Foot & Ankle Injury Rehabilitation (B)

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Knee Pain

Knee pain such as Runners Knee also known as patella-femoral pain syndrome is one of the most common causes of pain at the front of the knee and accounts for approximately 25% of all knee injuries seen in sports injury clinics.

Despite the name, it affects both active and sedentary people eg office workers. It is not the only cause of knee pain in runners .  other common causes of knee pain related to biomechanical function include iliotibial band syndrome, patellar tendonitis and chondromalacia patella

Runners Knee usually comes on gradually – it is not triggered by a specific incident. People usually describe it as an ill-defined ache around the kneecap, particularly underneath and at the sides of the patella. There may also be a grinding/grating sounds associated with leg movement in patella femoral syndrome – this is known as crepitus and is caused by friction. The pain tends to come and go but is usually worse with:

-  Prolonged Activityeg running long distances, sports, skiing especially when going downhill
-  Stairs:especially coming downstairs
-  Sitting for long periods eg at the cinema, office workers, driving long distance.

Iliotibial Band Syndrome  is when the ITB gets irritated and inflamed due to friction. This most commonly happens on the outer side of the knee. As the leg bends and straightens, the Iliotibial Band glides over a bony lump on the side of the knee that sticks out slightly, the lateral epicondyle.  A bursa (small fluid filled sac) sits between the ITB and the bone to allow smooth, gliding movements, but if there is too much friction, the Iliotibial Band gets irritated.

 Inflammation of the ITB usually occurs from overuse and is most commonly seen in runners, especially long distance runners.

Patellar tendonitis is more commonly known as Jumpers Knee and is caused by microscopic damage to the patella tendon. The patella tendon is the most common place to develop knee tendonitis. The most defining characteristic of Patellar Tendonitis is tenderness when you press on the patella tendon, just below the kneecap.

Treatment of recurrent knee pain often requires the investigation and correction of the following possible cause factors.

- Muscle weakness: Weakness in the muscles reduces the support around the knee causing more weight to go through the kneecap. Also, if the muscles on one side of the knee are weak while the muscles on the other side are too strong, the kneecap will shift slightly to one side in the groove

- Foot Position: An abnormal foot position, such as flat feet, causes the foot to roll inwards which alters the way the forces go through the knee

-  Q Angle: This refers to the angle of the thigh bone. An increase in the Q angle puts more strain on the kneecap.

-  Anatomy: there can be a problem with the shape of the groove and/or kneecap which result in the two not lining up properly which can restrict the movement and cause friction.

- Footwear poorly fitted or worn footwearaffects the position and function of the foot and  can have a large bearing on the knee position during walking and running.