knee pain/weakness

I am hoping someone can help. I have a bothersome knee issue that i would like to rehab myself where possible.

Symptoms:

During certain movements I get a sharp pain on the top of the knee cap, probably from the quadricep tendon or that area. This happens in following occasions:

1. if i run, and I don't control my run, step loose or somewhat off balance
2. do an extreme off balance move, usually (but not always) involving the leg bent to an extreme angle, like a very deep squat (no weights)
3. if i put very heavy load on the quadricep muscle, the knee feels week, but does not hurt unless I also combine it with extreme flexing and/or off balance stepping

I noticed that over the past few months, when i walk down the stair, i tend to favor my leg that doesn't have this issue. Also if I do an exercise such as stair stepper type-movement with medium weights (50-60lbs or so), the knee with the problem feels weak and unsure (although it doesn't hurt in this type of movement, unless, again, I do it haphazardly and lose balance).

I did visit a orthopedic surgeon, but I have a hunch he's used to old people and prefers to deal with debilitating issue. My issue is not debilitating, but it can keep me from certain recreational activities (for example, rock climbing). The doctor's statement was that it wasn't something to treat for. Well ok, it may not keep me from walking to the store, but I believe that sports is important... :(


I will keep looking for a good sports medicine practitioner, but in the meanwhilem, can someone suggest:

1. the type of exercised I could perform to rerhab this issue
2. Are there any particular types of OTC braces (Ace, etc) that I could wear to help with this issue?
3. Anything I should avoid? treadmill? Should I switch to something less impact for a while? I already know not to use the machines that force leg extensions under weight, and I was told partial leg presses may be useful. Treadmill by itself does not cause pain unless I step wrong.

Data: Male, 38, 185 lbs, 6ft, used to regularly lift weights until a few years ago, including heavy squats... never felt a pain then, until a year or so after stopping due to... new wife and complicated schedule. :| I am looking to get back into the gym and my outdoor hobbies (mountaineering). I am right handed and footed (judging by past soccer experience), and the issue is in my right knee.

Could lifestyle cause something like this? I noticed a few years ago that I tended to fold my right leg under me when I sat on some chairs. I've been then forcing myself to cut this habit. Could it be an overly-stretched tendon due to this behavior?

Sorry for the long message, i was hoping to give as much info as possible.

Sounds to me like a Patello-femoral tracking dysfunction.
the main form of treatment would generally be to strengthen the quadriceps muscle group specifically VMO (vastus medialis obliqus)
It may be that basically you have always been strong which has meant you haven't had issues and then you stop doing gym / sport and the outer aspect of your quads is strong and tight and the medial aspect is weak. it can also be related to footwear and feet issues but usually if thats the case it will first happen when your a teenager and is usually fixed with orthotics (could be a place to look if strengthening doesn't work)
You can get braces that aim to hold the knee cap stable, they are usually fairly low profile things with a hole in the middle and velcro straps so that you attempt to position the knee cap properly. You can also try strapping the patella (if you google patella strapping i'm sure you'll find a diagram)
As far as quads exercises go basically any exercsies are generally good provided they do not cause your pain - straight leg raising with toes turned slightly out, cycling, leg extensions (low or no weight lots of reps) with toes out and if you can with a ball between your knees, leg press again low weight and again a ball between your knees...... the list goes on and on.

Thank you, that was very helpful. Significantly more than my "specialist" :)
I think he was trying to get at the same thing, but he didn't really care to explain it very well.


The things to stabilize the cap, i have tried one, but i do have a problem where it slides down my quad muscle after a while, and I can't tell if it's positioning things correctly. Is it supposed to support under the cap, over the cap, or just keep the cap from moving too much? Would a compression wrap (with no hole) work just as well, since they seem to be more comfortable, without the velcro straps?