My left knee has a history of giving way

S

StaFo

0
When I was 10 years old I jumped in the air, landed badly on my left leg and my knee gave way.
Since then, it has given way on the odd occasion.
I was never really active anyway, but the lack of confidence on my knee certainly made things worse.
Over the years I've found myself relying on my right leg, which has probably left my left even weaker.

Anyhow, I've taken it to a doctor.
He showed me how the quads were quite nicely built on the right and almost non-existent on the left, so I've decided to do a routine of exercises that will build my left leg's quads.

The reason I've posted here was to find out if this was a common problem that other people had experiences about, what had worked for them, and whether there were any exercises and routines people could recommend to build strength and confidence in my left leg?

Thanks
 
Did the doc actually give you a script for an MRI or the like to make sure there is no damage in your knee? Or did he just notice that your quads were unbalanced?
 
StaFo said:
The reason I've posted here was to find out if this was a common problem that other people had experiences about, what had worked for them, and whether there were any exercises and routines people could recommend to build strength and confidence in my left leg?
Click to expand...

Recurrent dislocations are unfortunately quite common. Usually the dislocation is due to imbalanced muscles (outside knee muscles stronger or tighter than inside ones and therefore the knee cap moves to the side at certain ranges- usually when you change directions when walking).

Generally speaking you need to exercise the inside muscles (VMO) and stretch out the outside ones (ITB). Sounds like you have already been given these exercises so keep going with them. You may also be shown taping to assist these muscles and if it still persists then your physio might double check your hip or ankle for underlying problems that overload your knee.

Cheers
 
~LV~ said:
Did the doc actually give you a script for an MRI or the like to make sure there is no damage in your knee? Or did he just notice that your quads were unbalanced?
Click to expand...
He noticed that the quads were unbalanced but also put me through an MRI.
The MRI showed no evidence of knee damage (e.g. cartilage or ligaments) so he'd suggested that I try training it, and if I keep having problems I can come back to him and get some keyhole surgery.
Hopefully it won't come to that though.

thuybridges said:
Recurrent dislocations are unfortunately quite common. Usually the dislocation is due to imbalanced muscles (outside knee muscles stronger or tighter than inside ones and therefore the knee cap moves to the side at certain ranges- usually when you change directions when walking).

Generally speaking you need to exercise the inside muscles (VMO) and stretch out the outside ones (ITB). Sounds like you have already been given these exercises so keep going with them. You may also be shown taping to assist these muscles and if it still persists then your physio might double check your hip or ankle for underlying problems that overload your knee.

Cheers
Click to expand...
This sounds pretty close to my own experience, although I've not come across the terms "inside" and "outside" muscles before.
Don't suppose you could elaborate on what you mean by them?
My physio gave me an exercise to build up the quads and found my calf muscles to be a bit tight so that's perhaps where I need to work on.
One thing I've noticed when doing squats is that my right leg is the one getting tired, even though it's the stronger one.
I think my body has gotten used to using the right leg and ignoring the left leg where it can.

Anyone recommend any particular exercises?
 
The side to side movement of your knee cap is governed by the muscles whose force pull it inwards ( primarily Vastus medialis Oblique, the inside knee muscle) and the muscles that pull it outwards (Vastus lateralis Oblique and the Illiotibial band).

Like a "tug-of-war" if one pulls more strongly than the other then the knee cap will move into that direction. So when you have a dislocation the force pulling the knee cap out is stronger than the force pulling it in. If both sides pull equally then no pain and no dislocation occurs.

If your muscles on the outside are tight, this predisposes to you to dislocations in that your "tug-of-war" has already started with the "outer" knee muscles at an advantage so stretching these if they are tight will help.

If your outside muscles turn on before your inside ones do, then this also predisposes you to dislocations and you need to train the VMO timing (your physio should be able to help you out on this) so that it switches on before your outer muscles do.

If your VMO is weak then it will also lose to a "tug-of-war" with the stronger outside ones. Training will therefore need to specifically target the VMO.

If you don't work a muscle it won't get tired, so you tire in your squats because you are preferentially loading up the right knee, you will probably notice that in front of a mirror, your weight is going through the right leg the lower you go. Your body has definitely been avoiding the left leg, but in fairness, we naturally do this to avoid more pain after the initial injury. Research also shows that the VMO has decreased firing potential in the presence of pain or injury.... you now also have de-conditioning to add to your mix!

You either need to do squats on a wobble board (forces you to weight bear evenly) or work on single leg exercises but be careful with lower limb alignment. You will need to be careful on all exercises that work both legs as you are probably compensating with your right leg eg squats are excellent for quads strength but does nothing to change timing, tightness or specific muscle imbalances particularly when you don't put weight through the left leg.

Chat to your physio about what your primary problem is and maybe ask to get a myotrac or other biofeedback on your VMO so you can compare your right to left leg (these are in use at most physiotherapy practices) strength when performing your exercises.

Good luck
 
A knee cap that tracs laterally (I guess it can track medially too, but I think laterally is WAY more common) will also dispose you injuries other than dislocations (I don't think I've heard of it disposing for dislocations before, actually.). The knee cap has a place on the femur that it's supposed to rest against. There's a grove in the femur that fits with a small elevation under the knee cap. If the knee tracks sideways then that elevation under the knee cap won't lie in it's groove, it will lie on the elevation next to the groove. (I hope that was understandable) this will, over time, wear the elevation in the knee cap down.

Another thing is that the rectus femoris can also pull the knee cap to the side. If you look at your patella tendon (the tendon running down from the knee cap to the shin) and imagine a straight line that follows the line of that tendon. Then you look at your rectus femoris and see it's line of pull. The angle between these two lines is your "Q-angle" (at least that's what the Norwegian text books call it) with a big Q angle your RF will pull the knee cap a lot to the side, which isn't good.
here's a pic that showes the lines.


Now a Q angle is normal, but a big one can be a problem.

Also, I have a question for thuybridges: How do you mean that the IT band pulls the knee cap laterally? it attaches to the tibia, not the patella, as far as I know..
 
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Hi Karky,
thanks for the detail you provided with the image etc.

In answer to the queries you raised:

1) The knee cap can track laterally or medially depending on the pull of the forces on it although the vast majority of dislocations are lateral (I have only seen two medial dislocating knees in my time).

2) (Apologies in advance to those who don't know all the muscles and attachments - I generally aim to keep my posts as much in layman's terms as possible, but this one is going to be a bit difficult).
Although the ITB does not directly attach to the knee cap, its importance is made through its fascial connections; the strong attachment to the lateral retinaculum of the knee and synergistic function with the VLO. A tight ITB will tension up the lateral aspect of the knee through these attachments which will increase the Q angle thus increasing the potential for lateral movement of the knee cap.

To relieve pain and improve knee function, massaging/releasing the ITB and retinaculum is often prescribed.

A quick check for StaFo: to see if the ITB is relevant to your problem position yourself in side lying so that the left knee is on top. In this side lying position, grab your ankle to do your typical quads stretch on the left leg (good technique of course). If the knee is pointing slightly up towards the ceiling then the ITB is usually tight, to check if it affects your left knee, bend up the right leg at the hip and rest the right foot on the side of the left knee and gently push the left knee down towards the floor again with the right foot, an increase in knee pain and symptoms would suggest that the ITB plays a role in your knee condition.

Hope this all helps.
 
Thanks a lot for that! I should have thought about fascial connections.

And when you say knee dislocations, you mean dislocation of the joint between the tibia and the femur, right? not a patella dislocation?
How can the patella being pulled one way or the other make the joint between the femur and the tibia dislocate?

You seem like you good knowledge, I hope you stick around the forum! Don't be afraid to make complicated posts, either. We need people who has a sound basis in anatomy :)
 
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