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Knee Pain – Patello Femoral Pain Syndrome

Knee Pain – Patello Femoral Pain Syndrome

PFPS (Patello Femoral Pain Syndrome) is one of the common knee pain condition affecting active population of all age groups. It is found more in women because of wider pelvis which changes the direction of forces acting on knee joint.

Patella (knee cap) sits in a groove which is present in the lower part of thigh bone (femur). In a normal knee it glides up and down in the groove smoothly, whenever there is knee bending and straightening movement, such as going up and down stairs. However, in an affected knee the patella moves out of the groove causing friction between the two bones which eventually results in pain. Pain can vary from dull ache to sharp pain, which might be accompanied by clicking or momentary weakness in knee joint.




Knee cap is held in position with a good balance between outer and inner structures around the knee cap. Structures which are responsible for movement around the knee are the muscles. The muscle present in front of the thigh is known as quadriceps, as it has four prevailing muscles. Any imbalance between these 4 muscles can change the way the patella moves.

Contributing factors:

  • Poor lower limb mechanics due to
    • Increased foot pronation (foot  flattening)
    • Decrease lumbopelvic (lower-back and hip area) stability due to weak core (abdominal) and gluteal (hip) muscles
    • Decrease VMO (vastus medialis obliques) activity, the inner most muscle of quadriceps




  • Incorrect footwear
  • Muscle tightness; specially increase in Vastus lateralis (outer most muscle of quadriceps) and Illiotibial band (ITB) tightness/activity. ITB is a connective tissue band present on the outer thigh
  • Tight hip flexors and Tensor fascia latae muscle
  • Poor sporting technique/ergonomics
  • Heel strike running pattern increases GRF (ground reaction force)
  • Over-training
  • Sudden increase in training intensity/frequency

Treatment options – Click here



Ankle Mobility – Significance in Injury Prevention

Ankle mobility and its significance in injury prevention

Let it be walking, running, jumping or landing, ankle is the first major joint, from where the forces are transferred up in the body. So it makes the ankle joint a lot more important than what people think of it. Ankle joint is often overlooked while dealing with conditions occurring at knee joint, hip joint or lower back. Primarily ankle joint movements include dorsiflexion (toes coming closer to shin) and plantar flexion (tip toeing) (Fig 1 & 2). Limited dorsiflexion at ankle joint affects shock absorption and many functional movements such as squats and going downstairs.

Every time our foot lands on the ground while walking, running or landing, there is ‘Ground Reaction Force’ produced. To keep the forces acting on the body within limits, it is important for the body’s musculature to absorb the forces.  Under impact activities every joint involved should work in their optimal range. If any joint’s range of motion is affected, it will increase stress on the other joints. This will also influence the muscle function and shock absorption around the affected joint.This is why ankle mobility is important to prevent injuries at foot, knee, hip and Lower back.

dorsiflexion

Fig 1 – Dorsiflexion

plantar-flexion

Fig 2 – Plantarflexion


 



A simple example to better understand it is to do a small jump, landing with stiff joints and another landing while bending at different joints. Landing with stiff joints will feel heavier and impart high forces on the joints. On the other hand, same landing done while allowing ankle knee and hip joints to bend, will feel much lighter. A good range of motion in joints allows the muscle to stretch more and absorb the forces optimally. Therefore limited/restricted joint range at ankle joint will increase the share of Ground reaction force more on knee and hip joint. In addition, a stiff ankle not only lacks in absorbing shock but it also reduces your overall agility and control.


 



Factors leading to reduce ankle mobility – Click here


 


ITB Tightness – A runner’s nightmare

ITB tightness – A runner’s nightmare

ITB (Illiotibial Band) related conditions are commonly seen in endurance sports. Running, cycling, hiking are some such sports where an individual is highly prone to ITB related injuries. ITB tightness cannot be ignored, as it can lead to many injuries which can affect one’s performance. Quite often it’s not the tightness itself but increased loading or strain on the ITB because of other biomechanical factors.  These injuries are usually overuse type and if they develop, they can keep an athlete off sports for weeks or more. So, it is very important to keep a check on its tightness in order to prevent injuries.

Illiotibial band is a thick band of fascia found on the outer side of the thigh. It runs from the pelvic bone, crosses hip and knee joints and gets attached to the tibia (lower leg bone). At the hip joint, gluteus maximus and TFL (tensor fascia lata) muscle merge into ITB. It also attaches to the fascia of vastus lateralis muscle (outer thigh muscle), which is a part of your quadriceps muscle. Illiotiabial band is an essential structure as it helps in stabilizing the knee joint.




A tight illiotibial band or increased loading/strain on it due to biomechanical factors, can lead to anterior knee pain, external hip snapping and ITB Friction Syndrome. In external hip snapping, an audible click occurs from ITB moving over greater trochanter (bony protuberance) of thigh bone. Pain might also be present along with an audible click when an individual flexes and extends the hip.ITB-fs

While in ITB Friction Syndrome, pain is present on the outer side of the knee. This pain usually sets in during activity and increases gradually, which can further force an athlete to discontinue. You might notice tenderness on palpation and swelling may as well be present. This condition develops due to increase in friction and compression between the ITB and lateral femoral condyle (outer bony protuberance of thigh bone near knee joint).




Next page – Factors leading to excessive loading on Illiotibial Band



When and why to use an Ice Pack?

When and why to use an Ice Pack?

Article by Adele Ang

adele

Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries.


In Asian cultures, applying cold packs to injured body parts is frowned upon. As there is a belief that it can lead to ‘rheumatism’, which is typically characterised as stiff and achy joints. As a kid, my dad would rub a hard-boiled egg, straight out of boiling water, on a bruise formed on my head or my knees the very moment after sustaining these bruises.

I was told that this is done to improve blood circulation to the bruise, for the bruise to dissolve, as well as to avoid having to cut the bruise out as it will be ‘dead flesh’, should blood permanently fail to return to the bruise. Really frightened that this threat might really happen, I endured the painful hot egg treatment with every bruise I sustained as a kid.




Applying cold therapy to injuries is not common practice in Asian cultures, whether it’s Traditional Chinese Medicine or Ayurvedic Medicine, heat therapy is still a treatment of choice. As such, it’s not common knowledge among some patients when to apply heat and when to apply cold.

Here are 3 pointers to help you decide to reach for ice whenever you sustained an injury.




1.First 72 hours

The basic guideline is that cold therapy should be applied in the first 3 days following an injury. Inflammation which is our bodies healing mechanism happens immediately following an injury, whereby blood flow is increased to that area to commence healing. As a result of inflammation, pain is experienced and the injured area will be swollen and warm to touch.

2.Red, swollen and warm to touch (past 72 hours)

When the area concerned presents with redness, swelling and is warm to touch. These 3 things suggest that the injured structures are still inflamed. Cold therapy may at times need to be continued after 72 hours especially when the injury sustained is extensive and/or it affects parts of our body such as the foot and ankle which usually have more persistent swelling due to continuous load on these areas if weight is placed on then as well as due to gravity pulling more fluid down to those areas.




3.Difficulty moving the injured area due to pain

Usually pain is intense and unremitting and episodic as well. May have been more than a few days, could be weeks or months prior but is episodic. A recurring injury to the same area may result in such a presentation, usually heat therapy is applied but should you feel worse or in more pain after, you may respond better to cold therapy. This may be due to repeated inflammatory responses to the injured area usually resulting from repeated aggravation of the same area as a result of insufficient rest as well as not receiving proper treatment, including physiotherapy and rehabilitation following the injury.

Rehab Mantra
Stay Fit. Love Life

 


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Knee Pain – Patello Femoral Pain Syndrome

Knee Pain – Patello Femoral Pain Syndrome

PFPS (Patello Femoral Pain Syndrome) is one of the common knee pain condition affecting active population of all age groups. It is found more in women because of wider pelvis which changes the direction of forces acting on knee joint.

Patella (knee cap) sits in a groove which is present in the lower part of thigh bone (femur). In a normal knee it glides up and down in the groove smoothly, whenever there is knee bending and straightening movement, such as going up and down stairs. However, in an affected knee the patella moves out of the groove causing friction between the two bones which eventually results in pain. Pain can vary from dull ache to sharp pain, which might be accompanied by clicking or momentary weakness in knee joint.




Knee cap is held in position with a good balance between outer and inner structures around the knee cap. Structures which are responsible for movement around the knee are the muscles. The muscle present in front of the thigh is known as quadriceps, as it has four prevailing muscles. Any imbalance between these 4 muscles can change the way the patella moves.

Contributing factors:

  • Poor lower limb mechanics due to
    • Increased foot pronation (foot  flattening)
    • Decrease lumbopelvic (lower-back and hip area) stability due to weak core (abdominal) and gluteal (hip) muscles
    • Decrease VMO (vastus medialis obliques) activity, the inner most muscle of quadriceps




  • Incorrect footwear
  • Muscle tightness; specially increase in Vastus lateralis (outer most muscle of quadriceps) and Illiotibial band (ITB) tightness/activity. ITB is a connective tissue band present on the outer thigh
  • Tight hip flexors and Tensor fascia latae muscle
  • Poor sporting technique/ergonomics
  • Heel strike running pattern increases GRF (ground reaction force)
  • Over-training
  • Sudden increase in training intensity/frequency

Treatment options – Click here



Ankle Mobility – Significance in Injury Prevention

Ankle mobility and its significance in injury prevention

Let it be walking, running, jumping or landing, ankle is the first major joint, from where the forces are transferred up in the body. So it makes the ankle joint a lot more important than what people think of it. Ankle joint is often overlooked while dealing with conditions occurring at knee joint, hip joint or lower back. Primarily ankle joint movements include dorsiflexion (toes coming closer to shin) and plantar flexion (tip toeing) (Fig 1 & 2). Limited dorsiflexion at ankle joint affects shock absorption and many functional movements such as squats and going downstairs.

Every time our foot lands on the ground while walking, running or landing, there is ‘Ground Reaction Force’ produced. To keep the forces acting on the body within limits, it is important for the body’s musculature to absorb the forces.  Under impact activities every joint involved should work in their optimal range. If any joint’s range of motion is affected, it will increase stress on the other joints. This will also influence the muscle function and shock absorption around the affected joint.This is why ankle mobility is important to prevent injuries at foot, knee, hip and Lower back.

dorsiflexion

Fig 1 – Dorsiflexion

plantar-flexion

Fig 2 – Plantarflexion


 



A simple example to better understand it is to do a small jump, landing with stiff joints and another landing while bending at different joints. Landing with stiff joints will feel heavier and impart high forces on the joints. On the other hand, same landing done while allowing ankle knee and hip joints to bend, will feel much lighter. A good range of motion in joints allows the muscle to stretch more and absorb the forces optimally. Therefore limited/restricted joint range at ankle joint will increase the share of Ground reaction force more on knee and hip joint. In addition, a stiff ankle not only lacks in absorbing shock but it also reduces your overall agility and control.


 



Factors leading to reduce ankle mobility – Click here


 


ITB Tightness – A runner’s nightmare

ITB tightness – A runner’s nightmare

ITB (Illiotibial Band) related conditions are commonly seen in endurance sports. Running, cycling, hiking are some such sports where an individual is highly prone to ITB related injuries. ITB tightness cannot be ignored, as it can lead to many injuries which can affect one’s performance. Quite often it’s not the tightness itself but increased loading or strain on the ITB because of other biomechanical factors.  These injuries are usually overuse type and if they develop, they can keep an athlete off sports for weeks or more. So, it is very important to keep a check on its tightness in order to prevent injuries.

Illiotibial band is a thick band of fascia found on the outer side of the thigh. It runs from the pelvic bone, crosses hip and knee joints and gets attached to the tibia (lower leg bone). At the hip joint, gluteus maximus and TFL (tensor fascia lata) muscle merge into ITB. It also attaches to the fascia of vastus lateralis muscle (outer thigh muscle), which is a part of your quadriceps muscle. Illiotiabial band is an essential structure as it helps in stabilizing the knee joint.




A tight illiotibial band or increased loading/strain on it due to biomechanical factors, can lead to anterior knee pain, external hip snapping and ITB Friction Syndrome. In external hip snapping, an audible click occurs from ITB moving over greater trochanter (bony protuberance) of thigh bone. Pain might also be present along with an audible click when an individual flexes and extends the hip.ITB-fs

While in ITB Friction Syndrome, pain is present on the outer side of the knee. This pain usually sets in during activity and increases gradually, which can further force an athlete to discontinue. You might notice tenderness on palpation and swelling may as well be present. This condition develops due to increase in friction and compression between the ITB and lateral femoral condyle (outer bony protuberance of thigh bone near knee joint).




Next page – Factors leading to excessive loading on Illiotibial Band



When and why to use an Ice Pack?

When and why to use an Ice Pack?

Article by Adele Ang

adele

Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries.


In Asian cultures, applying cold packs to injured body parts is frowned upon. As there is a belief that it can lead to ‘rheumatism’, which is typically characterised as stiff and achy joints. As a kid, my dad would rub a hard-boiled egg, straight out of boiling water, on a bruise formed on my head or my knees the very moment after sustaining these bruises.

I was told that this is done to improve blood circulation to the bruise, for the bruise to dissolve, as well as to avoid having to cut the bruise out as it will be ‘dead flesh’, should blood permanently fail to return to the bruise. Really frightened that this threat might really happen, I endured the painful hot egg treatment with every bruise I sustained as a kid.




Applying cold therapy to injuries is not common practice in Asian cultures, whether it’s Traditional Chinese Medicine or Ayurvedic Medicine, heat therapy is still a treatment of choice. As such, it’s not common knowledge among some patients when to apply heat and when to apply cold.

Here are 3 pointers to help you decide to reach for ice whenever you sustained an injury.




1.First 72 hours

The basic guideline is that cold therapy should be applied in the first 3 days following an injury. Inflammation which is our bodies healing mechanism happens immediately following an injury, whereby blood flow is increased to that area to commence healing. As a result of inflammation, pain is experienced and the injured area will be swollen and warm to touch.

2.Red, swollen and warm to touch (past 72 hours)

When the area concerned presents with redness, swelling and is warm to touch. These 3 things suggest that the injured structures are still inflamed. Cold therapy may at times need to be continued after 72 hours especially when the injury sustained is extensive and/or it affects parts of our body such as the foot and ankle which usually have more persistent swelling due to continuous load on these areas if weight is placed on then as well as due to gravity pulling more fluid down to those areas.




3.Difficulty moving the injured area due to pain

Usually pain is intense and unremitting and episodic as well. May have been more than a few days, could be weeks or months prior but is episodic. A recurring injury to the same area may result in such a presentation, usually heat therapy is applied but should you feel worse or in more pain after, you may respond better to cold therapy. This may be due to repeated inflammatory responses to the injured area usually resulting from repeated aggravation of the same area as a result of insufficient rest as well as not receiving proper treatment, including physiotherapy and rehabilitation following the injury.

Rehab Mantra
Stay Fit. Love Life

 


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Knee pain in adolescents – Is it because of SLJ Syndrome?

 

Sinding Larsen Johansson Syndrome

Sinding Larsen Johansson Syndrome is a condition causing knee pain in early adolescent (10-15years) age group. It is often seen in active individuals involved in high impact sporting activities which involve repetitive jumping or running. Basketball, volleyball and track and field are common examples but it can also be seen in sports like squash, tennis, gymnastics and soccer.

Excessive and repetitive stress on knee leads to irritation and inflammation of the growth plate of the patella (knee cap).  The growth plate which is present at the inferior pole of the patella is attached to the patella tendon. The other end of the patella tendon is attached to the shin bone. Increase in traction forces of the patellar tendon on the growth plate leads to its inflammation. Symptoms include pain, swelling and tenderness at the bottom of the knee cap (patella). Pain increases with activities like running, jumping, kneeling, squatting and even climbing up and down the stairs.







Read contributing factors and treatment on Page 2





 

Low waist, tight pants and their health hazards!!

Health Hazards of Low Waist and Tight Pants

Low waist, tight pants are in fashion and they look good and trendy, but everything comes with a price. Price here is not money, it’s your health. Without being aware of the harmful effects of wearing low waist,tight pants on your body and health, we tend to follow the trend blindly. These type of  pants can be the main reason behind hip pain, low back pain, knee pain and even hernia.

Low back and knee pain

Our body needs certain amount of contribution from different joints to perform activities. For example, to bend down and pick up something, the hip joint should have enough mobility to reduce stress on knee and low back. The right way to bend down is to bend more at hip while keeping the spine neutral (straight) and knees behind toes. People often have to change the way they bend forward while wearing a low rise pant to avoid showing their butt line. In order to avoid slipping of pants while bending forward, people either tend to bend more at the knees or low back. Excessive bending at knees over and over again can lead to early wear and tear of the knee joint. Similarly increased bending at back can lead to low back problems.

To maintain a neutral spine while sitting, pelvis needs to be maintained in neutral position as well. Excessive anterior (forward) tilting or posterior (backward) tilting makes it difficult for the spine to maintain a neutral posture. Position of pelvis largely depends on hip joint mobility. When wearing a low rise or tight fit pants, the forces on the pelvis increases, thus making it tilt backwards. This posterior tilting of pelvis constrains the spine to maintain a neutral position and makes it curve backwards. When your spine is pushed into a backward curve position it increases pressure on the disc resulting in a bulge or prolapse.

Meralgia paraesthetica

In this condition there can be pain, numbness, hypersensitivity or pins and needles on the outer thigh because of nerve compression. The nerve affected is the lateral cutaneous nerve of thigh. It used to be seen in people with big belly wearing tight belts just above the groin area. Now, it can be seen in people wearing tight low waist jeans, as it just sits over the groin area.

Hernias and hydrocele

Because of reduced hip range and slouched posture, the abdominal muscle becomes lax and the support required from it is reduced. There is also no external support to the abdominal wall from the belt as it is worn too low. All these factors have increased chances of hernia and hydrocele.

 

Rehab Mantra
Stay Fit. Love Life

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All You Need To Know About Knee Pain – Part 1
Three Common Knee Conditions Discussed

 

Knee pain is one of the most common conditions occurring in all age groups. However, knee pain has always been kept under an umbrella term – Arthritis (Wear and Tear) and reasons given behind it are mostly age and weight.

Now the question comes, how correct are these reasons? Is it the only diagnosis/condition? Does one really has to live with it the entire life? And can it be cured simply by reducing weight?



Let’s find answers to these questions:

First of all, not all knee pain is Arthritis. There are several other conditions that occur in knee such as patella femoral pain syndrome, fat pad impingement, patella tendinopathy, meniscal impingement or tear and many more. So a proper diagnosis is important for one’s recovery in a realistic time frame.

Now by reducing weight can this problem be cured? To answer this question, we first need to know the various contributing factors and symptoms of a condition.

Joint pain, joint stiffness and swelling are the few signs and symptoms of a condition. And the factors which lead to these symptoms are known as contributing factors which can be muscle tightness, poor body mechanics, muscle imbalance, poor posture, weight, poor sporting technique and many more.

Once the condition and the contributing factors have been figured out with help of a physiotherapist or orthopedic, it will be easier to set the SMART (specific, measurable, achievable, realistic and time bound) goals.

Let’s discuss few of the common knee conditions.

Patello femoral knee pain (PFPS) commonly known as runners knee

PFPS is one of the common knee conditions affecting active population of all age groups. It is found more in women because of wider pelvis which changes the direction of forces acting on knee joint.

Patella (knee cap) sits in a groove which is present in the lower part of thigh bone (femur). In a normal knee it glides up and down in the groove smoothly whenever there is knee bending and straightening movement such as in going up and down stairs. However, in an affected knee the patella moves out of the groove causing friction between the two bones which eventually results in pain. Pain can vary from dull ache to sharp pain which might be accompanied by clicking or momentary weakness in knee joint.

knee pic new

                                       Picture 1

 

 

Knee cap is held in position with a good balance between outer and inner structures around the knee cap. Structures which are responsible for movement around the knee are the muscles. The group of muscle present in front of the thigh is known as quadriceps (refer picture 1) as it has four prevailing muscles. Any imbalance between these 4 muscles can cause change in the way the knee cap moves.

 

Contributing factors:

  • Poor lower limb mechanics due to
    • Increased foot pronation (foot  flattening)
    • Decrease lumbopelvic (lowerback and hip area) stability due to weak core (abdominal) and gluteal (hip) muscles
    • Decrease VMO (vastus medialis obliques) activity, the inner most muscle of quadriceps
  • Poor/incorrect footwear
  • Muscle tightness; specially increase in Vastus lateralis (outer most muscle of quadripceps) and Illiotibial band (ITB) tightness/activity. ITB is a connective tissue band present on the outer thigh.
  • Poor sporting technique/ergonomics.
  • Over-training

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors specific to your problem and start working on them
  • Joint mobilization
  • Soft tissue release and stretching exercises specially ITB and quads
  • Getting your footwear checked
  • Gluteal and quadriceps muscle strengthening exercises
  • Running/walking/stairs technique correction
  • Taping

 

Patellar tendinosis  (commonly known as jumper’s knee)

Patella tendon is the continuity of the quadriceps muscle which is present just below your knee cap. Patellar tendinosis is the inflammation of the patellar tendon. Common site of inflammation is just below the knee cap where the patellar tendon originates.

It is commonly seen in population doing high impact activities like basketball, sprinting and volleyball.

knee pic new

 

Causes:

  • Poor sporting technique (like jumping and landing)
  • Increase muscle tightness especially quad, hamstring and calf
  • Lack of cool down and stretching
  • Weak gluteal and quadriceps muscles
  • Stiff ankle joint leading to reduced shock absorption during ground contact

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Soft tissue release
  • Transverse friction massage
  • Correcting sporting techniques
  • Icing
  • Taping
  • Eccentric quads exercises
  • Gluteal strengthening exercises
  • Stretching exercises

 




Fat pad impingement (Hoffa’s Syndrome)

Fat pad is present just below the inferior pole of patella (knee cap) and behind patella tendon (tendon just below your knee cap). In some cases, the fat gets irritated by the inferior pole of knee cap and causes pain and inflammation. It is often confused with inflammation of patella tendon as the location of pain is same.

knee fat pad

        The yellow area in the above picture refers to Fat Pad.

 

It is commonly seen in people who can overextend their knees (known as genu recurvatum). Poor quads control, improper running and sporting techniques or a direct blow can lead to fat pad irritation also.

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Joint mobilization
  • Knee control exercises
  • Icing
  • Taping

 

Rehab Mantra
Stay Fit. Love Life

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