wk 9- knee pain Flashcards
knee pathology of bone
stress fracture of patella
knee pathology of soft tissue
patella tendinopathy
ITB friction syndrome
quad tendinopathy
infrapatella bursitis
fat pad impingement
os goods schlatters diease
bakers cyst
knee pathology of joint
patellofemoral pain
medial compartment OA
knee pathology of nerves
referred pain
patellofemoral pain syndrome
pain around or behind the patella in the absence of other pathologyies
can involve structures like
cartilage
bone
retinaculum
fat pad
what does the patella do during extension flexion
extension- patella sits laterally to trochlea
flexion -patella moves medially to lie withinintercondylar notch
130deg of flexion- moves laterally
movement is controlled by VMO and vastus lateralis and should stay within trochlea groove
when is PFJP aggrevated
squatting, walking up stairs, running, bounding, when the knee is flexed with load going through it
intrinsic and extrinisic risk factors of PFJP
ext:
1. GRF
2. surface/footwear
3. speed/mass
4. type of movement
intrin:
1. increased hip internal rotation
2. increased hip aduction
3.increased knee valgus
4. increased tibial external rotation
5. pronated foot type
6. lack of sagittal plane motions
7. inadequate flexibility of knee
8. trunk contralateral drop/anterior lean
9. patella positioning
key features of PFJP
onset during
running, steps/stairs, hills, weightbearing activities with knee flexion
vague pain
may click or have crepitus
quad contraction may be painful
restricted medial glide
functional testing: squats, stairs
taping should decrease pain
imaging for PFJP
x ray - skyline patella,knee 30eg flexion
CT
MRI
management options for PFJP
- rest
- exercise
-Quads retraining: (contract VMO, palpating or taping for sensory feedback helps)
-hip retraining: strengthen abductors, external rotations and extensors to control medial knee
-strengthening and endurance to imrpove function and pain - taping- reduces pain, helps activate VMO, positioning of patella- medial glide taping
- manual therapy
- foot orthoses- prefab
- bracing-maintains medial glide
patellar tendinopathy features
common in basketballers, long and high jumpers
onset during, change of direction, cutting and jumping activities
inferior pole of patella pain
no swelling, no clicking, no crepitus
normal ROM and movement
quad contraction painful
taping doesnt help
imaging for patella tendinopathy
US
MRI
management of patella tendinopathy
- deload/rest
- improve landing technique
- biomechical correction (ankle ROM, flexibility in hamstring, calf and quad, weakness of glutes, quad and cal)
- progressively load tendon with strength 4 stages protocol
isometric 1 month
isotonic 2 months
energy storage 1 month
energy storge and release 2 months
sport specific 6 months of rehab point - surgery - only if conservative failed
recovery can take between 3-6months or up to a year for long standing cases/return to sport
additional treamtent options for patella tendinopathy for biomechanical correction
- soft tissue therapy of quads, hammy and calf muscles
-friction massage
-myofascial release
-trigger point
additional treatment options for patella tendinopathy
- ice
- injections
- sclerosing injections with polidocanol
-blood injection therapy
CORTICOSTEROID NOT SUCCESSFUL
medial compartment OA
most common MSK disorder
progressive loss of cartilage and joint space in medial compartment resulting in varus malalignment
risk factors of OA
- BMI
- previous knee injury
- load distribution (increased knee adduction moment - longer moment arm which results in increased medial compression forces)
eg lateral varus thrust - genetics
what foot orthotic additions can decrease the knee adduction moment
lateral wedge (valgus wedge)
lateral posting
lateral kirby skive
or
asics unloading shoe
bracing to redistribute load
common lateral knee pathologies
ITB syndrome
lateral menisucus abnormality
what not to miss on lateral knee pain
peroneal nerve injury
perthes disease
slipped capital femoral epiphysis
ITBFS
overuse injury in runners, cyclists endurance athletes
increased compression of richly innervated and vascularised layer of fat and connective tissue that sepeartes ITB from lateral epicondyle
ITBFS risk factors
- tibial internal rotation
- increase in hip adduction
- weakness in knee flexion/extension
features of ITBFS
ache over lateral aspect of knee
aggrevated by running/cycling
tenderness over lateral femoral epicondyle (2-3cm) ABOVE LATERAL JOINT LINE
ober’s test
managament of ITBFS
- activity modification
- ice, electrotherapy
- NSAIDs early on
- cortisone injection to reduce pain
- soft tissue massage, needling, triggering
6.strength - single leg squats, abductors - surgery
what doesnt work on ITB
stretching
pes anserinus tendinopathy/bursitis
sartorius, gracilis, semitendinosis tendons
primary action in knee flexion and resist valgus strain
often seen in swimmers, runners, cyclists with medial knee positions
