Ossi Schmidt: lateral patella malalignment & old shoulder injuries

Hey Ossi,

Have you any experience of lateral patella malalignment?

I had key hole surgery in May 2010 that discovered the above problem and instead of going for realignment surgery like my surgeon advised, I decided to go the physio route and worked on rebalancing muscles, strengthening hip and glute muscles for 3/4 months. I returned to the field with reduced pain initially but now the pain is overwhelming and I have to take painkillers before training. It's even uncomfortable when walking and I also sometimes get a dull pain while sitting/resting.

Do I go for the surgery? Or do I go back to rehab in the off-season and try to minimise the pain once again?

Thanks and kind regards,

Philip

Hi Philip,

A very debilitating injury this is - as Yoda might say. If you were in front of me I wouldn't have to ask this, but I do wonder what age you are? Were the findings of the arthroscopy just lateral patellar malalignment as you say or was there a suggestion of developing chondromalacia patellae?

Lateral gliding of the patella causes contact with the lateral epicondyle of the femur every time you bend and straighten your knee. That causes friction, wear and tear, inflammation i.e. pain. The only effective remedy is getting the patella back into the central position in alignment with the femoral groove. Muscle strengthening - in this case the medial muscle belly of the quadriceps at the front of your thigh (VMO) - is the long term exercise to protect your knee cap from further wear and tear. In the short-term McConnell Taping is the answer to get you to the end of the season. But you will probably be working on a maintenance programme of your muscle balance for the rest of your sporting days.

Get somebody to teach you the taping technique and get back to the gym asap.

Ossi

Hi Ossi,

I was wondering if you could help, I have an injury on my shoulder that I have had for about 10 years, It is on the back of my shoulder just above the bone. The problem is that when you touch it its incredibly painful but appart from that I wouldnt feel it at all. I can lift things, play sports with out a bother but if someone touches me there I will fold like an accordion. But once or twice a year the pain will spread and I can barley use my arm for about a day or two and then it goes back to normal.

I have seen 3 different physiotherapists with this problem each tried to massage it out (which is very painful) one has even tried acupuncture on it which only worked for a few days and it was back to normal, all of them gave me basically the same exercises that I followed but they never worked. Have you any idea what this could be and how do I get rid of it ??

Any help would be great.

Regards

Thomas

How frustrating Thomas.

You call your pain/complaint an injury. That would suggest a history of some kind, which caused this to develop. So here are the first questions:

Was there any sudden cause/onset or did it develop gradually?

Are you relating this to some kind of sporting activity?

What sport do/did you play?

Perhaps it comes from the kind of work you do?

In the absence of your answers and a series of tests, I will have to surmise that the structure in question is your levator scapulae - the muscle that lifts your shoulder blade towards your ear. That muscle is notoriously over-worked due to our preponderance of sitting. I am making an assumption that you've developed deposits of lactic acid in that muscle, which makes the muscle very hard and painful to the touch. Why this should only happen on one side (which side? by the way - are you right-or left-handed? Is it on your dominant side? Do you hold your phone in the crook of your neck while typing on the computer? etc.) depends on the answers to the questions in brackets above.

Having these deposits broken down is very painful and requires a long series of massage, along with regular arm/shoulder exercises such as swimming, racket sports, shoulder rolls and neck stretches along with changes in work practices - if that's where the origin of the problem lies.

I'm sorry Thomas if all of the above sounds too simple or too tedious to accept, but in the absence of more specifics, I'm afraid I have no other suggestions.

Please feel free to call me,

Ossi

Ossi is a chartered physiotherapist. His practice is Brookfield Physiotherapy & Sports Injury Clinic, is located at Ardmanning Avenue, Togher Road, Cork. Tel: 021-4962268

To ask Ossi a question just send fire it off to shout@joe.ie with 'Sports Injury Q&A' in the subject line, and he'll get back to you in the coming weeks.