Defined

Can be a general term for general knee pain.  If the knee cap is displaced and is not tracking correctly over the femur, inflammation and pain can occur to the underside of the patella.

Knee pain can be a common problem among people active in sports which involve running and general flexing of the knee joint.  One of the most common causes of knee pain is chondromalacia or patello femoral syndrome generally caused by an irritation of the undersurface of the kneecap (or patella).  The irritation can lead to a roughening of the kneecap which normally should be smooth on the undersurface, a condition called chondromalacia.

Symptoms

The patient experiences acute pain at certain points of the biomechanical gait, generally resulting from pressure of the kneecap as it becomes irritated and roughened.  The tracking of the patella is particularly important as it moves in a groove at the lower end of the femur (thigh bone).  The patient may complain about pain either side or under the patella and often of a dull ache after exercise, including sporting activities, or upon rising from a prone or seated positions.

Biomechanical Aetiology

The amount of internal tibial "rotation" is directly proportional to the amount of excess pronation and so medial displacement of the patello femoral path laterally displaces the patella moving the patella from its correct tracking position and thereby encouraging wear and tear on the cartilage with resultant pain and inflammation.

Wasting of medial lateral may occur and the 'quads' may weaken, reducing the body's ability to maintain control and thereby allowing the patella further latitude to displace.

Medial knee pain has been associated with excessive pronation due to the medial strain placed on the collateral ligaments and vice versa for lateral pain and supination, whereas anterior knee pain is often a combination of both pronation and supination factors.

Treatment

Maintaining natural biomechanical control by changing the ground to suit the foot structure can be achieved by using ICB Orthotics which will give pelvic stability and calcaneal control.

Strapping to control the position of the patella can be used but best results will be achieved by combining with orthotic therapy.

Strengthening VMO's should be undertaken in the neutral calcaneal position using an orthotic as this will allow for correct structural positioning and optimum soft tissue results.

ICB Orthotics will correct the calcaneal angle and reduce calcaneal eversion associated with excess subtalar joint pronation therapy and limiting secondary internal tibial rotation and its tractional effects on the knee.

Additional Treatment

RICE therapy (15 minutes 3-4 times per day) and muscle balancing.

Exercises

• Strengthening of the quadriceps, especially VMO's - correct the foot position!  Do not allow the patient to pronate or position foot in out-toed position whilst exercising.
• Stretching of quadriceps and hamstrings.
  
  

Content & Images © 2006 Footsteps Orthotics Pty Limited