Orthopedist visit...seeking advice

[jicjac]

Mark,

I'm seeking some insight from your years of training people of various shapes and sizes and physical ailments.

I went to see an orthopedic surgeon today to diagnose a problem I have had with my right knee for years. Long story short, after his examination and a few x-rays, he diagnosed my knees as having lateral patella maltracking. I'm sure you've heard of this before, but in layman's terms, my knee caps track toward the outside of my legs. For some reason only my right knee seems to be affected with any noticeable ache or pain during extension. In addition, he says that this condition also affects my feet to the extent that I place my weight toward the outside edges of my soles when I walk thus wearing out the heals of my shoes in an angled way.

He recommended stretching the quads and the hamstrings before weight lifting. He also said that squatting any lower than 45 degrees put tons of stress on the knees (I was very dubious of him at this point, but didn't want to debate). He recommended the use of an over the counter knee brace for the pained knee.

After his squatting advice, I took everything with a grain of salt. I was even more disturbed when I learned he played football and college and strength trained with the team.

So, I know you're not a medical doctor, but what do you think of his diagnosis and recommendations? Have you trained anyone with this condition before and, if so, should I modify my squats in any way in terms of stance? Because of this condition, my right quad does have some noticeable atrophy due to my years of favoring my left leg; any tips on playing catch up?

Any advice you have will be most appreciated. Thanks

[Mark Rippetoe]

I have heard of this diagnosis many times. In my opinion -- I am not a doctor -- it is a bullshit diagnosis, the result of these weekend sports medicine seminars they often attend. Tight piriformis syndrome is the same type of thing: sounds cryptic enough to dazzle, but when everybody with knee pain leaves the office with the same diagnosis, the pattern comes from something other than the patient demographic, perhaps one of the presenters at the CME meeting. If your patella maltracks laterally, it involves a rupture or luxation of the medial retinaculum (look it up). Mine is ruptured on my right knee and scarred down poorly, but I track just fine. You probably have a tight IT band, and a massage therapist can fix this quickly. You have seen me mention it before, in fact, in relation to knee pain.