KNEE PROBLEMS

Ilio Tibial Band Syndrome (ITBS)

ITBS is a common knee problem that causes pain on the outside of the knee (lateral side) during activity. The majority of people that suffer from ITBS are runners, but not exclusively. The ilio tibial band is a belt like tissue running down the outside of the thigh, starting from the hip and finishing near the knee cap (patella). ITBS is the result of inflamation caused by the band rubbing on the outer edge of the thigh bone (femoral condyle) near to the knee cap. The reason that the band starts to rub in this way is due to a combination of factors:

• Over-pronation (low arches) of the feet? excessive internal rotation of the leg
• Tightness of the Ilio Tibial Band
• Increase in running distance
• Running over uneven terrain

Treatment for ITBS is generally conservative (non-surgical). Functional foot orthoses (insoles) will reduce the internal rotation by controlling over pronation. This will reduce the stretching of the ilio tibial band and swelling which is leading to pain.

Other treatments such as stretching of the ilio tibial band, strengthening of the muscles on the inside of knee, ice therapy to the area of swelling and anti inflammatory medication might further help to cure the knee pain.

 

Patellar Dislocation

Patellar dislocation happens when the patella (kneecap) pulls away from the natural groove in which it runs (femoral groove). Partial dislocation of the patella is known as patellar subluxation. Most of the time the patella subluxes laterally (outwards) as shown in the attached picture.

The muscle on the medial (inside) of the thigh is important in stabilizing the patella. When the patella subluxes, the muscle can be damaged along with the patellar ligament. Damage to these structures can make the knee feel unstable. Many patients who suffer from long term instability find it beneficial to use some type of knee orthosis which stabilises the patella. In combination with strengthening exercises and proprioception (biofeedback) exercises, there can be huge improvements in stability.

Patella dislocation is most likely during activities involving twisting, cutting, pivoting and jumping. Stabilising the patella can improve the ability to perform these activities without risking dislocation. When participating in high impact activities, many people wear stabilization braces to prevent dislocation.

Patella stabilization braces work by helping the patella to run in the femoral groove without pulling away to the side. The pictured knee brace has a reinforced area round the patella to stop it from pulling laterally. The neoprene construction of the rest of the brace helps to improve proprioception and prevent the knee from other injuries such as ligament damage.

 

 

 

 

 

Osteoarthritis of the Knee

Osteoarthritis is a condition that can affect any joint in the body but commonly affects the knee. Sometimes termed “wear and tear”, osteoarthritis (OA) happens when the cartilage layer covering the bone is gradually worn away, leaving the bones more and more exposed. In most cases, this leads to pain which may become worse over time.

Severe OA can lead to bony, angular deformity over the course of time and the increasing deformity leads to faster progression of the OA due to abnormal forces across the joint. When people have OA of the knee, they complain of problems such as:

• Pain in the knee (sharp pain on the medial or lateral side, inside the joint)
• Knee giving way unexpectantly (loss of proprioception)
• Knee deviating away from being straight
  

Orthotic knee bracing can help to reduce some of the pain and deformity caused by OA. There are two different types of braces:

• Unloader braces
• Supportive braces
  

 

Unloader Braces

An unloader brace may help to reduce pain if only one compartment of the knee is affected by the arthritis. The medial compartment is on the inner side of the knee. The lateral compartment is on the outer side of the knee. Doctors are able to tell which compartment of the knee is affected based on the symptoms, physical findings and x-ray findings.

When one compartment is affected by osteoarthritis, the affected compartment tends to collapse. The goal of the unloader brace is to unload the weight from the collapsed compartment. If the inside (medial) compartment is collapsed, a brace is used to put more force on the healthy outside (lateral) compartment and less on the arthritic, inside (medial) compartment.

 

Supportive Braces

For many people, wearing an unloader brace is not suitable due to their size and weight. For other people, the OA destabilises the knee which causes to the knee to give way quickly.

For such people, there are a large number of neoprene and elasticated braces which can help. Compliance with such braces is much higher but the style of knee brace is entirely dependant on individual anatomy and the knee problem.

 

Ligament Injuries

There are 4 ligaments in the knee:

• Anterior Cruciate ligament
• Posterior Cruciate ligament
• Medial Collatral ligament
• Lateral Collateral ligament

Damage to any of these ligaments can cause severe instability at the knee. This is much more common in athletes and sports people. Many ligament injuries are treated surgically but ligament knee braces can be used to delay surgery or to augment stability following surgery.

 

Ligament Knee Bracing

The type of ligament knee brace used will depend on the injury and the level of severity. These types of braces are known as functional knee braces. The strapping arrangement of the brace will attempt to replace the function of the damaged ligament. The knee braces will also improve proprioception which is sometimes diminished following a ligament injury.

Knee pain takes many different forms and is a wide ranging topic. Knee bracing is not suitable for everyone but is a non invasive treatment and therefore a safe and reversible option prior to considering surgery.

 

 

 

If you require any further information regarding knee pain, please contact us.