K is for Knee

When we think of the knee (which is a modified hinge joint), and indeed any form of hinge, we would be mistaken to think that it is a simple joint – but it is far from that. Look at the snapshot on the left which shows a front on view of the right knee. You can see there’s a lot of muscles, tendons and ligaments and other (hidden) soft tissues all converging around this joint.

Injuries to ligaments are probably the most common at this joint, and unfortunately often quite debilitating. In addition to ligament injury the knee is at risk of overuse conditions (e.g. tendonitis, patellofemoral pain syndrome, Osgood-Shlatters disease and bursitis) as well as general trauma.

We treat a lot of runners in our clinic, and we are both fell runners, so we know how frustrating it can be to be out of action with injuries. As we’ve already covered one of the most common syndromes, Iliotibial Band in our earlier article (I is for ITB) we are going to focus this article on “Runner’s Knee”, also known as Chondromalacia Patellae.

What is this condition?

Chondromalacia Patellae is damage and degeneration of the articular cartilage of the patella (knee cap) – imagine it as wear and tear, or softening of the cartilage. It usually happens because of overuse (common amongst runners), but can also result though trauma, abnormal force applied through the joint, or because the patella is misaligned.  In addition to overuse, this condition can be a result of degenerative arthritis.

Signs and symptoms

In general pain will be present, and will often worse after being seated for a long time, or when ascending stairs. There will be tenderness around the patella and when the knee is extended a grinding/grating sensation might be felt. Left untreated loose bodies can break off the roughened surface of the patella and float in the joint, causing further damage and pain. Occasionally there will be swelling found at the knee joint in this condition.

How is it treated?

Initially treatment is by following the R.I.C.E. protocol. Rehabilitation usually will mean limiting the aggravating activities, strengthening and stretching the upper muscles (quadriceps and hamstrings). Reducing muscle and soft tissue tension can help to ease stress on the knee. Rehabilitation should also incorporate targeted muscle strengthening to improve muscle balance (often an issue if patella tracking is the cause). Any activity which causes pain will need to be avoided (e.g. deep knee bending/squatting) until the movements can be performed without pain. Reintroduction of the causal activities needs to be gradual.

Can Soft Tissue Therapy help?

Yes it can. Soft tissue therapy can be used to aid proper alignment of the patella, which in turn should reduce the friction and therefore the degeneration of the articular surface. To do this, a full assessment of the muscles acting on the knee would take place and any which are tight (generally the innermost quadriceps) or have adhesions would be released and stretched. Muscles not firing correctly could also be contributing to this condition – one technique we use (Muscle Energy Technique) works on the neurological aspect of muscles and can help to improve muscle firing and strength.

Applying kinesiology tape to alter (i.e. improve) the way the patella moves could be beneficial whilst muscle rebalancing is taking place. We use RockTape in our clinic.

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