Daily Mobility Exercises by Dr. Kelly Starrett Forums Knee Kneecap Pressure – Patellar Tracking Issue?


Viewing 27 reply threads
  • Author
    • #70613
      Avatar[email protected]

      Hi everyone, 

      I’ve recently developed a knee issue that I can’t seem to figure out. The first sign of trouble came while taking exaggerated steps upstairs; I believe I overloaded the joint and immediately felt a sharp pain to medial side of the knee. There was no pain when walking on flat ground or bending the knee, no swelling, and after taking it easy for a day or two I was able to walk up stairs without issue. About a week later, I felt a strange pressure developing in the knee region and loss of terminal knee extension. 

      This has persisted for the past week and I have been mobilizing with almost every technique I can find with little change (except for terminal knee extension, which resets itself afterward). There is no obvious swelling, no sharp pain/tenderness to touch, although the patellar tendon does feel a little tight. I have a history of poor lower body mobility so I have been working extra hard to stay loose. I’ve added static glute and quad contractions in order to get the system firing correctly and mobilize the VMO, and I’ve been working on terminal knee extension multiple times per day.
      I recently tried voodoo flossing the patellar tendon and this provided momentary relief from symptoms; I didn’t squat while using the bands yet, as I’m unsure if squatting will cause further injury. I have an initial appointment with a physician on Friday to get their opinion and I’m considering seeing a Chiro just to rule out any musculoskeletal issues, although I’m wondering if I should instead go straight to a PT. Thanks for reading, any advice is welcomed.
    • #73315
      AvatarNathan Richer

      If there is any pain, then go to see a clinician first to rule out anything serious.

      I personally would go to a PT first. While physicians may know about the issues, I have found that PTs can get you back on track faster and better.
    • #73317
      Avatar[email protected]

      Thanks, David. The physician advised me to cycle Ibuprofen for a month and see what happens. When I mentioned Dr. Starrett’s research and findings she almost blew a gasket in disgust and bewilderment. As much as I don’t want to jump on the ibuprofen train, there seems to be some underlying inflammation that just won’t calm down, so perhaps I’ll give it a run for a week and see what happens. 

    • #73318
      AvatarNathan Richer

      My general rule is if a doctor or some clinician prescribes a drug to you, then it’s probably ok under their supervision.  Taking ibuprofen every day on your own to combat the effects of training is a bad idea.

      Also the world of medicine and training changes daily.  What is dogma today can be tomorrow’s outdated, or even wrong info…
    • #73320

      I think you need to see someone like Kelly. An athlete who has studied the human body, and has experience treating people without the use of drugs.

      Ultimately, the drug can still only put a bandaid on an issue. There’s still something that caused and most likely will continue to cause the issue after you finish your cycle of ibuprofen.

      That being said, Kelly always speaks to this “model” of human movement. His view takes on the lens of viewing the body as a machine. This machine was designed to work in many ways and at various capacities. However, Kelly’s emphasis of study and education is based on finding the most optimal, for performance AND stability. His approach takes into account the dynamics of physics and gravity (much like oly lifters do) in direct relation to the moving parts, “gizmo’s”, and levers that compose the “system of systems”.

      This “model” however relies on some level of healthy tissue. You can be injured in a way that going through “proper” movements may still cause pain. I’ve learned that there’s a balance in biomechanics. One part is going through a movement with good form, the other is engaging the right muscles at the right time in the right way. Sometimes you can’t always get the latter part to kick off because of a bad muscular imbalance, a small but substantial injury, or just really bad neuromuscular control.

      The fix: A trained individual that knows the body very well and that can diagnose issues without needing to resort to drugs on measuring devices.

      While the human body is a phenomenal piece of machinery, it isn’t always that difficult to diagnose issues within it. I think Kelly believes in this, and he’s trying to show us how.

      You’re eager to learn, now you just have to find the right person in the field that can help you understand. I went to 3 different doctors and 2 physical therapists before studying this stuff extensively. There’s a lot of “useless” (for lack of a better word) professionals out there that you have to wade through to get a good product.

    • #73332
      Avatar[email protected]


      Thank you for the great response, I believe you’ve hit the nail on the head.
       I’ve learned that there’s a balance in biomechanics. One part is going through a movement with good form, the other is engaging the right muscles at the right time in the right way. Sometimes you can’t always get the latter part to kick off because of a bad muscular imbalance, a small but substantial injury, or just really bad neuromuscular control.”

      I’ve had a sneaking suspicion that there’s been a bigger issue, and I’m leaning towards this being a combination of muscular imbalance (years of not strength training legs), neuromuscular control issues (firing order), and inflammation of the patellar tendon. Just trying to do VMO isolation work was tough, even more so on the good leg! I’ve started implementing banded distraction into the terminal knee extensions, which feels like it’s making some positive change. As I previously mentioned, the patellar tendon still seems slightly inflamed, although there is no direct pain to touch (which makes me wonder about the severity).

      Overall, things are starting to slowly improve. I’m still hesitant to start squatting, although I feel like it wouldn’t put me in pain to do so, so maybe I should start hitting the double voodoo band squat. I’m going to look into seeing a Neurokinetic Therapist next week, hopefully one who has a strength training/crossfit background. I’m paying for years of underdeveloped leg muscles and a series of events which put me on the couch/sitting at the computer more than I wanted to over the past year. In 6 months of trying to get things going again I’ve had 5 setbacks 🙁 – optimism is hard to come by these days!

    • #73334

      I hear ya man. My case is about 90% similar to yours.

      Have you tried single leg extensions with a weight for squeezing out 5 reps? I’ve been doing these all along and they’ve done a few things for me.

      1 – They have helped repair the patella tendon, I feel in a similar way that eccentric decline squats help to rehab the tendon. By stretching and pulling at it to increase blood flow and break down scar tissue.
      2 – They have helped get the timing, in particular of the VMO, of all 4 quads to fire in unison and keep the tibia rotating around the knee joint in proper alignment. It’s actually pretty interesting, because sometimes having an injured tendon can provide direct feedback – when I time all 4 quads right, my tendon won’t feel pain, but the moment my VMO fires late, or my upper quads aren’t really engaging because maybe I’ve dropped my posture from the glutes up, my tendon lights right up with pain to tell me something is wrong.

      When you do them:
          -Sit with proper posture in the upper body and tight glutes.
          -Don’t point your toe, pull it back as far as possible.
          -Make sure you’re still using the principles and torque through external rotation.
                  You should feel that you have to rotate your leg a bit and put some tension at your knee to get your quads to really pull in good balance on your patella.
          -Lastly, (I’d like to know what happens to you) focus on really using all the muscles around your knee. When I do this, it really kicks my VMO in earlier than it normally would, and I can feel that side of the patella pull in unison with the outside part of the patella. Also, I almost always feel and hear the inside (VMO) part of the patella crack and kind of tear for the first few reps. Sometimes I can get this same crack and tear to happen if I just block the upper part of my foot on something heavy and flex my quad hard in a gradual manner. After a few reps of the tearing and stretching of the actual tendon, the rest are nice and smooth.

      Let me know if you give the extensions a try and if you think they give you similar benefits.

      I really don’t like the idea of isolation training – but for the purposes of correcting muscular imbalances, I think they can be well utilized. Once the balance is achieved, I would think the training would shift to jump boxes which still focus on a stable spine and upper body, with the power coming from the legs, and the intensities can now vary from a single weight, to an environment of higher variables. Then also start an overall strengthening program that involves various compound lifts and keep the isolation work to a minimum.

    • #73374
      Avatar[email protected]

      Thanks for all the great advice. I’ve started to make positive change, but a new issue has developed. While working terminal knee extension, I’m feeling pain in the kneecap at full range. Could I be possible be working this too much, or perhaps have aggravated the PCL?

    • #73399

      My gut tells me to focus on using a lax ball to tack the hamstring muscles while sitting and going through leg extension ROM.

      Also, focus on rolling side to side the back of the knee, and the area’s just above and below. Make sure you’re rolling as far as possible so that you’re almost rolling the side of the knee.

      Hit up the suprapatella pouch with a roller and the front of the tibia.

      Let me know if you feel any relief from about 15-20 minutes of the above.

    • #73407
    • #73429

      A good alternative to NSAIDs it wobenzym. Take a look at it. Its an enzyme supplement with a lot of positive testimonials.

    • #73433
      Avatar[email protected]

      Thanks everyone for keeping the great advice coming. The past week has yielded excellent positive change, and for the first time in a while I feel like my quads are alive and working as they should be. I can now contract the VMO with both legs on command without issue, and I no longer have pressure in the knee.

      My lower body mobility still has a long way to go; it seems as though once I free up an area, the muscle quickly reverts back to it’s junky state. Trying to reverse years of abuse + lack of mobility work is challenging and intimidating, I wish I knew about this years ago, but better late than never!

    • #73435

      What do you think addressed the issues the best?

    • #73443

      Great to hear of your improvements.
      Yes, the tissue may revert to old positioning because you are changing positional habits.
      As with breaking any habit it can be tough.
      Keep working with it.

    • #73719
      Avatar[email protected]

      Hey guys, 

      One month later, I’m disappointed to report that there is still an issue, although I have learned a lot in the meantime and believe I am ultimately on the path to a more supple future. I’ve leaned towards thinking that the root problem is originating almost entirely upstream. I’ve been focusing a lot on solid neutral posture, not sitting so much, and implementing all of the mobility techniques in the arsenal. Here’s what I’ve discovered:
      – Horrible standing posture, no glute activation, anterior pelvic tilt (for a very long period of time).
      *Have corrected.

      – Right glute & hip flexors were frozen & tacked down; glute contraction was vastly different from the left (almost non existent on the right), could not generate torque on the right side.
      *Have made improvement, can now generate torque and I’m feeling the R glute. Still feels slightly inhibited.

      – Bouts of extreme rectus femurs tightness.
      *Hammered the quads, TFL, adductors, etc.

      – Hamstrings incredibly short and tight.
      *This is the tough one, years of stiffness to work through, implemented PNF’ing and band work. My straight leg raise while lying on my back gets about 2.5-3ft off the ground. I cannot straighten my leg when doing seated hamstring smash and floss with a lax ball 
      In short, it’s a mess. I’ve taken steps towards targeting everything, there have been good days and bad, but I haven’t been able to resume training – which has been the goal for the past 6 months (injury roadblocks). I find that targeting the glute stiffness on my own is difficult, although I did have some massage work done and everything felt completely relieved for a short period of time afterwards.
      At this point I’m not really sure what steps to take next, other than continue with mobility work and go see a PT. I did some air squats yesterday just to see how the system was functioning; no pain in the knee itself, but tightness was felt below the kneecap in the patellar tendon. I’ll tell you what, the past month has felt like a year. Between this and a chronic forearm problem I’m certainly feeling desperation kicking in. I can’t believe I let myself go down this road and get so far off track! I used to burn through the benchmark WOD’s like it was my job, now I feel like a tacked down brokedi**. Sorry to vent, but this is the only outlet where I feel like some people might be able to relate.
    • #73721
      AvatarNathan Richer

      hey man it sounds like great progress.  unfortunately as you’ve discovered, it can take an annoyingly long time, especially to reverse problems that have been around for a while, especially those that become neurological and while some releases do improve the neurological, i have found that even after releasing some muscles, the neurological problems are still there and require other modalities to fix.

      keep it up and as Kstarr says, don’t take a day off from smashing and mob-ing. be careful when working out of course that your stiffness doesn’t create a larger injury while you’re trying to fix things…
    • #73724

      I am in a similiar situation except over 6 years into my injury still and I still haven’t recovered.

      My advice:
      1. Try avoid sitting as much as possible (atleast until you reverse your sittuation), sitting wrecks havick on your hip flexors
      2. Get an Ultrasound to rule out soft tissue damage
      3. Get an x-ray to look at the tracking and joint space
      4. Buy a set of suction cups and start adding suctions cupping as one of your tools to self-myofascial release your tight muscles
      5. Go see a chiro or osteopath to rule out pelvic, spine alignment issues and leg length discrepency.They can also work on aligning the body and help mobilizing tissue.
      6. Do atleast 2 mobs a day
      7. If possible find someone who can do electrically stimulated trigger point dry needling (electroacupuncture/PENS)
      8. Try supplementing with Serrapeptase: its fibrolytic enzyme that decreases scar tissue in the body, helps with flexibility and inflammation. 
      You say you corrected your anterior pelvic tilt? Congratulations. How did you manage to correct it within 1 month. 
    • #73732
      AvatarNathan Webster

      Have you gotten your meniscus checked out?

    • #73739
      Avatar[email protected]

      Kefu – 

      Thanks for the wealth of additional advice! I’m sorry to hear that you’ve been dealing with that for so long, how does it affect your training and what treatment have you had most success with? I hadn’t heard of cupping before, I’ll definitely take a look at implementing that and other techniques you’ve mentioned. I’m hoping I caught onto the mistakes I was making early enough before too much damage was done. This all hit me during a period of inactivity and excessive couch sitting; my lifestyle has changed (for the better) and I’m hoping the increased activity paired with correct movement will help me get back into training very soon. Regarding the pelvic tilt, I believe the main thing which has helped me to start correcting this is simply enforcing the postural bracing sequence and activating my glutes. It’s a daily fight for positioning, but I can feel my body adapting to the new changes.
      I haven’t had the meniscus checked out, nor have I been able to get any imaging done. They didn’t suspect and ligament damage or anything serious enough which would warrant further examination. I’m going through the VA and they are very hesitant to spend any more money on you than they already have to – perhaps after I see one of their physical therapists they might recommend having something done. 
      Thanks again for the solid recommendations and words of encouragement. I dislike all this woe-is-me’ing, I know there are others who have it much worse, I just look forward to being competitive once again and reclaiming my physical potential. 
    • #73827
      Avatar[email protected]


      I haven’t walked right in over two months now, positive progress is lost. What recommendations do you have for the next step? Would it be more bang for the buck to go see Roop over at SFCF or see a sports medicine physician? The VA scheduled me to see a PT…in a month and a half.
    • #73828

      You should make an appointment to see a doctor.
      Who/what type of professional you see would depend on the situation, and the information you have about your situation. What are you dealing with? This information will help set direction to your course of action.
      Have you seen a doctor yet?

    • #73829
      Avatar[email protected]

      Hi Kaitlin,

      I have seen a doctor, they did not make a diagnosis, in their opinion there was no evidence of ligament/significant damage (enough to warrant imaging or further treatment), and sent me on my way.
      I don’t know what I’m dealing with, sometimes the patellar tendon area gets tight, sometimes the suprapatellar pouch feels junky (especially on the medial side). I’ve flossed/tacked/voodoo flossed/stretched/banded distraction/ up & down stream –  in short, I’ve reached the end range of my ability to treat this.
      I would not describe this as pain, just the “junky” feeling of a machine running without proper lubrication/off alignment. I can squat without sharp pain, just excessive tightness and discomfort.
    • #73831

      Have you considered seeing another doctor?
      You could ask around at the gym you attend if anyone has recommendations.
      Have you had anyone look at your technique on the skills where you experience this issue?
      Episode 352: Dealing With Old Junky Tissue
      How many times during the day are you spending time with mobility?

    • #73834
      AvatarNathan Richer

      I know a great PT in SF if you need one – check out Hal Rosenberg at http://www.chiromedicalgroup.com/.  I assumed you were close by to SF Bay if you said you could see Roop… or see Roop – i thought i saw him post his official PT certification on instagram or twitter just recently…!

    • #74004
      Avatar[email protected]

      Thanks for the recommendations.

      Nothing’s changed in the past few weeks, in fact it seems to be getting worse; this evening I’m experiencing unusual redness and warmth to touch of the kneecap. Any idea what this could be indicators of, other than general irritation? Bursitis?
    • #74005
      Avatar[email protected]

      Here’s a current image, WTF is going on w/ my right knee!? The visual offset is pretty concerning. 

    • #74037

      Regarding the pelvic tilt, I believe the main thing which has helped me to start correcting this is simply enforcing the postural bracing sequence and activating my glutes. It’s a daily fight for positioning, but I can feel my body adapting to the new changes:

      What do you mean by enforcing the postural bracing sequence? What is the postural bracing sequence?
    • #74053
      Avatar[email protected]

      The sequence Kelly describes in Chapter 2 of BASL: feet straight, butt squeezed (setting the pelvic in neutral/hips external rotation), ribcage down in order to align with pelvis, belly tight, head in neutral, shoulders externally rotated, etc.

      No takers on the image above?
Viewing 27 reply threads
  • You must be logged in to reply to this topic.