We treat meniscal tears, jumper’s knee, tendonitis, bursitis, ITB syndrome, patellar tendonitis, patellofemoral pain syndrome (PFS), ligament tears.
ANATOMY:
The bones of the knee, the femur and the tibia, meet to form a hinge joint.
The joint is protected in front by the patella (kneecap). The knee joint is cushioned by articular cartilage that covers the ends of the tibia and femur. The lateral and medial menisci are pads of cartilage that further cushion the joint, acting as shock absorbers between the bones. Ligaments help to stabilize the knee.
The lateral and medial collateral ligaments (MCL and LCL) run along the sides of the knee and limit sideways movement. The anterior cruciate ligament (ACL) connects the tibia to the femur at the center of the knee. Its function is to limit rotation and forward motion of the tibia. The posterior cruciate ligament (PCL) limits backward motion of the tibia.
COMMON KNEE PROBLEMS:
PATELLOFEMORAL SYNDROME (PFS):
PFS is the most common cause of chronic knee pain and is also known as chondromalacia patella. Abnormal tracking of the knee cap over the femur causes inflammation, pain and can also cause softening of the cartilage on the underside of the knee cap. The abnormal tracking is usually in an outward direction and is most commonly caused by a weak VMO (the innermost quadriceps muscle) and having flat feet and/or “knocked” knees.
MENISCUS INJURY:
Meniscal tears are among the most common knee injuries. Menisci can tear in different ways, usually due to a twisting motion and a “pop” may be felt if the meniscus tears. The most common symptoms of meniscal tear are pain, stiffness and swelling, catching or locking of the knee, sensation of the knee “giving way” and loss of range of motion.
Meniscal tears can be identified in the clinic using special tests such as the McMurray test, Thessaly test, and Apley Compression test.
PES ANSERINE BURSITIS:
Pes anserine bursitis is inflammation of the pes anserine bursa which is located at the inner aspect of the knee. This bursa is a fluid filled sac which acts as a cushion for the tendons of the sartorius, gracilis, and semitendinosus muscles at the distal point of insertion on the tibia (shin bone). Symptoms can include pain, tenderness and swelling at the inner aspect of the knee.
ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY:
The ACL is one of the most commonly injured ligaments of the knee. Approximately Brown CH, Carson EW. Revision anterior cruciate ligament surgery. Clin Sports Med 1999;18:109-171. 50 percent of ACL injuries occur in combination with damage to the meniscus, articular cartilage, or other ligaments. The mechanism of injury is often associated with deceleration along with cutting, pivoting or sidestepping maneuvers. After the injury, patients usually experience pain, decreased range of motion, swelling and an unstable feeling in the knee.
ACL injuries can be identified in the clinic using special tests such as the Lachman’s test or Anterior Drawer test. MRI is the gold standard for diagnosis.
TREATMENT:
- Treatment is patient specific depending on the extent and type of injury
- Treatment should minimize pain, increase strength and range of motion, and return patients back to pre-injury status
- Treatment may include:
- Electrical stimulation to decrease pain and swelling
- Ultrasound- deep heat/sound treatment used to treat the muscles and tendons that are deep inside
- Manual techniques such as massage and stretching to assist with increasing range of motion
- Stabilization- exercises to strengthen the muscles surrounding the knee joint
- Surgery is the last resort, but is sometimes necessary if traditional physical therapy treatment is not providing desired results.
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