knee development questions before I go see a doc

[danlightbulb]

Guys,

For those who may remember I have posted about knee issues here for the last few months.

I am going to go see a doc, but I want to do so armed with as much information as possible. If I don't, then I am likely to get fobbed off.

To recap - my issues started with painful patella tendon pain during squatting around 120kg. Since then I have continual dull aches in the knee, and it is painful when I squat down or bend at the knee or have the knee bent for any length of time for example when sitting. Impact makes it worse (i.e running or kicking a ball). Whilst it does not affect my day to day mobility, it is preventing me squatting anywhere near what I was previously capable of. I have been through the necessary form checks and tried to do stretches, flossing, rest, ice, ibuprofen. I still have the issue.

Now, I have long believed that I have fundamental knee anatomy issues stemming, I believe, from under development during childhood. I would like to get the forum's opinion on this, and to what extent this may be contributing to my knee issues. I know posting pictures is kind of frowned upon here but I have to do something as I'm at the end of my tether with this. If I'm going to the doc I want to know in advance whether I should be expecting a referral based not only on my pain issues but also if there is a chance of some underlying issues with the knee itself. Otherwise I am likely to get fobbed off by the doc.

So on to the detail.

I believe I have underdeveloped knees characterised by a very prominent and high riding patella sitting atop an otherwise very narrow knee joint. I also have very short quad muscles which may be contributing to some imbalances.

Here is a picture of my knee from the front. The total width of the knee joint at the widest point of the bone is only 9cm. My patella is 5cm wide on its own and is circled in green here. It is prominent, and sticks out from my knee when my knee is flexed at 90 degrees as here.



Here is the knee from the side view, showing the prominent patella and its high riding location on the knee bones.



Here is the knee looking top down (i.e from where I would normally look at it myself). Again the prominent patella can be clearly seen in context of the overall narrowness of the knee joint.



And the final picture shows where my quads lie when my leg is fully straight (quad marked out in red pen), to show that there is a significant distance from my quad muscle to my knee joint, and with a long tendon presumably connecting the two.




Guys, coaches, has anyone come across knee issues before like this? Is there a development issue here with my knees at all? How could this potentially effect my lifting if at all? What questions do I need to go in to the doc with, if any?

Regards
Dan

[chrisd]

Guys,




So on to the detail.

I believe I have underdeveloped knees characterised by a very prominent and high riding patella sitting atop an otherwise very narrow knee joint. I also have very short quad muscles which may be contributing to some imbalances.

Your quadriceps reach from their insertion point to their attachment points. They may have shorter muscle bellies than some, but the rest is made up with tendons. If they were really too short, you wouldn't be able to bend your knees.

Here is a picture of my knee from the front. The total width of the knee joint at the widest point of the bone is only 9cm. My patella is 5cm wide on its own and is circled in green here. It is prominent, and sticks out from my knee when my knee is flexed at 90 degrees as here.

About the same as mine. Slightly above average, although measurements were taken post mortem in this study http://www.sajs.co.za/sites/default/...%20Article.pdf

And the final picture shows where my quads lie when my leg is fully straight (quad marked out in red pen), to show that there is a significant distance from my quad muscle to my knee joint, and with a long tendon presumably connecting the two.

I'm assuming right leg. I have about a hand's width of space between the obvious part of my vastus lateralis and my patella. Your vastus medialis doesn't look so big in this picture. There's some debate about this, but it is reckoned, by some, that if your outer and inner quadriceps muscles differ in strength, the kneecap won't 'track' properly over the femur and this can cause pain.

Runner's knee is an example of this.

The problem here is that any kind of knee pain can be blamed on this and you get railroaded off to physio to do lying leg raises. Physios love diagnosing this, because they can treat it and they can't do much about bones or cartilage.

Guys, coaches, has anyone come across knee issues before like this? Is there a development issue here with my knees at all? How could this potentially effect my lifting if at all? What questions do I need to go in to the doc with, if any?

I'm not saying that you don't have some deep issue that affects your knee and causes pain, but the things you have pointed to don't seem significant. Have your knees been examined by a doctor before ? Did he say "Good gracious, your knees look really strange".

Your doctor may steer you towards physiotherapy. You may have to go through with that before going back for further investigation. You may not.

[danlightbulb]

Thanks. No ive never been to a doctor about this before. I personally think my knees are strange compared to knees i see in other people. I know there is nothing that can be done about the bones anyway.

This is why i havent bothered with a doctor before, because there surely should be no better physio than doing heavy squatting and getting stronger, and i expect to just get fobbed off like i have done with every other ailment ive ever seen the doctor about. So i'd much rather self diagnose, but can only go so far.

There is just a huge lack of information. I cannot find any other examples on the internet where the knees display a highly prominent patella like mine are. Looking at other knees its as if mine are missing a whole area of bulk above the patella.

[fencer]

My advice is simple. Go to a Doctor and tell them you need an MRI scan. Say you've done numerous strength and conditioning/physio etc etc and it's time to get the knee scanned. That will either give you a diagnosis or narrow down your options.

Second, see a podiatrist. I saw one and they told me that despite not having flat feet, when I walked, I pushed my foot down which put pressure on the tibia and ergo the pattella tendon. Swapping to running shoes with a big cushion and an insole made for my foot has helped things a lot.

Best of luck.

[crc]

Thanks. No ive never been to a doctor about this before. I personally think my knees are strange compared to knees i see in other people. I know there is nothing that can be done about the bones anyway.

This is why i havent bothered with a doctor before, because there surely should be no better physio than doing heavy squatting and getting stronger, and i expect to just get fobbed off like i have done with every other ailment ive ever seen the doctor about. So i'd much rather self diagnose, but can only go so far.

There is just a huge lack of information. I cannot find any other examples on the internet where the knees display a highly prominent patella like mine are. Looking at other knees its as if mine are missing a whole area of bulk above the patella.

What sort of feedback did you get when you posted a form check video of your squats? Everything was correct, i.e. it must be an anthropometric issue causing the pain?

[pklancs]

Hi Dan! I came across your pictures and post just now. I too have this - it's called patella alta (high patella). It's generally harmless, but it does leave you with underdeveloped quads and sometimes subluxation. I agree it's very visible, and I've been aware of having it since I was a kid. Try googling it. There are also one or two Youtube videos which people with the problem have posted.

How on earth do you post photos here? I have some I can upload.

Paul

[Frankie]

What sort of feedback did you get when you posted a form check video of your squats? Everything was correct, i.e. it must be an anthropometric issue causing the pain?

Second this. Everyone wants to jump to the conclusion that they are a special snow flake, I speak from personal experience and it's very common on boards. OP, do a form check video or get training - or let us know if this has already happened. You implied the pain only started since you are squatting: Occam's Razor.

I would bet money this fixes the issue. It will save you time and effort and pain and cash and faith in modern medicine.