Patello-Femoral Pain Syndrome

Patello-femoral pain syndrome is an inflammation to the front of the knee joint caused by the patella (knee cap) not tracking properly over the distal femur (thigh bone at the knee). The patella normally rides in a groove on the femur. The patella is like a fulcrum, it gives leverage to the big muscles on the front of the thigh. These thigh muscles are called the quadriceps because they consist of four muscles

With patello-femoral syndrome (PFS), you get an imbalance in these muscles—usually the lateral or outside muscle overpowers the inner medial muscle, and this pulls the patella out of its normal groove. When the patella doesn’t track properly, it causes pain under the patella. PFS can have multiple causes, which can include foot problems, such as foot pronation, weak lateral hip muscles, genu valgum (knock-kneed), and a larger Q-angle (the angle from the front hip to middle of the knee cap). These can all affect the biomechanics of the patello-femoral joint. When experiencing these problems with your knee, it’s important to find ways not to keep it irritated.

Occasionally, the injuries start with a clear-cut onset, like stepping in a hole or falling on your knee. Usually, though, it feels like it comes out of nowhere. This means that you’ve been gradually creating the injury over a longer period of time like a few days or weeks. Something that you do during the day sets it off, but it’s commonly very hard to figure out was exactly is the aggravating activity. Nonetheless, you’ve overdone it. Try not to worry if you can’t figure out exactly why your knee got sore. That may not be necessary to determine in order to get better. The more often you make your knee sore, the longer it will take to get better.

The inflammation seldom builds up to a level where it keeps you in bed, so it’s tempting to keep up and about on it. This may keep it stirred up. Try to avoid all the activities that make it sore, i.e., sitting with your knee bent for a long time, walking a lot, going up and down stairs, or exercising. While it doesn’t cause more damage, it does keep the inflammation from going away. You may find it helpful to sit with your knee straight or get up and move around occasionally. Also, try stairs one step at a time using your uninjured leg. These knee injuries can be very stubborn before they get better. The sooner you stop aggravating it, the sooner you can get back to the activities you like.

Low Back Pain & Core Strength

Low back pain can be the result of many different things. Pain can be triggered by some combination of overuse, muscle strain, and/or injuries to the muscles, ligaments, and discs that support the spine. Over time, a muscle injury that has not been managed correctly may lead to an overall imbalance in the spine. This can lead to constant tension on the muscles, ligaments, bones, making the back more prone to injury or re-injury.

Since low back pain can be caused by injury to various structures in the spine and its supporting structures, it is important to consult your professional health care provider if you have had back pain lasting longer than 1-2 weeks. They can provide a diagnosis and explain what structure is injured so that appropriate treatment and exercises can be prescribed for your specific injury.

Each diagnosis is treated with different protocols, therefore it is important that you consult a health care professional before beginning any strenuous rehabilitation program. Low back exercises and flexibility can be the best treatment option for almost all types of back problems as it is likely to help restore balance in the spine. Low back exercises concentrate on strengthening with the abdominal muscles, to be able to give stabilization of the spine. Rehabilitation programs or preventative rehabilitation programs that focus on strengthening lumbar muscles combined with core stability and proprioception will reduce the risk of low back pain if exercises are done correctly, and on a regular basis.

Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS) is the result of inflammation and irritation of the distal portion of the iliotibial tendon (see illustration) as it rubs against the bursa that lies underneath the tendon and lateral femoral condyle (outer part of the thigh bone at the knee), or less commonly, the greater tuberosity (outer part of the thigh bone at the hip). This overuse injury occurs with repetitive flexion (bending) and extension (straightening) of the knee. This could also occur because of a lack of flexibility of the ITB, which can result in an increase in tension on the ITB during activity. When experiencing these problems with your knee, it’s important to find ways not to keep it irritated.

Occasionally, the injuries start with a clear-cut onset, like stepping in a hole or falling on your knee. Usually though it feels like it comes out of nowhere. This means that you’ve been gradually creating the injury over a longer period of time like a few days or weeks. Something that you do during the day sets it off, but it’s commonly very hard to figure out was exactly is the aggravating activity. Nonetheless, you’ve overdone it. Try not to worry if you can’t figure out exactly why your knee got sore. That may not be necessary to determine in order to get better.

The more often you make your knee sore, the longer it will take to get better. The inflammation seldom builds up to a level where it keeps you in bed, so it’s tempting to keep up and about on it. This may keep it stirred up. Try to avoid all the activities that make it sore, i.e., sitting with your knee bent for a long time, walking a lot, going up and down stairs, or exercising. While it doesn’t cause more damage, it does keep the inflammation from going away. You may find it helpful to sit with your knee straight or get up and move around occasionally. Also, try stairs one step at a time using your uninjured leg. These knee injuries can be very stubborn before they get better. The sooner you stop aggravating it, the sooner you can get back to the activities you like. If you have given it enough time to rest and it still persists, it is time to make an appointment to have it properly assessed and suggestions on possible treatment and rehabilitation.

Plantar Fasciitis (Foot Pain)

Our Feet are our Foundation – What can you do about foot/heel pain?

Most people can identify with taking the first few steps out of bed in the morning and feeling a searing pain in the bottom of their foot. It appears to get better when further steps are taken. It can come back often if you are on your feet for long periods of time, or at the end of the day. You can also experience it during or after exercise; such as running, or with weight changes; such as with pregnancy.

If you have had this foot pain, you are not alone. We have all had this issue at one time or another. It is part of the charm of being human and upright, bearing our full body weight on our feet.

The clinical name is Plantar Fasciitis pronounced (PLAN-ter fash-ee-EYE-tis) or Plantar Fasciosis, if it has been around for a while.

What is plantar fasciitis and why does it happen?

The plantar fascia is a band of tissue (ligament) in the bottom of our foot that connects the heel bone to the toes. Its job is to support our foot when we stand, walk or run. When we bear the full weight of our body on our feet it exerts an immense amount of force through this ligament. Excessive force can cause the plantar fascia to overstretch from the toes into the heel, much like a thick elastic band. If the strain continues enough, it then pulls on the heel causing small micro tears. These tears lead to pain and swelling. However, your body is an amazing machine, and it will try to repair itself. The constant tugging at the heel bone can cause a boney growth to form on the bottom of the heel bone. This is called a bone spur, and can be detected by an x-ray. Most people forget that bone is a living, growing tissue in our body. It continually changes based on the forces you apply to it. So if the plantar fascia is constantly pulling on the heel bone, more bone will form to support that extra force. It will attempt to strongly attach the fascia to the heel bone to prevent it from pulling the tendon right off of the bone. Our bodies are truly amazing!

How do health care providers diagnose plantar fasciitis?

We examine your feet and speak with you about the history of your problem. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. That is done with a thorough examination of your feet testing the muscles, joints and function of the foot while you are standing and walking.

One thing we often over-look are the basics we learned in school, which comes in the form of a song. The foot bone’s connected to the..ankle bone, the ankle bone’s connected to the…knee bone…to the hip bone…etc. Not only are we upright creatures, but walking is a very complicated process for all of these joints and muscles to work together in concert to move us around. Often as a chiropractor I see a foot problem show up as pain in the hip, knee or even the low back. Again, this shouldn’t come as a big surprise. If a problem goes on long enough, our body responds by trying to correct itself. Unfortunately, it doesn’t always do so in a positive way.

Thus, it is important to further assess your muscles and joints of the entire leg and hip, to determine if there might be a bigger issue at play here. Why did you get the foot pain? What can be done in the future to help prevent it from happening again?

Once your examination is complete, and we have confirmed that it is plantar fasciitis, we have treatment options that will help speed your recovery. Treatment will often help you return to your active lifestyle more quickly. Most often, in fact 90% of the time plantar fasciitis will resolve with non-invasive and non-surgical treatments.

How is it treated?

It is important to note, there is no single treatment that works best for everyone with plantar fasciitis.

Here are a few things to try first on your own:

* Give it some rest. If you are a runner, change to a softer surface. Or change to biking, swimming or an elliptical machine.

* Roll it out with a tennis ball a couple of times a day, for a minute each time.

* Stretch out the foot, toes and also the calf with basic heel stretches off of a step or toes against a wall.

* Roll it out on a frozen water bottle at the end of the day, to help relieve pain and bring down inflammation.

If it is persistent and you have given it some time to “work itself out”, then it is likely time to see a therapist. Don’t wait too long, 6-8 weeks is enough time.

A doctor may recommend splints worn at night, non-steroidal anti-inflammatory medications or possibly an injection of medication into the heel. An x-ray may be ordered to rule in or out other possibilities.

A therapist (chiropractor, physiotherapist, massage therapist, osteopath) may recommend more advanced non-invasive techniques.

Often the first treatment we use is to control pain and swelling with use of ice packs and soft tissue massage. We also give you exercises to improve flexibility in the calf muscles and plantar fascia. (these are similar to the suggestions listed above).

Although a customized orthotic can be useful, it is used conservatively if the problem is persistent. An orthotic is often not a long-term solution, unless there are structural issues that will not change with therapy. To provide temporary relief, we may recommend the use of a heel cup or a silicone heel pad which can reduce the pressure on the area of pain.

One of the most effective non-invasive techniques I have encountered so far has been Extracorporeal Shockwave Therapy, simply known as “Shockwave”. There has been scientific research to support its effectiveness (75-95%), along with our success clinically. It is a non-surgical treatment, with no side effects, available at a reasonable cost. The treatments are non-invasive and promote a rapid recovery of injured soft tissue, bone and heel pain.

What is Shockwave?

It is an intense, but very short energy wave traveling faster than the speed of sound. This technology has been used for decades for millions of people for issues such as breaking up kidney stones.

Therapy sessions are short, usually 20-30 minutes, and provide successful relief of chronic pain and restore mobility. Permanent relief typically begins about 72 hours following treatment. Typical treatment plans consist of 3 treatments, spaced a week apart. Most insurance companies will cover this therapy.

In addition, there are often joints and muscles in your foot &/or leg &/ hip that are not working properly. These mechanical issues often cause or contribute to the foot pain. We often perform soft-tissue massage, mobilize joints and teach strengthening exercises to further provide pain relief and prevent future problems.

Often the best results take a combination of different approaches and can take some time. You may have less pain within a few weeks, but it may take a month or so for the pain to go away completely. It really depends on a number of variables. In some situations, it can take up to a full year or more for the problem to be completely resolved. So don’t get discouraged. Continue to be diligent with your exercises and therapy recommended by your health care professional.

Please book a consultation at our office if you would like us to provide you with more information regarding Plantar Fasciitis or other muscular and skeletal complaints you may be experiencing. We are here to help you bring your optimal health back into balance.

as published on Huntsville Doppler