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The Knee Cap and Knee Pain

13 Jul

The knee can be divided into four compartments—the front, inside, back, and outside—which intimately interact with each other. The compartment located in the front of the knee includes the knee cap (or patella), the groove in which it slides in, and the muscles that attach to the patella. The patella is the body’s largest “floating bone” (technically called a sesmoid bone). The function of the patella is to act as a kind of pulley that allows the knee to fully and easily extend. This area of the knee is often referred to as the “extensor mechanism”, as it is responsible for allowing the knee to extend or straighten.

When full extension cannot be accomplished, this is referred to as “extension lag” or “flexion contracture.” Extension lag is often caused by weakness of one of the four quadriceps muscles called the vastus medialis oblique (VMO), and depending on the cause of the weakness, exercises that specifically address this problem are very important in regaining the ability of the knee to fully lock out in extension.

Flexion contracture results in a similar inability to fully extend or straighten the knee, but the cause is not due to muscle weakness but rather the shortening or “contracture” of the muscles that flex the knee called the hamstrings, which are located behind the leg and knee. This can happen when patients are bed-bound, and it can become a permanent impairment if the hamstrings are not used or properly stretched on a regular basis.

Another problem associated with the patella is a softening of the cartilage behind the knee cap, which is called chondromalacia patella (CP). One symptom associated CP includes burning pain in the front of the knee, especially when the knee is bent for a prolonged period of time. Symptoms can be very intense but usually improve quickly once the knee is straightened out or the person can stand or walk.

The shape of the patella as well as the shape and depth of the groove in which the knee cap glides can be altered by trauma and/or genetic reasons. This can also predispose the patient to problems in this compartment of the knee. A common genetic example is an excessively knocked knee (technically called genu valgus). This results in the disproportionate rubbing of the patella on the outer ridge of the femoral groove, which can be painful.

Doctors of chiropractic are trained to assess, diagnose, and treat patients with knee pain utilizing manual therapies, modalities, exercise, and orthotics for foot/ankle conditions, as well as the application of braces and/or taping of the knee.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Is Your Foot Causing Your Knee Pain?

13 Apr

Due to bipedal locomotion (walking around on two legs), foot and ankle problems have the potential to affect EVERYTHING above the feet—even the knees!

When analyzing the way we walk (also known as our gait), we find when the heel strike takes place, the heel and foot motion causes “supination” or the rolling OUT of the ankle. As the unloaded leg begins to swing forwards, there is a quick transition to pronation where the heel and ankle roll inwards and the medial longitudinal arch (MLA) of the foot flattens and pronates NORMALLY!

During the transition from supination to pronation, the flattening of the MLA acts like a spring to propel us forwards followed by the “toe off”, the last phase, as we push off with our big toe and the cycle starts with the other leg. However, if you watch people walk from behind, you will see MANY ankles roll inwards too much. This is call “hyperpronation” and that is NOT NORMAL!

So at what point does this normal pronation become hyperpronation? The answer is NOT black and white, as there is no specific “cut-off” point but rather, a range of abnormal. Hence, we use the terms mild, moderate, and severe hyperpronation to describe the variance or the degrees of abnormality. Hyperpronation can lead to the development of bunions and foot/ankle instability that can cause and/or contribute to knee, hip, pelvis, and spinal problems—even neck and head complaints can result (the “domino effect”)!

One study looked at the incidence of hyperpronation in 50 subjects who had an anterior cruciate ligament (ACL) rupture vs. 50 without a history of knee / ACL injury. They found the ACL-injured subjects had greater pronation than the noninjured subjects suggesting that the presence of hyperpronation increases the risk of ACL injury.

Doctors of chiropractic are trained to evaluate and treat knee conditions of all kinds. Often this may include prescribing exercises or utilizing foot orthotics in an effort to restore the biomechanics of the foot, which can have positive effects not only on the knees but also further up the body.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

What Is Causing My Knee Pain?

24 Oct

It’s easy to focus on the knee when it hurts, but is the pain truly arising from the knee? There are many studies that link knee pain to problems with the lower back, hips, ankles, and feet. This month, let’s focus on the role the foot and ankle play in preserving knee health!

Because we are all bipeds—we walk on two legs—EVERYTHING from the ground up affects the rest of the body. The first “link” of this “kinetic chain” is our feet, and the last link is the head.

If any of the links are altered lower down in the kinetic chain, it will affect the links that follow—usually in a negative way!

For example, a flat foot and/or pronated ankle (where the foot and ankle rolls inward) can create a “knocked knee” effect. The next time you’re in the mall or grocery store, look at people from behind and watch how many roll their ankle(s) inwards when they walk. This is especially noticeable among those wearing shorts and flip flops. It’s estimated that 80% of us are over-pronating by the age of 30, and many of us are born with congenital flat feet, so this behavior is not uncommon in kids.

There are many tissues in the knee that can generate pain. In the over-pronation scenario, the medial, or inside compartment, of the knee is overloaded by opening up excessively while the lateral, or outer compartment, over-compresses or jams together. We often find medial and/or lateral compartment pain in the over-pronated ankle/knocked-knee side.

The front of the knee houses the knee cap that glides in a groove, and the knocked-knee results in overloading on the outside of the knee cap/groove creating a condition called lateral patellofemoral pressure syndrome and/or chondromalacia patella.

When you present for a chiropractic evaluation, your doctor will pay great attention to your gait or walking rhythm and look for over-pronation vs. supination (an outward shift of the ankle), the degree the knee “knocks” inwards (genu valgum) vs. outwards (genu varum or “bow-legged”), respectively. You can correct the pronation effect and unload the compartment that is literally getting “beat up” (hopefully BEFORE arthritis occurs) by placing a medial (or lateral) heel wedge into a foot orthotic.

The next topic is exercise! It is SO important to keep the muscles around the knee stretched and strong! There is ONE particular muscle (vastus medialis oblique or VMO) that connects our upper/inner knee cap to the medial/inside leg. It is the ONLY muscle that counteracts the outward pull by the other quadriceps muscles that attach to the kneecap. Your doctor of chiropractic can show you how to specifically exercise and isolate the VMO, if necessary.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.