knee pain

Meniscus Injuries

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There are many injuries that forced athletes out of training or competition, some injuries more than others. An injury that can become problematic over time are meniscus tears. It is well known that the knees are a common site of injury in all sports, and overall the American Academy of Orthopedic Surgeons estimate that they perform 850,000 meniscectomies per year (1). 

Not sure what a meniscus tear is? Want to know more about outcomes to treatment? 

Continue reading to learn more...

Iliotibial Band Syndrome

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Ever experience knee pain, and have been told it is IT-Band Syndrome? 

Did you know what that meant? Or how that came about? 

Iliotibial Band Syndrome (ITBS) is another overuse injury experienced by some athletes, more so runners and cyclists. According to Ferber et al it is the second leading cause of lateral knee pain in runners (2). It is most commonly described as a friction injury at which the tendon “rubs” over the lateral femoral condyle of the knee creating pain (1) that can present as sharpness, burning, and sometimes swelling. 

This short post goes into explaining what ITBS is, what researchers have found the culprit to be to developing this injury, and some things to think about it in order to feel better. 

Continue Reading ...

Clinical Pattern Recognition: Knee Pain

From anatomy to discovering the patient!

knee pain
  • Prevalence of articular cartilage pathologies is reported to be between 60% and 70%
  • Injuries to the menisci are the second most common injury to the knee
  • Approximately 80,000 to 250,000 injuries occur to the anterior cruciate ligament (ACL) per year in the United States, with about 100,000 ACL reconstructions performed annually, the sixth most common orthopaedic procedure in the United States.
  • Two of the most common multiligament knee injuries involve the MCL and the ACL, and the posterolateral corner (PLC) and the ACL or the PCL.
    • Approximately 70% of all ACL injuries are noncontact in nature
  • 95% of patients with PCL injuries have associated ligamentous injuries in the ipsilateral knee
  • LCL injuries usually are part of more extensive injuries that involve the posterior lateral corner

See more prevalence information in the Clinical Pattern Recognition: Orthopaedics app here

Meet the 8 common Knee pain patients from the Knee Mobility Deficits Clinical Practice Guidelines!  And Knee stability and movement coordination impairments Clinical Practice Guidelines + More!


Clinical Pattern Recognition

Click on the pain pattern to learn about the patients and develop your clinical patterns

1.     Knee Osteoarthritis- Knee pain and mobility deficits (Watch 1 min video)

2. Hamstring strain- Knee pain and muscle power deficits (Watch 1 min video)

3.  Iliotibial band syndrome – Lateral knee pain (Watch 1 min video | Step-by-Step Guide)

4. Medial collateral ligament sprain- Knee stability and movement coordination impairments (Watch 1 min video | Step-by-Step Guide)

5. Meniscal tear- Knee pain and mobility deficits (Watch 1 min video | Step-by-step Guide)

6. Patellar tendinitis/tendinosis- Knee pain and muscle power deficits (Watch 1 min video | Step-by-Step Guide)

7. Patellofemoral pain syndrome- Anterior knee pain (Watch 1 min video)

8. Pes anserine bursitis- Medial knee pain (Watch 1 min video)

Iliotibial (IT) Band Syndrome

 Lateral Knee Pain

Image via PhysioU

Image via PhysioU

Is your patient presenting with lateral knee pain potentially related to a recent increase in frequency of sport or physical activity? If lower extremity biomechanics are subpar, the iliotibial (IT) band may be the source of tissue irritation!

For more clinical findings click here!


Anatomy

Image via Complete Anatomy by 3D4 Medical

Image via Complete Anatomy by 3D4 Medical

Special Tests

The  Ober’s test  is commonly used to assess the length or stiffness of the IT band! (Click image to watch 1-2 minute video)

The Ober’s test is commonly used to assess the length or stiffness of the IT band! (Click image to watch 1-2 minute video)

Treatment

If pathological tension is present in the tensor fascia latae (TFL) or in the IT band,  soft tissue mobilization via foam roll  can be beneficial! (Click image to watch 1-2 minute video)

If pathological tension is present in the tensor fascia latae (TFL) or in the IT band, soft tissue mobilization via foam roll can be beneficial! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Rehabilitation programs  should address both tissue source and the underlying mechanisms causing tissue pathology. In the case of IT band syndrome, a common mechanism seen is a femoral adduction/internal rotation movement fault. Assess and treat up and down the chain!   (Click image to watch 1-2 minute video)

Rehabilitation programs should address both tissue source and the underlying mechanisms causing tissue pathology. In the case of IT band syndrome, a common mechanism seen is a femoral adduction/internal rotation movement fault. Assess and treat up and down the chain!

 (Click image to watch 1-2 minute video)

Anterior Cruciate Ligament (ACL) Sprain

Knee Stability and Movement Coordination Impairments

Medial knee pain

If a patient presents to clinic with a history of an audible “snap” or “pop” that potentially occurred during a sporting event; followed by complaint of knee instability and difficulty with weight bearing they may have sprained or torn their ACL!

For more clinical findings click here!

Anatomy

Image via Complete Anatomy by 3D4 Medical

Image via Complete Anatomy by 3D4 Medical

Special Test

·      As we all know, one test is not enough to completely rule in or rule out potential pathology; however, the specificity of the Lachman test (94) makes it an excellent test to help rule in ACL pathology!    (Click image to watch 1-2 minute video)

·      As we all know, one test is not enough to completely rule in or rule out potential pathology; however, the specificity of the Lachman test (94) makes it an excellent test to help rule in ACL pathology!    (Click image to watch 1-2 minute video)

Treatment

Treatment of ACL injuries depends on whether or not the patient undergoes surgical intervention along with their prior level of activity and prospective level of activity post injury.  Quadriceps strengthening  tends to be necessary in both cases; in fact quadriceps strength is the highest predictor of returning to  full activities of daily living in those who underwent ACL repair! (Click image to watch 1-2 minute video)

Treatment of ACL injuries depends on whether or not the patient undergoes surgical intervention along with their prior level of activity and prospective level of activity post injury. Quadriceps strengthening tends to be necessary in both cases; in fact quadriceps strength is the highest predictor of returning to  full activities of daily living in those who underwent ACL repair! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Once full range of motion has been achieved and adequate lower extremity strength and motor control have been established via protocol progression, the next step for patients who plan to return to more vigorous activity would be implementation of plyometric/reactive training.  Single limb hop testing  can also double as therapeutic exercise! (Click image to watch 1-2 minute video)   

Once full range of motion has been achieved and adequate lower extremity strength and motor control have been established via protocol progression, the next step for patients who plan to return to more vigorous activity would be implementation of plyometric/reactive training. Single limb hop testing can also double as therapeutic exercise! (Click image to watch 1-2 minute video)