Correcting Patella Tilt Non-Surgically

[ridgeline]

I have mild (to moderate) patella tilt which i've stated in other threads.
I am considering an LR and have read tons on this website and the internet in general (which can be a good or bad thing).

Historically I have not had much knee pain other than a baker's cyst, until recently. Since I have mild to moderate tilt, I am trying to find experiences of correcting this non-surgically as it is hard to find much good info.

So, anyone out there alleviate symptoms, or tilt all together via non-surgical methods?
It almost seems strange that due to tight muscles, tendons, ligaments that cutting into them is some OSs first choice.

What about message therapy, yoga, ART, etc.?
And can mild patella tilt actually be helped non-surgically?
Or would surgery be the best option (for my case - mild/moderate tilt)

Curios....And thanks
jeff

[Jessyca]

I would encourage you to try physical therapy. They will be able to show you exercises specifically to strengthen the muscles necessary to hold the patella in the right place. I think I was initially told to try 8 weeks (3x per week) of intensive PT.

Massage therapy and yoga may help, but with PT the physios will know what exercises will help the most.

[ksi]

Hi Jeff
I also have patella tilt and from what I've been told, the main cause of this is a tight illiotibial band and a tight lateral retinaculum. Exercising the inner thigh muscles and stretching the illiotibial band usually help. The physiotherapist I go to usually uses ultrasound to release the tightness in my IT band and that sometimes helps for a couple of days. Otherwise massage, acupressure and yoga are good. I tried yoga for a while and it did help, although there were some things that caused my knee to hurt.
Anyway some good exercises for your inner thighs:
- rest your back against a wall and put a ball (football size) between your knees and slide down the wall a little whilst squeezing the ball.
- whilst sitting down, lift your leg in front of you whilst having your foot turned slightly outwards.

I hope this helped

[ridgeline]

Thank you for the replies.
I have often heard of the need to strengthen the muscle structures, but not sure that is my problem as I am an athlete and legs are very strong, though tight.

I'll have to research more, but don't really understand how strengthening the VMO on someone with lateral patella tilt would help - if anything it would continue to push the patella in the lateral direction and the intent of the lateral release is to get it to move more medially, no? I'm sure I'm wrong on this, just trying to understand it.

Ironically, trying to strengthen my VMO really worsended my condition and I have been very limited mobility wise for several months since I started that routine.

As well, how is it possible, after running 5 ultra marathons last year with zero knee pain in my "good" knee that it now hurts like hell after essentially 3 months of rest! arrghh... maybe due to overcompensation?

frustrated...

[madel23]

With many athletes (myself included) the lateral quads are stronger than the VMO, and this causes the patella to tilt laterally. Therefore, loosening the lateral structures and strengthening the VMO should improve things. I would definitely give PT a try before surgery. Does your patella tilt only when you bend your knee, or also when it is straight. If the former, I would think you can avoid surgery.

Madeline

[ksi]

I can see what you mean about strengthening the VMO, but many people that have patellofemoral get it due to a muscle imbalance - the outer thigh muscles are stronger than the inner. Due to the imbalance, the tighter outer thigh muscles pull the patella out or tilt it and the inner thigh muscles aren't strong enough to pull it back. This may not apply to you, but a physiotherapist may help you to find the problems that are causing the patella tilt. Another thing that can cause patellofemoral is the feet - so shoes that support the foot are important.

[ridgeline]

Madeline -
i'm not sure... I've had an MRI and xray, and the tilt shows on the MRI so the knee was straight. On the xray it appeared to sit in the groove without tilt. Not sure what that means.

ksi - thanks, your description makes sense. Although, now after really injuring my knee (there is some patella thickening which I assume means scaring, and effusion causing a bunch of pain) i'm kind of worried about doing more VMO exercises.

[Silkncardcrafts]

Hi Jeff,

My understanding is that patella tilt can not be fixed apart from having surgery.

Sounds like your muscles are really strong. So, probably can't do a lot more.

The best type of scan for patella problems is actually a CT scan. Have you had one of those yet ?

One other thing you may want to try is clinical pilates. I have found it to really help.

Would also urge you to seek out another opinion from a patello-femoral specialist. Whereabouts are you located ?

[ridgeline]

Silkncardcrafts -
I've have to look into the pilates, sounds fun.

I live in western, MA .. happy to get a doc recc., though as I've stated previously I really like my guy and his assessment was backed up by a second opinion from Umass center that treat a lot of pro athletes.. Doesn't mean they're right though...

currently i am considering the surgery to have someone in there with a first hand look - not pictures. not a good reason i know, but feeling like I need to take some action.

[Silkncardcrafts]

Hi Jeff,

In the U.S. it may be called rehab pilates, not totally sure. Another option would be to go and see a physiatrist or a sports physician. They may have some other ideas.

Excuse my ignorance, but what does MA stand for ? What other states is it close to ?

You have obviously exhausted a lot of conservative treatment. It may be worth considering an arthroscope. Would be asking about some CT scans first though. They will tell the real story.

[ridgeline]

Silkncardcrafts -
sorry MA = Massachusetts.

I see you've had more than 1 LR and fixes!
I'm nervous about the LR mainly due to this board. It was very similar when my mother has breast cancer...the internet, though amazing, was almost the worst thing. Too many different experiences that are not analogous, or outdated discussions of technology, success rates, etc...

my ortho, who is a little arrogant/very confident which i actually like, is perplexed by the stories i tell him i read about. He said LRs fail 1) because of poor selection and 2) bad surgeons and guarantees me it won't make me any worse, but no promises it will make me better.
His rehab time frame is also a lot less than others 1-2 months, on a bike in 4 weeks he said. I questioned this and he said he is not very aggresive with the release. My original issue is a Baker's Cyst...maybe the tilt is causing it?

I don't know... either he is a BS artist and doesn't know his stuff or he does and I am in good hands.
Which one is pretty important! ha

[Silkncardcrafts]

Hi Jeff,

It concerns me that your OS is alarmed about the failures with a LR. In most cases they go to plan, but there are always risks with any operation. Unfortunately, there is no magical wand your OS can wave.

If the LR is done for the right reasons there is no reason why it shouldn't work.

I unfortunately am one of the rare cases where I developed medial instability from the lateral release. My surgeon does a lot of LR's and have been the only patient of his to develop this.

Your OS is sooooo unrealistic about the timeframe it isn't even funny !!!

I would be getting another opinion definitely.

Not sure whether they are too far, but do know of some good OS's in MI.

[Heathers_new_knee]

Hey Jeff~
Your thread caught my eye as I'm facing similair issues. I was in an auto accident and severely shattered the left kneecap. The right one took a blow too, though. Bruised and banged up but, has progressively gotten worse over the past 2 yrs. Did you ever hit your knee on anything?

So, I thought I'd share here. I've been in PT almost continuously since July 07 and have been doing similtanous exercises with BOTH legs. My right leg has actually become VERY strong and the muscles are just massive now. Guess because it's taken the majority of the work-load with the left one's injury, too. However, the tilt/lateral tracking problem is no better. Do you experience the popping and grinding of the kneecap, too? It's a mechanical problem of the knee so, bracing or McConnell taping hasn't completely "held" either of them in place...they just have a mind of their own, I guess. The extensive surgery that the left one had in Jan. 09 has been successful for the most part. Just some medial catching but, re-strengthening now might help it. Just workin hard and waiting now.

If you're worried about the LR, you might ask your OS his statistic rates of success with them out of how many. You "can" always get a 2nd opinion if you're still unsure, too. I also agree about seeing someone who's experienced in patellofemoral issues and has a decent track record if your OS doesn't do many LR's. Just my 2 cents but, each OS can have their own tweaks in variations of the how-to's with this stuff. Sue (ghost) is from Massachusetts and is preparing for PFJR right now. She might be able to offer some insight on her doc if you're curious, too. Hope this helps!! Take care!!

Heather

[han_3]

Hi Jeff,

It's a bit of a delayed reply I know but here's my 2p for what it's worth...

If you're an athlete then the muscles get tight really quickly form the training, there's a chance that you don't even notice quite how tight things have got. This is especially true of the IT band for which the 'stretch' cannot be truely felt. It's really important to keep doing the PT stretches for your IT band as this may well improve the tilt (which I'm assuming is causing you some problems). A good PT can advise you on appropriate stretches and taping procedures.

Taping works for some people and not others - I personally found it to cause more problems than it solved with my knee. With regard to building muscle strength, I found that my sport and strengthening exercises were pretty useless because after my 3rd dislocation the PT discovered that I wasn't engaging the right muscle in the right place. Moral of that story is to seek expert advice (and get them to check) on you engaging muscles correctly. Yoga seems to be working for me in that it keeps everything stretched out and I'm more aware of when muscles are tightening up but there are some positions you will need to avoid. A good yoga instructor will be able to both advise you on this and give you a suitable alternative position.

Good luck with everything anyhow

[NadiaMac]

Jeff:
Sorry, late to this thread. did you end up going with the LR? Did you get any info on nonsurgical alternatives?

I'm in a similar situation, in that I've never had knee problems, but now face a possible LR (further to knee injury from impact, in my case). My OS suggested that I might be able to rehab the knee with serious soft-tissue work, but no guarantees and he says it could take longer than rehab from a mild LR (which he said would be 7 months!).