T Nation

knee problems

I have been diagnosed with a tracking problem in both knees.The doctor said that the outside thighs are overdeveloped and causing my knees to track towards the outside.I’ve been to a physical therapist twice so far and she has me doing leg lifts,toes up $ toes out,no wieght 15 reps 3 sets.Are there any other exercises that will help? She said no squats,deads etc. There’s got to be something more I can do. Would ART be of use for this kind of condition?

I had the same problem in high school and the physical therapist had me doing the same exercises back then (1988). I eventually had arthroscopic surgery (lateral release). It was done as an outpatient procedure, and made a huge difference.

How do you squat? If you squat with wide foot placement, try squatting very narrow until the tracking corrects itself. I’ve delt with this for about 10 years now. There are some tricks you can do to minimize it or eleviate it. Most PT’s aren’t to progressive. Let me know how it goes.

If the assesment was correct, you would probably benefit from squats and deadlifts, provided they are done with a wide stance. However I have talked with more than enough physical therapists/massage therapists who diagnose EVERY lateral knee tracking scenario as an overdeveloped vastus lateralis, when that may not be the case. You may have chronicaly tight external rotators of the femur, and underdeveloped internal rotators. Only thing is, this can be tricky to fix (if it’s even the case). The posterior fibers of the gluteus medius are lateral rotators(what you want to loosen), but the anterior fibers are medial rotators, and the gluteus minimus is also a medial rotator of the femur. Try stretching just the posterior fibers of your glut med! In a perfect world you could stretch just the gemelli, piriformis, and post. glut med, while strengthening the obturators, pectinius, adductors, vastus medialis, and gracillis. In fact, the whole problem could even stem from a tight gracillis, since it can medialy rotate the tibia on the femur, causing your foot to point inward! The answer…stretch everything at and around the hip joint, and get an ART or a neuromuscular CMT to palpate and find where the problem lies. The prescribed leg lifts should have retired in the 80’s where they belong. Maybe Dr Ken Kinakin can chime in, I’d like to hear what he says.


Thanks for the plug Goldberg. Sometimes it gets a little old trying to explain ART every other minute or so. I talked to your Doc the other week. I’m sure he’d appreciate you preaching the gospel. Thanks again.

outside thighs overdeveloped? In other words, there is an imbalance somewhere and something is out of whack because of it. I’ve become more and more convinced that a lot of problems just have more to do with culturally-encouraged dysfunctions rather than some type of great medical problem. First thing I would do is see an ART practitioner, they can probably do some great things to start you off. Then, I’d pick up Pete Egoscue’s book ‘Method of Health through Motion’ where he discusses the various deviations and imbalances common in ‘technological’ societies. I’m taking most of this month off from lifting (bodyweight only and medicine ball work) and doing a lot of the exercises in his book to get my pelvis/hips properly aligned as well as adjust an imbalance in my torso rotation. for what its worth, the exercises and ideas in his book have worked well for me, in the short time i’ve been using them, my shoulders are closer to level with each other, i’m experiencing less pain in my traps/neck, and my feet are not everting as much when i walk.

I just saw an infomercial for phase4 orthotics,if I do have some kind of imbalance could these help or are these BS.I’m a sorter at UPS and stand for about 5 hrs which seems to aggravate the problem even though I’m not really bending my knees.
Thanks for the imput so far

You must have a pretty severe imbalance for those leg lifts to be doing anything significant. Bicycling can do a lot to balance the strength of the quad muscles, just make sure you have the seat adjusted to the right height (too low will exacerbate the problem). I know in my case, when I started riding, all my knee problems disappeared.

SA… the shoes will only mask the symptoms of dysfunction for so long. Its like the people who do squats with their heels on plates. Its masking an imbalance but in the long run the only thing that really ‘helps’ is to correct the imbalance.