Patellofemoral Pain: Why Your Kneecap Won’t Stay On Its Track

If you’re looking for answers on why you continue to have patellofemoral pain when you go up or down the stairs, rather than wait around for the one size fits all approach to come up short, think about what it would take for you to be proactive. 

Proactive, in the sense that when you head off to the school-to-workplace product that leaves a lot of what you’re looking for out – you’ll be more prepared.

By choosing to take the path where you take it upon yourself to do the homework beforehand, you’ll most certainly save yourself a considerable amount of time and avoid a lot of frustration.

If you’ve ever thought, this can’t be as easy as doing the cookie-cutter strengthening and stretching exercises that’s recommended for patellofemoral pain, I’m here to tell you that you’re on the right track.

Rocking the boat with a better question in mind.  

*It turns out it doesn’t make a lot of sense to address your kneecap.* (answers coming)

I realize you’ve been feeling the pain around your patella (read: kneecap). But as counterintuitive as this may sound right now, that doesn’t mean your kneecap has anything to do with why you continue to feel pain in the same area.

Consider this: If the track that your kneecap is supposed to be staying on was operating better than it was before you started to feel the pain around your kneecap, that little bone would be more than happy to stay on its track.

With that in mind, getting out from under patellofemoral pain has more to do with muscles giving your bones the green light to move at the right time than it does with where you’re feeling the sensation of pain.

(Curiosity)

If you’re interested in learning more about why you continue to feel patellofemoral pain, a great place to start is to explore all of the different directions in which bones are capable of moving.

To give you a feel for what I’m referring to here, throughout your base of support alone, you have 28 bones.  One of the bones of your foot that you’re already familiar with is the heel.

A heel bone that’s a component part of what you’re already referring to as your ankle.

*Since two out of the three bones that make up your ankle are located in your leg – that makes your leg an extension of your heel.* 

*And since the bigger of the two bones of your leg make up half of the bones of your knee – that means your knee is relying on your foot to move at the right time.* 

Since your leg connects to your thigh, the smooth white cartilage that looks a lot like what you would see at the end of a chicken bone serves as a track for your kneecap.

Much like a couple of pieces to a puzzle, the convex contact surface on the underside of your kneecap meets the concave surface of your thigh (read: femur).

<figure><img src="https://www.engagingmuscles.com/wp-content/uploads/2017/02/Patellofemoral-pain-occurs-here.jpg" alt= "patellofemoral pain occurs here" width="580" Height="375" /></figure>

For more information, hover over this image.

As you can see for yourself in the above image, your femur provides the track that your kneecap doesn’t want to stay on.

*Until somebody takes the time to improve how the track moves -patellofemoral pain is more than likely going to persist.*

This isn’t about mobility.  It’s about stability.

To be clear, I’m not referring to stability from something that is outside of your body.

Knee braces, athletic tape, kinesiology tape, and ‘custom’ orthotics to name a few examples.

*All of which focus on your kneecap (a.k.a, the symptom).*

How about the environment of your feet?

Just in case you’ve never thought about this before, if you wear a running shoe with a built-up heel for activities that don’t include running, the ramp angle alone is enough to throw off how your kneecap rides on its track.

<figure><img src="https://www.engagingmuscles.com/wp-content/uploads/2017/02/Foot-lying-on-platform-for-running-shoe.jpg" alt= "Foot lying on platform for running shoe" width="580" Height="431" /></figure>

And then when someone recommends you throw a pair of clumsy orthotics into the mix, in doing so, the track has no other alternative than to be thrown off in even more directions.

*Directions that don’t come close to where those bones should be at the time that you’re going down the stairs or climbing up a hill.*

To say the same thing in a slightly different way, if you’re being asked to perform lunges in an athletic shoe that elevates your heel, it’s impossible for all of those bones to flex at the right time.

(Principles)

This, at a time where you’re still being told one of the biggest exercise myths of all time – don’t allow your knees to go past your toes.

*Even if you don’t have any patellofemoral pain to speak of right now; when you force your feet to function in an athletic shoe that has a relatively steep angle from your heel to the front of your foot, your knees have no choice but to move at the wrong time.*

[ Sidebar: If you’re looking to change the *starting position* of your feet, and in turn, your knees, but are concerned that you won’t have enough cushion, there are zero-drop running shoes with plenty of cushioning. There are also flat shoes that allow for more ground feel. ]

While going through the process of figuring out all of this for yourself, keep in mind, it’s your muscles that are responsible for allowing motion.

*Just in case you didn’t catch that – it’s your muscles that are responsible for allowing motion.*  

Which is not the same as describing all of the ways in which motion can occur.

It’s not enough to just have more motion at a joint.  The goal is to have stability throughout all of the available motion at the joint.

*If you want to have optimal motion at a joint (and have it last longer than a few hours  🙂 ), you first have to have muscles that are capable of stabilizing all of the available motions the joint allows for.*

There are plenty of people that have been labeled as having more motion than what’s considered to be the norm, but yet they still have patellofemoral pain or back pain, etc.

Even though the structure of a joint isn’t much different from person to person, the reality is, some people have more motion than others.

Which is why some people are naturally drawn to yoga.  But just because yoga has been shown to be beneficial for one person, doesn’t mean everybody should be running out to do yoga.

(Prevention)

In talking about patellofemoral pain thus far, it’s important to remember that in order to get the job done with more efficiency, the bones that make up your knee are relying on more than just themselves.

*Therefore, just because you have muscles that are responsible for moving bones that make up your knee doesn’t mean they’re capable of performing their role on time.*

[ Sidebar: For more information on muscles that are under-performing, check out my interview with Massage & Fitness Magazine.  I also wrote about muscles that are under-performing in my last article, Tight Muscles Aren’t As Bad As You Think (Here’s Why). ]  

I’m not saying you have to know everything there is to know on this subject.  What I’m saying is, when it comes to patellofemoral pain, it doesn’t take much to know more than what a physical therapist is capable of telling you.

If you’re having a difficult time wrapping your head around that, think about how much expertise can be gained from working in a field where most of the people are caught up in peddling the same inputs that aren’t capable of reaching the ultimate outcome

The ultimate outcome being your ability to perform better than you were before you came in for the first time.

“Experience isn’t hard to acquire.  It’s based in staying power.  If someone can figure out how to do their job just well enough in order to hang around just long enough and keep from getting fired, they can gain extensive experience. That does not mean they are building much expertise.  It doesn’t mean they are acquiring more knowledge.  It doesn’t mean they’ve become an expert.  It just means they’ve hung around long enough.”

 

– Jim Keenan, Not Taught (affiliate)

 

Since you don’t know what you don’t know, I recommend setting your sights on getting better answers.  Answers that are worth exploring.

To save yourself a lot of time and frustration, all you have to do is possess enough second-layer knowledge that you can recognize a physical therapist’s first-layer knowledge from a mile away.

Strengthening: relying on the next best guess

*How physical therapists determine which muscles are tight from muscles that are weak needs to be called into question.*  

*If for no other reason than, it’s impossible to strengthen a muscle that’s not capable of contracting optimally.*  

But yet they’ll pretend otherwise.

In other words, even though you’ve been told you have a quadricep muscle that’s weak, without an accurate way of knowing whether it’s tight or weak, I’m sure you can see that they could be strengthening a muscle that’s already strong, and stretching a muscle that’s too weak to play its role at the right time.   

Either way, if you’re doing more than you’re accustomed to doing, you’re going to come off the other side of the conveyor belt feeling stronger.

Whereas if you’re going into physical therapy as somebody who goes to the gym on a regular basis, for reasons that go unsaid, you’re probably not going to stick around long.

*Rather than tell you that you’re walking away from physical therapy with a false sense of strength, I’ll just say you can’t exercise your way out of something exercise contributed to in the first place.*


Stretching: allowing for less spring on every step

A physical therapist can stretch the muscles they assume are tight all they want.  But no matter how much force is applied, until what’s causing the muscles to be tight in the first place is addressed, those same muscles are going to tighten up again…

It’s a vicious cycle.

A vicious cycle that has you relying on all of what the factory model leaves out.

This scenario also explains why foam rolling, and chiropractic adjustments keep you coming back for more of the same.

(Priorities)

*Believe it or not, you actually want muscles to provide a certain amount of stiffness.*  

*A physicist would compare the amount of stiffness I’m referring to here to that of a spring.*

So when it comes to performance, the goal is to get your muscles to have a certain level of spring to them.

Much like a spring, your muscles have to be able to store elastic energy to overcome gravity on every step.

[ Sidebar: If you’ve ever dealt with plantar fasciitis, your muscles were more than likely functioning less like a spring and more like a Slinky.

The same could be said for why you continue to feel patellofemoral pain.

It’s this lack of stiffness throughout your muscles that won’t allow your body to overcome gravity at the right time. ]

*When you have muscles that aren’t capable of pulling at the right time, the likelihood of a bone lagging behind is much greater.  It’s this lag time that doesn’t allow your kneecap to stay on its track.*

In thinking about your muscle’s ability to store elastic energy, this lag time can also be referred to as an energy leak.

Taping: since it has properties of a Band-Aid it’s highly unlikely to by capable of anything more than that

Taping your kneecap with athletic training tape or even kinesiology tape isn’t capable of preventing your kneecap from coming off of its track.

Since an input that’s capable of changing how the track moves wasn’t taken into consideration beforehand, it only makes sense that once the tape is removed your kneecap is going to come off its track, again…

Besides being just another attempt at addressing the symptoms, no matter how well the tape is applied, it isn’t doing anything to improve how muscles above or below your knee function.

Not just any muscles.  Muscles that aren’t capable of performing their role for you.

*Until you have muscles that are capable of stabilizing all of the different directions your foot is capable of moving at its respective joints, your knee won’t move at the right time either.*

*And let’s not forget about all the ways in which your hip is supposed to move.* (emphasis added)

Orthotics: nothing more than forcing the track to go in the wrong direction at the wrong time

If you understand all that I’ve written up to this point, then, you can see why orthotics aren’t doing anything beyond addressing the *symptom*.

For even more information on orthotics, read, Plantar Fasciitis: What The Experts Aren’t Telling You About Orthotics.

While everybody and their uncle focus on over-pronation as the cause for everything under the sun, the *source* can be found in your foot’s inability to supinate at the right time.


Given all the different things your body has been expected to do over many years, all of which occurred prior to you feeling patellofemoral pain, it only makes sense that you aren’t functioning in the same way that everybody else is.

But yet you’re being treated as is if you are.

Rather than have someone continue to focus on your kneecap, look for a practitioner that’s capable of improving upon how the track moves.  For you.  Not the ten people that came through the factory door with patellofemoral pain before you.

SHIP.

(Art)

If you found this post to be educational, and you know somebody that’s been dealing with patellofemoral pain or runner’s knee, I would greatly appreciate you sharing this post.  You can do this by emailing it to a friend, family member, colleague or feel free to share it on Facebook. 

A big thanks in advance.  😀 

Thanks for taking the time to read this post!  If you enjoyed this post, please subscribe to Engaging Muscles.  You can also like Engaging Muscles on Facebook, subscribe to my YouTube Channel or feel free to connect with me on Twitter @rickmerriam

Book mentioned (affiliate):

Not Taught by Jim Keenan

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Patellofemoral Pain: Why Your Kneecap Won't Stay On Its Track
Article Name
Patellofemoral Pain: Why Your Kneecap Won't Stay On Its Track
Description
If you're interested in learning more about why you continue to feel patellofemoral pain, a great place to start is to explore all of the different directions in which bones are capable of moving.
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I have held a license to practice massage therapy for over 20 years. For the first 18 years of my career, I was a nationally certified personal trainer. During that time, I completed thousands of one-on-one personal training sessions. I went on to teach biomechanics to personal trainers, group exercise instructors, and physical therapists throughout New England. I worked as a sports massage therapist at ESPN. Over the last few years, I have been quoted in Runner’s World UK, Massage Therapy & Bodywork, Massage Magazine, IDEA Fitness Journal, Massage & Fitness Magazine, and The Guardian Liberty Voice. I have also served as an applied biomechanics consultant for the fitness staff at Canyon Ranch, The Greenbrier, and ESPN. For the last 7 years, I've been teaching applied anatomy & kinesiology at Parker University. I have a private sports massage therapy practice in Dallas, Texas.