the accessory work to address the underlying causes and within a month or so was back to normal. Too often we neglect how important all the muscles are in our body. Too much focus on one part, another gets neglected creating an imbalance leading to painful syndromes.

Conclusion

Patella femoral tracking disorders are potentially preventable by correcting the muscle imbalances and correcting any misalignments in the pelvis. That said, do yourself a favor. Get yourself checked out by a health professional i.e. Chiropractor, trainer/coach and listen to your body. It has an ability to let you know that something is wrong through signs, symptoms and observation of posture.