Iliotibial band syndrome is inflammation of the iliotibial band where it attaches to the hip bone and/or outer surface of the knee.
The iliotibial band (ITB) runs from the outside of the thigh down to the knee. It is a thick and strong structure made up of a tissue known as fascia. The ITB aids associative hip muscles for movement and provides support to the outside of the knee.
The ITB is prone to injury in runners, suggested to affect 4-8% of those participating in long distance. This is due to the repetitive nature of movement causing the ITB to repeatedly create friction on the outer surface of the knee, resulting in pain and inflammation.
– Pain on the outside of the knee
– Pain on the outside of the hip
– Snapping sensation around the hip
– Pain that improves with rest
– Increased pain with downhill running
– running on tracks without banking
– Increasing your level of sport/activity (over training)
– Wearing shoes with poor shock absorption
Partial tearing of the anterior cruciate ligament
The ACL is located deep within the knee joint, attaching to the femur (upper leg) and tibia (lower leg) bone. Its primary function is to resist anterior translation (forward movement) of the tibia.
Any force that pushes the tibia anteriorly (forward) whether severe (being slide tackled from behind) or having to decelerate (slowing/halting running pace) will place stress on the ACL. The ACL may be predisposed to tearing if the surrounding muscles are weak or imbalanced; such as the hamstrings being too weak or the quadriceps being too strong in relation. Over pronation (foot falling inwards) will also place greater tension on the ACL by rotating the tibia internally.
-Feeling of instability or “giving way” when standing
-“Clicking/popping” sensation at time of injury
-Loss of range of motion, particularly extension (straightening the leg)
Physical examination from a professional can help determine if the ACL is damaged and understand the severity of injury. Treatment will often focus on strengthening the surrounding muscles and ensuring proper balance. Alongside rehabilitative exercise, massage, acupuncture, electrostimulation, and other modalities have been found effective in treating ACL injury. The hip and foot may also need to be treated if predisposing factors are found that are contributing to dysfunction of the knee. In cases of severe partial tearing surgery may be advised.
– Plyometric (explosive movement) dominant exercise during recovery
– Prolonged crutch use or bracing
Partial tearing of the posterior cruciate ligament
The PCL is located deep inside the knee joint and primarily limits posterior translation of the tibia (the lower leg moving backward) on the femur (thigh bone). The PCL is approx. twice as strong as its counterpart the ACL and thus injury is much less common.
The PCL is placed under stress when the tibia is moved posteriorly (backward), therefore incidents such as impact trauma to the shin can cause injury. There might be predisposing factors to the injury occurring, such as muscular imbalance or weak quadriceps and/or popliteus muscle.
-Pain behind the knee, especially on bending
-Feeling as if the knee might “give way”
A professional assessment will help determine an appropriate programme to help rehabilitate the injury. Crutches might be required initially leading toward the patient being encouraged to walk without aid. Often exercise will be focused on strengthening the quadriceps. Manual therapy can assist moving the joints through its range of motion to assist in recovery. Other treatment therapies such as taping, acupuncture, and manipulation may provide additional relief and promote the rate of healing.
-Plyometric (fast/explosive) exercises during recovery
-Heavy squatting too early
Partial tearing of the medial collateral ligament
The MCL attaches to the inner side of the femur (thigh bone) to the inner side of the tibia (leg bone) located externally from the joint. It is one of the strongest ligaments in the body yet the most commonly injured in the knee. The MCL helps to prevent valgus stress (the knee falling inward).
A blow to the outer side of the knee causing valgus stress can overstretch and tear the MCL. Over pronation and sudden sharp changes in direction may also cause injury to this ligament. Weak or imbalanced surrounding musculature might be causing a predisposition to this type of injury.
-Pain on the inside of the knee
-Tenderness to touch inside of the knee
Most cases of MCL sprain respond excellent to conservative (non-surgical) intervention. In some cases bracing might be suggested during the acute phase of injury. A strengthening routine is often advised to enable better support from the muscles protecting the ligaments from excessive stress.
-Prolonged bracing/splinting in acute phase
-Sports involving excessive pivoting during recovery
Partial tearing of the lateral collateral ligament
The LCL supports the outer side of the knee joint and primarily resists varus stress (knee joint being forced outward). It attaches to the fibular head (top of the outer shin bone) and lateral femoral condyle (bony prominence on the outside of the thigh bone). Secondarily, it helps prevent too much internal rotation of the tibia (movement created by turning your foot inward)
Force to the inside of the side causing varus stress can overstretch and tear the LCL. Sharp changes in direction may also cause injury to this ligament. Weak or imbalanced surrounding musculature might be causing a predisposition to this type of injury. The ITB and short head of biceps femoris muscles assist the LCL is stabilisation and thus might be implicated. It is the least commonly sprained of the 4 major ligaments of the knee.
-locking or catching sensation in the knee when moving
-Tenderness when touching the outer surface of the knee
The prognosis for LCL injury is good with surgical intervention rarely required. Conservative treatment may focus on strengthening muscles that help support that side of the joint and examining other structures that might be predisposing you to weakness in this area.
-Pivoting exercises during recovery
-Avoid prolonged bracing post-acute phase
-Avoid contact sports during where the inside of the knee/leg is likely to be struck
Tear to either the medial or lateral meniscus
The medial meniscus is located on the inner side of the knee and lateral meniscus on the outer side. Both menisci are located adjacent to each other in the superior surface (top of) of the tibia forming a connection with the femur (thigh) bone. Their primary function is to aid congruency between the femur and tibia and enable greater shock absorption. The medial meniscus has a greater function for stability whilst the lateral is more mobile. Approximately 75% of all meniscus tears are medial.
Tears to the meniscus can be degenerative meaning they occur insidiously with age related changes, or traumatic. Trauma to the menisci usually occurs from end of range movement such as forcing the knee into hyperflexion or hyperextension with or without rotation. The menisci injured and location of the tear will be dependent on the plane of force. It’s suggested People with ACL deficiency are 40% more likely to incur a meniscus tear due to instability.
– Pain on hyperflexion (maximal knee bending) and forced extension (maximal leg straightening
-Popping or clicking during movement
-Feeling the joint becoming locked in a certain position.
– Pain on twisting with the knees whilst standing.
Rehabilitation is often focused around increasing knee joint stability by assessing and strengthening musculature to prevent reoccurrence of injury. Although most cases respond to conservative treatment tears can be progressive and may eventually require surgery.
Damage and irritation to the articular surface of the patella (inside of the knee cap)
The patella enables greater forced to be generated from the quadriceps muscles improving knee extension power by 35-50%. The patella achieves this by increasing the leverage that the tendon can exert on the femur by increasing the angle at which it acts.
Damage to the articular surface of the patella may arise from overuse, trauma or be degenerative. There can be many contributing factors for this condition. Trauma that results in compression of the patella with translational force may cause frictional damage to the articular cartilage. This condition may arise more insidiously due to poor gait mechanics causing maltracking (incorrect movement) of the patella from muscular imbalance or anatomical predisposition (increased Q angle).
Pain usually begins insidiously and starts off mild, creating a vague dull intermittent ache on the anterior (front) of the knee. This may then progress to a sharp catching or grinding pain.
Physical examination can assess how the patella tracks (moves) during activity and what may be causing dysfunctional movement predisposing to this condition. Corrective exercise and techniques such as massage and stretching can then be administered dependent upon the case.
-Incorrect/poorly fitting footwear
-Excessive patellofemoral contact force, i.e. jumping, walking downstairs
Degeneration of the infrapatellar tendon (tendon below the knee cap). Also known as patellofemoral pain syndrome and jumper’s knee.
The infrapatellar tendon attaches directly beneath the patella (knee cap). It is a continuation of the quadriceps tendon (muscles at the front of the thigh) that enable the leg to straighten.
Overuse and structural fault are common reasons for occurrence.
-Pain worsened with stairs (especially going down)
-Increased pain with prolonged sitting with the knees bent
-Knee pain around infrapatellar (but poorly localised)
Significant improvement is expected in 2-3 weeks. Tends to be chronic and reoccurring. An elastic knee brace with horseshoe pad to counter pressure, especially if patella maltracking is apparent may be advised.
– Heavy deep squats
– Increasing training freq/intensity
Inflammation of one of the bursae of the knee.
There are 14 bursae surrounding the knee, of these 14, 5 are considered primary bursae that are more prone to injury. Bursae resemble sacs, or pocket like structures which contain synovial fluid – a clear viscous fluid that serves to reduce friction of joints and surrounding structures.
Bursae may become inflamed from direct trauma or friction/compression e.g. Prolonged kneeling. Other less common causes are infection or inflammatory arthrosis.
– Localised tenderness and pain pressing onto specific bursae.
– Swelling may be visible
– Area may feel warm to touch
-Elastic sleeve (depending on bursae affected)
– Compression or activities causing friction to the area
Shin splints is a vague term for exercise induced leg pain, “shin splints” may be used to describe a symptom or a diagnosis.
There are numerous causes of shin/leg pain, the 2 most common are Medial Tibial Stress Syndrome (Posterior shin splints) and Tibialis Anterior Strain (Anterior Shin Splints). These both relate to a strain or tendinopathy of muscles acting on the tibia (the larger of the 2 leg bones)
Repetitive impact e.g. running, endurance training, poor conditioning and over training play a key role in development. Muscle imbalance and over pronation (foot falling inwards) has also been known to contribute.
-Pain in the leg which increases with activity
-Small lumps/nodules may be felt along where the muscles attaches to the tibia
-Rarely, swelling or redness may be apparent.
PRICE, gentle stretching and massage therapy to address tight/hypertonic muscles causing additional strain. Gait may be assessed to address any issues causing predisposition. Foot and ankle may require mobilisation.
-Limit avoid hard surfaces or hills
-Warm up adequately and avoid over training