Archive for knee pain

Plica Syndrome

Photo Credit: http://www.farnorthendurance.com

Plica is soft tissue that is present in about a fair amount of the population (estimates range from 50-95%). It’s essentially a fold in the synovial membrane on the anteromedial (front and middle) aspect of the knee. We all have it when we’re in utero, but for some, it’s reabsorbed during development. For those that still have it, it can be asymptomatic, or for some, it can become thickened and inflamed when the knee is overused. Risk factors include altered patella mobility, tightness of the quadriceps or hip muscles, muscular imbalances, improper technique with repetitive movements, a change in activity level or exercise routine, abnormal hip or knee structure, abnormal hip or knee biomechanics, trauma, or twisting. Plica syndrome may manifest as pain and/or tenderness in the anteromedial knee, catching or snapping when bending or straightening the knee, tightness in the knee, painful movement (especially the arc between 30° and 60°), pain with transfers, pain with stair climbing, or weak quadriceps.

Rehab

Your therapist will target your rehab based on his/her findings as to what may be contributing to your plica pain. This could include strengthening weak muscles, stretching tight muscles, gait training, stair training, transfer training, neuromuscular re-education, and addressing proper biomechanics and patellar tracking.

Strengthening exercises may include double or single leg squats (or mini squats), the leg press, steps-ups, lunges, or closed chain walking (forwards, backwards, and sideways). Your therapist may also focus on VMO activation via short arc quads (in parallel or turned-out) and things of the like. In addition to strengthening, stretching the quadriceps, hip flexors, and hamstrings may be beneficial. Pay attention to your biomechanics as you do things like go up stairs or get up out of chairs. Your knees may fall in towards the center of your body a bit instead of staying in line over your foot and ankle, which may be caused by weak gluteal muscles in the hip. This can, in turn, put extra pressure on the anteromedial portion of your knee. If this is the case, your therapist will add gluteal strengthening to your regimen, as well. Your therapist may also look at the biomechanics of your feet as you walk, jump, and land, as they may affect how your whole leg absorbs impact. Outside of exercises, bracing and taping (via kinesiotape or leukotape) may also be utilized for proper tracking and support.

In some instances, surgery is required, where the portion of the plica that’s interfering with movement will be resected, or cut out. If surgery is required, your doctor will most likely recommend RICE for a few days before starting rehab to reduce pain and swelling, increase AROM, improve strength, gait, and balance, and eventually, add in agility training, like running and jumping.

 

I hope you enjoyed our exploration of the knee. Please keep in mind that the list of injuries here is not exhaustive. If there is another injury you’d like me to go over, please let me know in the comments section.

Next up: a break from the joints, and a look into which kinestiotape lasts the longest. Stay tuned!

 

Sources:

http://physioworks.com.au/injuries-conditions-1/plica-syndrome

https://en.wikipedia.org/wiki/Plica_syndrome 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684145/

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Chondromalacia Patella

Photo Credit: http://www.houstonmethodist.org/

Chondromalacia patella refers to cartilage damage to the underneath side of the patella (the part that contacts the femur). It is often due to wear and tear over time, but can occasionally be caused by trauma, as well. Symptoms include pain with stair climbing (especially underneath the kneecap), getting stiff after sitting for long periods of time, and grinding in the knee known as crepitus. Muscle imbalances can also put you at a greater risk for this condition, the most notable being a difference between the strength of the VMO versus the strength of the more lateral muscles.

The VMO, or vastus medialis oblique, is a part of the quadriceps group of muscles.  This particular muscle sits just above and medial to the kneecap, and runs on an oblique, or diagonal orientation from the adductor magnus tendon to the tibial tuberosity.  This muscle plays a vital role in proper patella tracking.  If it is weaker than the muscle more lateral to it, like to vastus lateralis, the patella may not track properly (may be pulled more tot he outside of the leg). The patellar groove (also known as the intercondylar fossa of the femur) allows the patella to move along the femur without much friction or interference.  Should the patella be pulled out of this groove, the underneath side may encounter more friction as it tracks.  This can results in more wear and tear to the underneath side of the kneecap, resulting in chondromalacia patella.

Another thing that can lead to poor patellar tracking here is something called a poor Q patella between the quadriceps muscle (from its attachment at the AIIS) and the patellar tendon/ligament (and its attachment on the tibial tuberosity).  A normal Q angle is approximately 10-12 degrees for men and around 15-18 degrees for women.  A higher number can indicate poor patellar tracking, which may result in degeneration to the underneath side of the patella.  Those who hyperpronate at the ankle (or roll in) are at a higher risk for an increased Q angle.  Muscle imbalances, such as those mentioned above, may also affect your Q angle.

Photo credit: http://www.lbgmedical.com

Rehab

While no one (therapist or doctor) can fully reverse damage that has already been done to the cartilage underneath your patella, you can take actions to reduce pain, restore muscle balance, and keep it from progressing.  Your therapist will check the biomechanics of your knee, hip, and ankle as you move and walk, climb stairs, etc., to ensure proper patella tracking. Bracing and taping can be helpful in these cases.  Making sure the muscles surrounding your knee are strong and balanced is key.  This will often target strengthening the VMO while ensuring muscles like vastus lateralis, your IT Band, hamstrings, and calves are not too short (ie, need stretching to improve flexibility).

Some ways to target your VMO include quad sets with your foot turned our slightly, short arc quads (SAQ’s) in parallel or turned-out, SAQ’s or long arc quads (LAQ’s) with a ball or pillow between your knees, mini squats against a wall or ball squats, single leg mini squats or heel drops off a step, stationary lunges, step-ups or step-downs.  Exercises should be done in pain-free range and only done as long as you can control the movement and maintain proper alignment.

Photo credit: http://patellofemoral.completesportscare.com.au

Your therapist may also include neuromuscular re-education in your plan of care.  This involves re-teaching your muscles in which ones should fire and which ones shouldn’t (or perhaps, shouldn’t fire as much) when performing certain functional tasks.  This can often be very simple in concept, but difficult to master and frustrating at times, as you’ll be focusing on breaking bad habits and replacing them with good ones. When working to re-educate your muscles on the “right way” to do things, awareness and attention to detail are paramount.

Another part of your rehab regime may be agility training, which will include things like running, jumping, and landing training.  The Bosu Ball can again be helpful here, as I’ve often employed doing lunges with the front leg on the Bosu Ball once a certain amount of strength and control has been met, but more challenge is needed before the patient or dancer is released from physical therapy to resume his/her normal level of activity.

This concludes our look into chondromalacia patella.  Stay tuned next week as we look into patellar tendinopathy and jumper’s knee.

Sources

http://www.sportsinjuryclinic.net/rehabilitation-exercises/knee-hamstring-thigh-exercises/vmo-rehab

https://en.wikipedia.org/wiki/Intercondylar_fossa_of_femur

http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/q-angle

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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