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Knee Pain (Patello-femoral Syndrome)

Symptoms:

Patello-femoral Syndrome is the most common form of chronic knee pain and is characterised by pain occurring between the patella and the underlying femur. It causes pain and tenderness in the front of the knee. It is also known as Anterior Knee Pain. Patello-femoral pain is worse after sitting for long periods and getting up out of a chair or a car, or when climbing stairs. Some patients may experience a grinding or crunching sensation in the knee joint.

Causes:

Knee pain can be the result of many contributing factors, however, in most cases knee pain is simply caused by wear and tear as a result of the normal degenerative process of ageing. Over the years the cartilage behind the patella will soften and wear out, resulting in small areas of soft tissue breakdown and tearing. Normally the knee cap glides smoothly over the knee with walking and movement. Instead, because of damage and roughening of the cartilage, the patella rubs and grinds against the femur with every movement. This constant grinding leads to partial or complete erosion of the knee cartilage, causing pain and swelling.

In the knee joint there are two pads of cartilaginous tissue designed to disperse friction in the knee joint between the tibia and the femur (the meniscus, plural: menisci). Small pieces of the meniscus may tear away and a torn piece can begin to move inside the knee joint, getting caught between the bones, which in turn leads to pain, swelling and decreased mobility.

Excessive foot pronation also plays a role. As the foot excessively pronates the subtalar joint everts causing internal tibial rotation. The knee is a hinge joint, designed to flex and extend, not to rotate. Therefore internal tibial rotation results in mal-alignment of the



knee joint. When the knee joint tracks incorrectly, it will inevitably lead to excess wear and tear of the soft cartilage, resulting in inflammation and pain.

Another contributing factor to knee pain is muscle imbalance, whereby the inner quadriceps are weaker than the outside quadriceps. The stronger muscles on the outside pull the patella toward the side. Instead of the patella running properly in its groove, the muscle imbalance leads to mal-tracking of the patella, causing cartilage erosion and pain. This condition is also referred to as patella tracking disorder and it can be addressed by doing certain exercises which strengthen the weak muscles.

Treatment:

Physiotherapists have a range of treatment options available including exercises, taping, knee braces, ice therapy etc. In addition orthotic therapy can be useful for patients exhibiting excess pronation. Footlogics orthotics control pronation by correcting and realigning the subtalar joint, which in turns realigns the knee joint, allowing it to track correctly, thus preventing excess wear and tear in the joint, and alleviating associated pain.

Surgery is quite common these days and it usually involves an operation to the meniscus. There are three ways to solve the issue of a damaged meniscus: repair, removal or transplantation. Repair means the tissues are secured together, allowing the tissue to heal and repair itself naturally. Meniscus repair is now a very common form of treatment and the surgery is not very invasive, requiring only a small incision to be made. However when too much damage is done the only option left is to entirely remove the meniscus or parts of it. This is known as a meniscectomy. The problem is that total removal of the meniscus may lead to progressive arthritis of the knee joint and constant pain and swelling. In recent years meniscus transplantation is gaining popularity, replacing the damaged meniscus cartilage with tissue from a human donor. This will help restore normal knee function and it also will help protect the remaining joint surfaces.

Outside Knee & Hip Pain (Iliotibial Band Syndrome)

Symptoms:

Iliotibial Band Syndrome is a common overuse injury in athletes caused by abnormal friction and torsion of the ilio-tibial band over the knee and hip joints. The patient commonly presents with a gradual, rather severe pain on the outside knee joint and in some cases on the outside hip section. For some patients, simply walking up or down stairs can aggravate this condition. The pain usually subsides upon rest but re-occurs with activity.

Causes:

Excessive pronation leads to internal tibial rotation which in turn causes the ilio-tibial band to shear over the lateral femoral condyle. This results in friction, tightness and secondary inflammation.

Treatment:

Footlogics orthotics reduce internal rotation of the tibia as well as the rotation on the knee and hip joint. As a result orthotics will help reduce tractional and frictional forces on the ilio-tibial band. Exercises to strengthen and stretch the ilio-tibial band are also recommended.