Firstly, we will explain that this blog post is the first of a few about knee pain as there is a ton of information to share. Each will highlight a few separate conditions and how they can be managed. This blog post specifically will highlight patella tendinitis, patellofemoral pain syndrome, and iliotibial band syndrome.
How many of us struggle with knee pain but think ‘Ah, it will go away eventually’ and then leave it without getting it treated? A lot of us. At Chirolink we see this time and time again. Many of us don’t think it’s ‘serious’ enough to get it looked at. Because it’s not a sore back, we automatically think it’s less important. Yes, the spine does house our ever-important spinal cord, but this doesn’t mean the knee should be neglected when it’s in pain. Knees, biomechanically, are incredibly underrated and many of the conditions associated with it shouldn’t be ignored to prevent trouble down the line.
The first case that we’ll discuss is about Claire. Few weeks ago, Claire came to Chirolink with pain behind and below her kneecap. It had started niggling a few months ago but came to a head one week prior, after going to the gym and ‘overdoing’ it with her weighted lunges. She left it untreated for the week (and continued exercising) in the hope that it would get better but unfortunately, there was no improvement. Claire promptly booked to see us at Chirolink to get it checked. After an assessment, we determined that she was experiencing a patella tendinitis and patellofemoral pain syndrome. We quickly formulated a treatment plan and got her pain-free in no time.
Let’s break down each of these conditions:
Patella tendinitis and patellofemoral pain syndrome are two conditions that commonly go hand in hand. Patellofemoral pain syndrome is defined as pain at the front of the knee and surrounding the patella. It is suggested that the pain occurring is due to injury and inflammation of the cartilage at the back of the kneecap (patella). This occurs when the patella is not ‘tracking’ properly when pulled slightly towards the outer aspect of the knee consistently for a long period. This creates closer bone-on-bone contact between the patella and the femur. This method of injury is commonly the cause of patella tendinitis too where abnormal tension is placed on the tendon consistently for a long period, but it can also be caused by a sudden overload. The question is why would the patella track incorrectly? The patella itself is enveloped by the tendon of the quadriceps muscle. If something is biomechanically compromised in the chain upwards (the quadriceps, hip flexor, or extensor muscles and the joints of the pelvis), the movement of the patella is compromised.
Symptoms:
- Pain behind and around the patella (especially below it).
- Clicking and popping sounds with movement.
- Possible swelling surrounding the patella.
Our second case is about Kate. Unsure if this was the right place for her to be, Kate arrived at Chirolink seeking help for the pain she was experiencing at the side of her knee. It had been on and off for about 4 months but had noticeably progressed in the last two weeks. After taking a thorough history and physical examination, we discovered that Kate had significantly increased her cycling distance over the last month and that her bicycle setup wasn’t correct. These are two simple things put together to create what we call ITB (iliotibial band) syndrome. This is a frustrating condition for many sportsmen but can be managed well with the correct treatment protocols. A swift treatment plan was made for Kate and with each session, she has gotten better and better.
Let’s break it down:
ITB Syndrome is a condition that occurs when there is an increased workload placed on the tendon at the side of the knee, rubbing against the bone. This increased load results in considerably more friction and resultant inflammation. When this tendon is pulled too tight (from higher up the leg) or when there is sudden repetitive overload, it is more likely to happen. Why would it be pulled too tight? The ITB itself is formed by the gluteal muscles and the tensor fascia lata muscle joining together at the side of the hip. When these muscles are pulled too tight (because we often tend to sit too much or forget to stretch after exercise), they pull on the tendon.
Symptoms:
- Pain at the side of the knee – particularly when running cycling or walking downstairs.
- Possible swelling at the side of the knee.
- Possible clicking when bending the knee.
In both Claire’s and Kate’s conditions, the cause of the knee pain was due to overloading their respective tendons. Claire’s was due to a combination of sudden overload and repetitive micro-trauma whereas Kate’s was due to repetitive micro-trauma solely.
So, how do we treat these conditions?
We must ensure that the movement of the entire biomechanical chain is sound. This includes the knee and patella itself but also the foot and ankle, pelvis, and spine. Where there is abnormal movement, we employ safe and effective adjustments to restore normal movement and nerve function. Firstly, this provides optimal movement and function, but it can also have a resultant neural reflex reaction to the associated muscles, allowing them to release tension as well as activate properly. We use trigger point therapy for the problematic muscles and give effective stretches and home advice for our patients to receive the best outcome. Depending on the symptoms, diagnosis, and response to treatment, patients may be sent for further scans such as an X-ray or ultrasound when warranted.
A lot, we know! But there is so much more interesting information to come. If you’d like to learn more about the different causes of knee pain, keep an eye out for our next blog post that’s on its way.