I had this issue on both knee’s. My biggest issue was letting my knee’s break inwards when I did just about anything.

This was due to 2 big things. 1 – Mobility/Flexibility issues; which all of the hip, knee and ankle video’s helped with. 2 – Strength inbalances – I worked on my vmo so much (thinking it was patella femoral) that I neglected the other 3 quads, and needed to catch up. Also I needed to strengthen my glutes and hamstrings.

If you can do a proper squat and you can transfer the external rotation of your femurs to your everyday activities, you should be on the path to success.

The biggest key for me to work on was to engage my glutes and push my knee’s out (once I had the mobility). To go along with some analogies I’ve heard about the body being split up into an engine component and a transmission component, I feel that the glutes act as a clutch.  They really allow you to engage the hamstrings, the inner thigh muscles, and allow for solid support of the lower back.

For long term pain, I really tried to examine my diet/lifestyle and look for things that were causing chronic inflammation, therefore preventing certain joint ailments from fully healing. I have multiple food allergies so I’m really in-tune with these things and I have ot pay attention or I’ll wreck my week of training. Lack of sleep, stress/cortisol levels, alcohol (this was a big cause for me), certain medications or even mineral deficiencies, specific food issues (gluten, overindulgence in dairy, certain roots like tapioca or potato & nightshades, etc for me) etc.

I also found that studying, learning and dedicating myself to learning Pose technique running helped me to place my food down without the pounding and shearing force across the knee- and that was key to getting my knee to stop having kneecap issues.

Good luck with your journey!

Check your gait with video analysis- like the Coach’s Eye app for phones. This way you can look at how your leg is landing, pulling and moving from front, rear and side view. This really helped me to feel what was really happening. And then learning how to improve.

Hi guys, I also have a serious knee problem, my knee caps are pulled to the outside of the knee with pattelar pain as a result. Is strenghtening the VMO( wall sits) and loosin up the patellar pouch and IT band (foam roll) the best way to go? Or is there a better way to solve this problem?

Hey Thomas, here are a few Ideas.
1. Do you have full Terminal End Range Knee Extension? Kelly has a great Flossing video about distracting the leg with a band, performing a quad isometric and internally rotating the tibia while the femur is remaining fixed with overpressure to gain further knee extension. Here is a quick way to know if you are laking this. Check in supine and long sitting – If you have a huge gap under your knees when you are in a relaxed position chances are you’re lacking that end range motion. So not only do you want full extension of the knee, but you also want to have about 5-7* active hyper extension – this depends upon your body type. But here is how to check that – In long sitting you should be able to keep your leg on the ground (not performing partial straight leg raise), activate your quad and kick your heel off of the ground a couple of inches. Again its explained very well in the video.
2. Do you have full Hip Extension ROM? If you are limited in Hip extension you can get stuck in a all the time slow death position of slight hip flexion which will also result in knee flexion. A result of this is that it puts a ton more stress on your patella and quad/patellar tendons. Even worse is that it increases the wear down of your cartilage on the back of your patella. So fix it if this is a probelm.
3. Patella not gliding well- mainly up and down but also side to side. If the patella is not tracking up and down correctly it can cause it to do messed up stuff and get angry and be the cause of limited Knee ROM for both flexion and extension.
4. Intra quad/hamstring/Adductor intra muscular movement? – Are your muscles in these regions tacked down on each other or are they gliding smoothly over one another? If they are stiff/stuck/tacked on each othere then they will be painful when you do soft tissue mobs on them. Same goes for the muscles below the knee.
5. With my patients I don’t worry so much about “Isolating the VMO” to help with patellar tracking. Reason why is that all the current PT research shows you get the same benefit of activating the VMO with regular quad strengthening. They are a group and groups work together. So don’t worry so much about Isolating the VMO. Be much more concerned with body mechanics like locking in your ankles through your hips creating troque force. Body mechanics will be huge for you. Strengthen with proper technique and you will me in a much better position.

These are just a few quick thoughts to cover. Really there is a lot more that plays into it, but I hope you find these few tips helpful.

Drew Cook

Hi Drew, thanks for the big response! Made me look in other directions, I’m already missing a big piece of hip extension, no wonder why my knees need to work that hard! As you said my mechanics suck, years and years of basketbal mold me into an old man, still 23 do 🙂 Its hard to program my mobility because I’m missing pieces about everywhere, definitly ‘afraid’ of my hip mobs because I don’t know the atanomy of it and scared to overdo or wind up in a bad mob position.

Greetings Thomas

Hey Thomas, really quick thoughts. First don’t be discouraged that you are tight and immobile every where… atleast you know that you are tight. Everyone has a start point. Second remember the Tourtise and the Hare book… The hare starts off fast but doesn’t finish, but the tourtise is constant and finishes the race. So be the tourtise with addressing the stiffness and tightness. Third, Kelly’s mobility course is amazing if you ever get a chance to go to it. I completely agree with him and a fellow physiotherapist. One of his statements is to organize centrally to promote stability peripherally. I.e. Get your spine organized in good mechanics and engaged which will have a carry over effect to your arms and legs then get them organized. I think it wouldn’t be a stretch to take this strategy with addressing your problems of the knee. So start Centrally (Spine/Hips) and then progressively work outwards (to the knee then calf then foot). as you are able. Make progress like the tourtise on the hip and then when its time move down the chain. I’ll get some more stuff to you soon in helping understand the anatomy and with mobs.

Drew Cook

Allright thanks a lot Drew!