At 41 years of age, Jason came to our office with a complaint of knee pain with popping and grinding. He had a job that required that he stoop and squat frequently and this condition had begun to significantly affect his work. The condition had been present for six months and seemed to be worsening.
Upon inspection we noted that Jason had somewhat flat feet with associated medial rotation at the knees and hips on both sides. Spinal joint dysfunction was present in the lower lumbar and pelvic joints. We tested the knee itself and found a painful grinding of the knee cap during active knee extension. Imbalance was present with a shortening of the lateral quadriceps and thigh muscles and a weakness of the medial quadriceps muscle. X-ray and all other medical exams appeared normal.
Jason’s condition is known as a Patellar Tracking Syndrome. The patella (knee cap) is enveloped by the tendon of the quadriceps muscle, which inserts into the upper tibia. As the lower leg moves in flexion and extension, the patella tracks through a grove between the two condyles (rounded ends) of the femur. If the associated parts are in a neutral position and the forces acting through the tendon are symmetric, the patella slides through the groove unhindered. However, a common pattern can develop which throws this mechanism off. The lateral musculature is prone to shortening and tightening, while the medial musculature is prone to weakness. This trend, coupled with the abnormal alignment caused by flat feet, is a recipe for trouble.
Jason’s condition caused increased stresses to the knee and inflamed the soft tissues. Our team put together a plan for him which include wearing orthotics to correct the flat feet, adjusting the lower spine, and specific therapeutic exercises to rebalance the patellar tracking mechanism.