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Jumper’s Knee – Patellar Tendinopathy

FRONT OF THE #KNEE #PAIN: #PATELLAR #TENDINOPATHY AKA JUMPER’S KNEE

The patella (kneecap) tendon runs from the bottom of the knee cap to the top of the shin bone. You can feel it move by putting your hand just underneath the kneecap and straightening the leg.

Tendons like constant and gradual loading. So when they are asked to perform a new task that is significantly more load, such as a huge training change for athletes or when people go from doing nothing over Christmas to going 100mph in the gym, they get irritated.

Remember: GRADUAL, CONSTANT LOADING.

The tendon is injured by repetitive stress, and is very common on athletes participating in jumping sports, hence the name – Jumper’s Knee.

Interestingly, the tendon experiences the highest load when LANDING NOT JUMPING. This is because on jumping the quadricep muscle shortens and on landing it lengthens or ECCENTRICALLY CONTRACTS.

The questions to be asking yourself:

• Is the pain on below the kneecap directly on the tendon running into the shin bone? • Has there been a recent change in loading in training or activities?
• Is it better for movement once you’ve warmed up and worst a while after exercising?
• Pain on bending the knee fully (This stretches the tendon)?

The best way to test this is:
• Bend the knee a little (20-30°) while lying on your back or sitting
• Have someone hold your ankle and try to stop you extending the knee fully
• HOWEVER, you must let them win, so that you are resisting as they push and eventually they push your knee from 20 degrees to fully bent while your resist. If this causes pain it is a positive test.

Key for rehab is to find a level of activity that does not aggravate the tendon post exercise. This will tell you what amount of loading is safe for the tendon. Then it is key to SLOWLY AND GRADUALLY build up the tendon tolerance again. This can be a slow process and realistic timescales are needed.

Hope you enjoyed the post folks, stay tuned for more!

West 12 Health Centre

 

 

 

 

#jumpersknee #tendonpain #kneepain #tendinopathy #pain #west12healthcentre #osteopathy #acupuncture #rehab #biomechanics #movebetter #painmanagement #knee #fitness #osteopathyworks #sportsinjury #sportstherapy #fitfam #manualtherapy #structuralintegration #physicaltherapy #prehab #fitness #recovery

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Empathy and catastrophising influence pain inhibition

HealthSkills Blog

When I went to occupational therapy school I was introduced to nociception and the biological underpinnings of pain. I wasn’t, at that time, taught anything about the brain, attention, emotions or any social responses to pain behaviour. Like most health professionals educated in the early 1980’s, pain was a biological and physical phenomenon. I suppose that’s why it can be so hard for some of my colleagues to unlearn the things they learned way back then, and begin to integrate what we know about psychological and social aspects of our pain experience. Because pain is a truly biopsychosocial experience. Those pesky psychosocial factors aren’t just present in people who have difficulty recovering from pain, they’re actually integral to the entire experience.

Anyway, ’nuff said.

Today I stumbled across a cool study exploring two of the psychosocial phenomena that we’ve learned are involved in pain. The first is catastrophising. And…

View original post 922 more words

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A picture is not always worth a thousand words…

Great article illustrating how scans can be more harmful than helpful for those in pain.

The Sports Physio

The saying “a picture is worth a thousand words” is often used to explain how a complex situation, idea, or thought can be conveyed with a single still picture. There are many examples of when this is true, such as in the media when a poignant photograph expresses some joyful, or unfortunately more often some heartbreaking situation much better than any article could.

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A perfect example of a heartbreaking picture expressing a 1000+ words

And there are many examples when pictures can convey an idea or information effectively and easily within healthcare, such as the use of an info-graphic to help disseminate scientific literature and research just like Yann Le Meur @YLMSportScience and Chris Beardsley @SandCResearchdo so very well. Then there are other images that can get across a message or an idea simpler, quicker, easier than a blog or an article could such as my recent ‘physio…

View original post 1,695 more words

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FRONT OF THE KNEE PAIN – HOFA’S SYNDROME

FRONT OF THE KNEE PAIN and HOFA’S SYNDROME

As mentioned in previous posts, Hofa’s fat pad, along with the knee capsule is the MOST PAIN SENSITIVE STRUCTURE IN THE KNEE JOINT.

The Fat Pad is found just below the kneecap, directly behind the patellar tendon. It acts as a cushiom between the kneecap and the thigh bone behind.

Causes of Hofa’s Fat Pad Pain:

1. Direct blow to the knee.

2. Poor Biomechanics – a large Q angle, pes planus, increased internal rotation of the shin bone, instability of the knee.

3. History of knee hyperextension.

Signs and Symptoms of Hofa’s Fat Pad Pain:

• Banana shaped swelling and pain at the front of the knee below the kneecap

• Worse for full extension of the knee or full bending of the knee

• Squatting, running and going upstairs can make it worse

How to test your knee for this Syndrome:

• Lie down with the knee bent

• Therapist presses firmly on either side of the patellar tendon

• Patient straightens the knee as much as possible or the therapist extends the knee with their other hand while maintaining the pressure either side of the tendon

We hope you found this post helpful. The next post will be on PATELLAR TENDINOPATHY. Stay tuned!

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Front of the Knee Pain: Bursitis

#KNEE PAIN AND #BURSITIS

Bursae are sacs of fluid found between structures like bones and tendon to reduce friction between the structures as they move by one another.

There are many around the knee. #INFLAMMATION of a bursa –> BURSITIS. The main bursae are labelled🔝

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Common Causes of Bursitis:

• Trauma
• Overuse
• Infection

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Important History Questions:

1. Occupation? carpenters or plumbers on their knees a lot

2. Red and Swollen? Very local and well defined. Not widespread.

3. Trauma? Fall or Hurt

4. Worse for fully BENDING the knee?

5. Pain on prolonged sitting in a low chair?

Then it could be a bursitis

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Most Commonly Affected Bursae:

1. HOUSEMAID’S KNEE i.e. Prepatellar Bursa – Common in professions who spend a lot of time on their knees eg carpenters and plumbers. Due ti chronic stress on bursa.

2. CLERGYMAN’S KNEE i.e. Superficial Infrapatellar Bursa – commonly occurs with JUMPER’S KNEE due to repetitive strain on patella ligament in jumping activities.

3. PES #ANSERINE BURSITIS (not in image) – on the upper inside of shin. Common in RUNNERS, OVERWEIGHT MIDDLE AGES WOMEN, TYPE 2 DIABETICS AND OVER 50S WITH KNEE #OSTEOARTHRITIS.

4. SUPRAPATELLAR BURSITIS (above kneecap) – trauma or repetitive trauma from kneeling or overuse for example.

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Hope that was helpful. If that is you, you may benefit from treatment. Don’t hesitate to contact or DM us. Stay tuned for the next knee pain post!

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Kneecap Pain Causes: Part 2

PATELLOFEMORAL PAIN
CAUSES PART TWO: THE Q ANGLE

The #Qangle (above left image) aka the Quadricep angle is formerd by:

1. A vertical imaginary line running from the tibial tuberosity (bone at the top of the shin bone under the kneecap) through the middle of the kneecap.

2. A line from the ASIS (Bone sticking out at the top of the leg on the hip bone) through the middle of the kneecap.

The normal Q angle is said to be between 14 (males) to 17 (females) degrees. An angle of 18 degrees or more increases risk of knee pain and anterior cruciate ligament injury . This is because:

1. It increases the angle between the #patella and #quadricep #tendons –> potential injury.

2. The kneecap itself does not move in its groove as smoothly and there is am increased rate if degeneration and #sublux or #dislocation.

There are many factors that can increase the size of the Q angle. They are:

1. Females – have a wider #pelvis –> larger q angle. Anterior knee pain is very common in women <30 especially runners. #Osteoarthritis of the knee is also more common in females.

2. Hip Joint – #anterversion or #retroversion of the hip, coxa vara, osteoarthritis all INCREASE the Q angle.
3. Knee Joint – ‘Knock Knees’ and outward rotation of the shin bone aka Footballer’s Legs also INCREASES the Q angle.

4. Foot – #Overpronation or a flat arch also INCREASES the Q angle.

5. Muscle weakness or #Imbalance – Weak #glute muscles and deep leg muscles INCREASE the Q angle. A SHORTENED INCIDENTS calf head and #POPLITEUS also turn the shin bone inwards INCREASING the Q angle.
Some of these factors can be resolved with treatment and #rehabilitation.

Stay tuned for more on anterior knee pain.

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Kneecap Pain Causes: Part 1

#PATELLOFEMORAL PAIN

CAUSES PART 1:

INVOLVING THE KNEECAP ITSELF

#Patella Alta – above left diagram. Generally kneecaps sit in the groove and the bottom of the kneecap is about level with the joint line. However, people born with an unusually high knee cap or those left with one after surgery are susceptible to much faster degeneration of the back of the kneecap as it doesn’t sit in the groove well.

If the bottom angle of the #kneecap is line with or below the joint line (imaginary line where the knee bends) this is considered to be ‘normal’ or less likely for #cartilage damage to occur as quickly as when it is high.

#Trochlear Dysplasia – see above bottom right. This is when instead of having a stable groove to sit in. The kneecap sits in a shallow or flat groove. This allows excessive movement particularly right and left and decreases stability of the patella. It can lead to increased incidences of #dislocation and faster degeneration. When moving the kneecap side to side in a stable trochlear, the kneecap should rise a little when pushing to the outside of the leg.

Test for a shallow groove is done using the inverted J sign

– Patella Tilt – see above top right. If the patella is tilted one side more than the other, there is more chance of wearing on the side closer to the thigh bone. One tests this by springing the kneecap on the right and left sides.

Patella Testing:

1. Inverted J Sign – sit on high surface knees dangling of the side. Extend and flex knees, watch for patella moving excessively up and out as the knee extends or see link below.

https://youtu.be/MY54a3tAyU8

Then with the legs completely extended on a couch:

2. Check lowest angle of kneecap is in line with the joint line

3. Spring the kneecap on either side to test the tilt

4. Palpate behind kneecap when sliding it to the side for pain

5. Holding the kneecap to the left and then to the right, contract the quads. Test for apprehension or pain.

6. Lift kneecap and contract quads. See if pain disappears.

More to come!

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