Posts Tagged ‘Orthotics’

Patellofemoral Pain Syndrome in Runners

Knee pain is slowing my run to a crawl! Why is this happening? What is Patellofemoral syndrome?
Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.
The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the “patella”) moves on the groove of your thigh bone (called the “femur”). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been touted as a cause.
What can I do to help my knee mend and relieve the pain ?
Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.
The mainstay of treatment is physical therapy. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.
Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease and stabilize excessive foot motion that causes abnormal stress on the knee. Even just a simple arch support insert from the local drug store can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.
Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.
Will I ever be able to run again?
Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won’t get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability.
Remember, you’ll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”. Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients recover with conservative treatment, particularly if they maintain a disciplined approach.

Your Knee Pain May Be Caused By Your Feet

Many people, particularly those who are athletic or very active, suffer from knee pain.  Although there are many causes of knee pain, one of the most overlooked causes is foot imbalance.Our feet take a lot of abuse, and as a result there are many opportunities for structural failure in the foot.  One of the most common areas of foot failure is the medial arch.  The feet are incredibly complex and dynamic pieces of machinery.  They are designed to move and adapt depending on how we use them and what we require of them.  But over time there can be failures.  The result is an imbalance in the foot that can result in many issues.  When there is foot imbalance it is common for our gate, the movement of our entire body while walking, to change slightly to compensate.  This change in our gate can result in undue pressure at the knee.  You have probably seen people with what is commonly called “knock knees” or that are “bow legged.”  These are conditions where the knees are either unnaturally turned in (knocking together) or are turned out (bowed).  Although these symptoms can be caused by other issues, many times the underlying cause is foot disfunction.  Knock knees and bow legged are extreme examples of what can happen when you suffer from foot imbalance, but many minor shifts in the knees can lead to severe pain.A simple solution to this knee pain is orthotic arch supports.  One of the most common foot dysfunctions is over-pronation, where the foot “rolls” to the inside.  This is usually caused by the arches in the foot functioning improperly.  The result of over-pronation can often lead to knee pain.Proper orthotic arch supports or cushioned shoe insoles can often bring balance back to the foot, solving the underlying problem leading to knee pain.If you think your knee pain might be caused by a foot imbalance, check out the full line of top name brand insoles and arch supports at TheInsoleStore.com.  TheInsoleStore features doctor recommended Spenco Insoles and Arch Supports as well Superfeet Premium Insoles and Sof Sole Performance Insoles.  You might just have the answer to that painful knee problem.

Knee Pain and how orthotics can help…

Many of us suffer from chronic pain in the knees, hips or lower back. Often there is a connection between these complaints and the way you walk. This article sheds more light on knee pain and in particular how abnormal foot mechanics or asymmetry in our gait can affect knee function, causing pain and discomfort.Typical knee pain symptoms…”A sharp pain in the knee and a grinding sensation, especially when getting up out of chair or walking up stairs.”This description of knee pain is most common and refers to a condition called Patello-femoral Syndrome. Patello-femoral Syndrome is the most common form of chronic knee pain. It refers to pain occurring between the knee cap (the patella) and the underlying thigh bone (the femur). Patello-femoral Syndrome causes pain and tenderness in the front of the knee. The pain gets worse when you sit for a long period and get up. Or when you walk up stairs. Often, one will experience a grinding or crunching sensation in the knee.What exactly causes knee pain?There are number of different causes for knee pain. With age wear and tear occurs in the knee joint. Also over-use causes knee problems (for example in rugby/football players, and in tradespeople such a carpenters, bricklayers etc). Over time softening of the cartilage beneath the knee cap (the patella) will result in tissue breakdown and pain in the knee joint. Instead of gliding smoothly over the knee the knee cap grinds against the thigh bone when the knee moves. In turn this may result in heavy erosion of the cartilage. Apart from age and over-use the third most common cause of knee pain is faulty gait (i.e. the way we walk). Overpronation (=rolling inwards of the feet and lowering of the arches) is a major contributing factor to knee pain.Here’s why…The knee joint forms the link between the upper and lower leg. It is a hinge joint, which means it is only designed to flex and extend the lower leg, and not to rotate it. Unlike for instance your elbow joint which allows your underarm to move up and down, as well a twist (rotate). Overpronation of the feet means that with every step your foot rolls inwards too much. As the foot rolls inwards the bones in the lower leg are forced to rotate internally and this results in a twisting motion at the knee joint. This irregular motion of the knee will inevitably lead to excessive wear and tear in the knee joint causing long-term damage and chronic knee pain. Over-pronation not only causes bad knee function. An estimated 70% of the population suffers from some degree of over-pronation and this becomes evident in other areas of the body, especially at an older age. People with overpronation can display symptoms such as frequent ankle sprains, pain in the arches, leg pains, shin splints, hip pain, even lower back pain.Treatment options for knee painThe most commonly prescribed treatments by physiotherapists include rest (or decreased activity), ice packs and sometimes wearing a knee brace and also strengthening exercises. In addition, orthotic shoe inserts will be recommended to stabilise the feet and correct poor foot function. Footlogics orthotics can be used to prevent the unnatural rotation of the lower leg, thereby treating the cause of this type of knee pain. By supporting the arches they force the ankles and legs back into alignment, reducing the twisting on the knee and thereby providing relief to the painful knee joint.A number of studies have shown that bad knee function can be restored by using foot orthotics. Below are the extracts of two of these studies:Study 1) The Effect of Foot Orthoses on Patellofemoral Pain Syndrome (Knee Pain) – Amol Saxena, DPM and Jack Haddad, DPM – Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA.In a retrospective review of 102 patients treated for chondromalacia patellae and patellofemoral knee pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthotics was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved, showing a significant decrease in the level of pain with orthotics intervention (chi-square P < .001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD. (J Am Podiatr Med Assoc 93(4): 264-271, 2003)Study 2) The Role of Foot Orthotics as an Intervention for Patellofemoral Pain (Knee Pain) – Michael T. Gross, PT, PhD1- Judy L. Foxworth, PT, MS, OCS2Foot orthotics often are prescribed for patients with patellofemoral knee pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthotics may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile. J Orthop Phys Ther 2003;33:661-670.

Finding the Cause to Your Knee Pain Through Integrative Manual Therapy