Knee pain
History
A 43 year old female presents with recurrent knee pain after training at the gym or running on and off for a few years. The location of her knee pain is in the front of her knee near the inside. She does not have a history of knee injury. What can physiotherapy do to help?
Clinical examination
The patient does not have any symptoms walking and climbing stairs. Her knee pain is predominantly from squatting and worse in a single leg squat. While squatting, excessive knee adduction is observed. No flat feet are seen. Her knee joints are hypermobile but her right patella-femoral joint is not painful on palpation. Meniscus and ligament orthopaedic tests are negative. During quadriceps activation test, her vastus medialis oblique (VMO) was under-active and her patella was moving laterally. Her calves and hip external rotators are weak as well.
Her clinical presentation indicates a lateral tracking patella disorder.
Management
The cause of patella lateral tracking disorder is often multi-factorial. In terms of initial symptoms management, this patient responded well with McConnell Taping (medial glide of the patella with rigid tape), where she could squat without pain afterwards.
After a week, her knee pain settled. She then started a specific muscle training program focusing on activation, strength and endurance of the VMO, calves and hip external rotators. In her next review after another two weeks, there was noticeable improvement in her lower limb biomechanics since she started the exercises and she was happy with the results.
Clinically being able to have at least satisfactory closed chain lower limb biomechanics is very important to rehabilitation and injury prevention. For specific groups of people, such as runners and sports players, further dynamic, agility and plyometric assessment and training will be a key to their performance and sports specific injury prevention.
If you have any questions regarding your knees or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.