Patella Dislocation

Patella dislocation refers to the displacement of the knee cap out from its normal alignment from the groove of the femur (thigh bone). Most commonly, the patella tends to dislocate laterally towards the outside of the knee. As muscles, ligaments and stabilizing structures run through the knee joint, a dislocation can therefore disrupt these structures and cause them to be overstretched and damaged.

What causes patella dislocation?

Dislocation of the kneecap is often caused by a traumatic type incident, such as a direct blow to the knee in a twisting motion. However, there are also factors that can increase the risk of patella dislocation, such as:

  • Previous history of patella dislocation or subluxation
  • Poor tracking of the patella
  • Shallow femoral groove
  • Weak inner quadriceps muscles
  • Tight lateral muscles/support, such as vastus lateralis (lateral part of the quadriceps), ITB, hip flexors and biceps femoris (lateral part of the hamstring)

Symptoms include:

  • Visible relocation of the kneecap to outside of the knee
  • Swelling and tenderness at the kneecap
  • Pain in weight bearing or straightening of the leg
  • Feeling of instability, like it is giving way
  • Feeling of weakness in the quadriceps muscles

This injury is usually seen in athletic teenagers participating in sports involving a lot of twisting and turning motions. Pivoting your femur (thigh bone) internally on a planted foot while knee is bent is the most common mechanism of injury (Greiwe et al., 2010).

Relocation of the patella will be needed, either by self or by health professional. X-rays, ultrasound or MRI may be used to confirm diagnosis. Damaged structures can also be identified on imaging, but this will also be assessed in the physiotherapy session.

What can physio do for patella dislocations?

The first step is to reduce the swelling and inflammation as well as providing some temporary support such as taping or bracing. Normalizing and improving the range in which your knee moves will be the major focus during this period. Once everything has settled, a rigorous rehab program focusing on strengthening muscles of the lower limbs begins. This type of training takes at least 8-12 weeks to 6 months of regular physio visits and adherence to the program for the best results to prevent future dislocations and for safe return to sports and daily activities.

Here at Capital Physiotherapy, we believe early management and rehabilitation is essential, so if this has happened to you or you notice you are experiencing some of the symptoms listed and need further advice, contact us today at info@capitalphysiotherapy.com.au or call 0401 865 333. We are located conveniently at South Yarra, Balwyn and Footscray.

House Maid’s Knee

What a funny name for an injury! But what is it? 

This injury is commonly seen in patients who work or spend most their time on their knees. For instance, floorers, carpenters and in more historic times house maids who scrubbed floors thus the name, “House Maid’s Knee”. 

So, what is it?

House maid’s knee occurs when the bursa or fluid-like sac, that sits on top of your kneecap becomes inflamed from repetitive kneeling. Normally the bursa decreases the friction between the skin and kneecap but sometimes it can become inflamed and irritated when there is too much weight-bearing and loading on the kneecap. This can cause swelling, heat and inflammation leading to restricted movement and increased pain at the front of the knee.  

Thankfully, house maid’s knee can be easily treated by a physiotherapist. A course of anti-inflammatories can be taken to help reduce inflammation along with applying ice to the knee to decrease swelling. After this, stretches will be prescribed to reduce friction around the knee along with strengthening exercises to help support joint during movement. 

If are having knee issues or have any concerns, contact Capital Physiotherapy at info@capitalphysiotherapy.com.au and we can have you back to work in know time!

Runner’s Knee Pain (ITB Syndrome)

ITB Syndrome (Iliotibial friction syndrome) is one of the most common causes of “Runner’s Knee”. Being an overuse injury, it is caused by repeated trauma rather than a specific incident.
It arises at its proximal end from the tendons of the tensor fasciae latae and gluteus maximus muscles. From its origin, the Iliotibial tract travels along the lateral side of the thigh and across the knee joint, inserting on the lateral epicondyle of the tibia.

Sign and Symptom:

  • Pain with activities that require repetitive activities involving knee flexion-extension
  • Burning pain at the outer aspect of the knee.
  • The pain tends to be worse when running or coming down stairs.
  • There may be an audible snapping sensation the knee bends due to the band flicks over the bony tubercle.
  • There may also be some swelling on the outer side of the knee.
  • Pain is also exacerbated when running a long distance.
  • The onset occurred most frequently at the lateral knee after 2-3 km of running, or hiking over 16km.

At Capital Physiotherapy, all our physiotherapist is able to assess your running and come up with strategies to help you during your run. At capital physiotherapy, we have clinicians who have ample experience returning athletes back to sport. If you’ve got lingering pain that is sticking around longer than expected, book in with one of our friendly physiotherapists and get some recommendations on what to do. We are conveniently located at South Yarra, Footscray and Balwyn so choose a clinic most convenient for you. You may drop an email at info@capitalphysiotherapy.com.au or do an online booking here.

Osgood-Schlatter Syndrome

Osgood-Schlatter Syndrome usually occurs in children and would normally affects both knees. This can be classified as ‘growing pains’. The pain is usually located at the tibia tuberosity (the bump in the tibia) and can be very sensitive to touch. These tend to occur when the child is undergoing a growth spurt, as well as an intense period of exercise; specifically: soccer, basketball and ballet. Traditionally speaking, there are more boys being affected by this syndrome; however the gender gap is narrowing as more girls participates in sports.

Ongoing activity, without appropriate management by a physio, may result in an avulsion fracture, whereby a piece of bone is torn away from the main bone. In this case, a splint may be ordered to allow the fracture to union.

Osgood-Schlatter is normally treated conservatively when caught quite early. Physiotherapy is usually recommended to help guide rehabilitation. Treatment would involve reducing tight muscles in the quadriceps, hamstrings and gastrocnemius muscles; as well as some strengthening exercises. Taping may also help.

Physiotherapists can also liaise with your child’s coaches so that they can continue to train, but minimizing any activities that may aggravate the syndrome. This is important as stopping their training will stunt their skills growth. Stopping training will also result in muscle atrophy and tightness developing as you ‘wait’ until the pain goes away. This may then create a domino effect and result in other issues in the near future.

Our physiotherapists at Capital Physiotherapy are well experienced dealing with Osgood-Schlatter Syndrome. Not only are they qualified to assess the functioning of your child’s knee joint; but they also have experience working with different sports clubs. This means they are well placed to not just treat your child, but communicate with other stakeholders to ensure your child gets the best care they deserve. This holistic care is important for your child’s wellbeing and Capital Physiotherapy will deliver.

So don’t hesitate to contact us at Capital Physiotherapy and we will get your child back to their best!

Muscular Imbalance Causing Knee Pains

I have seen many people reporting of knee pains. Some who had a sporting incident, resulting in a traumatic damage to the knee; while others have been a gradual progression of knee pain. Initially the pain is described as mild, an annoying ache. With ongoing aggravation, the pain progresses in a sharper type, where it can eventually stop people from doing their daily activities. With these gradual progression type of pain, it is important that the knee is looked after quickly so that further aggravation and worsening of symptoms can be avoided.

The quadriceps muscles are made up of 3 main group of muscles. The first in the Vastus Lateralis; the second is the Vastus Intermedialis and the third is the Vastus Medialis Oblique. Each of these muscles attaches onto the patella and has its own direction of pull. The VL pulls the knee cap laterally (to the outside), while the VI pulls the knee cap directly upwards. The VMO, meanwhile, pulls the patella medially (to the inside).

Each of these muscles will interact in such a way that the knee cap is pulled directly up along the patellar groove. By keeping the knee cap moving smoothly along this groove, you can minimise the pressure around the knee cap.

As you can imagine, any issues with the quadriceps, will result in this finely tuned movement of the knee cap to be disturbed, causing issues in the future.

Improper training, could potentially result in the VL being overworked and getting much stronger than the VMO. You can see this when someone does a squat or a lunge and their knees are moving sideways. This results in an imbalance of the patella as it move up and down along the patella groove. The result of this would be increased friction along one side of the patella which will gradually become increasingly worsening knee pain.

Injuries to the knee will also affect the movement of the patella. The more significant and frequent injuries you have in the knee, the more your VMO becomes less activated. This will have the same impact as the above scenario over time; mainly a gradual worsening of pain; as well as wear and tear along your knee cap.

It is therefore imperative that you get your knee pain looked at as soon as you can. Further postponement as well as ongoing aggravation will result in worsening of your symptoms and finally preventing you from doing your exercises.

Come to our physios at Capital Physiotherapy. Our appointments are strictly 1-on-1 and we provide longer than industry standard appointments to truly understand, not just your body, but your exercise routine as well as a multitude of other factors that can affect you. It is only with a great understanding of your situation will you achieve the outcome you deserve.

So don’t wait any longer and call us now!

MCL and LCL injury

Other important ligaments in your knees are your Medical Collateral Ligament and the Lateral Collateral Ligament. These, along with the rest of the ligaments, work together to provide stability in the knee joint. The MCL, originates from the inside part of your femur (thigh) and attaches to the inside part of your tibia (leg). The LCL, on the other hand, originates from the outside part of your femur and attaches to the outside part of your tibia.

 

The MCL is important in providing stability in your knee, so that it does not bend inwards. Injuries to this ligament could be due to a prolonged stress on the MCL, such as during skiing. It can also be injured due to a traumatic incident, whereby you are tackled from the outside.

 

The LCL, meanwhile, is important in providing stability in your knee, so that it does not bend outwards. Injuries to this ligament are usually due to a traumatic incident, whereby you are tackled from the inside.

 

 

There are 3 grades of ligament tears:

  1. Grade 1=a small tear resulting in some pain but still allowing almost full function
  2. Grade 2=a moderate-significant amount of tear, causing significant pain and reduction in function
  3. Grade 3=a complete tear of the ligament, resulting in pain, instability as well as minimal function. A grade 3 tear may also involve damages on other structures as well.

It is important that after a knee injury and if you suspect an MCL or LCL tear, that you seek physiotherapy help as soon as you can. Our physios at Capital Physiotherapy are well trained to diagnose as well as clear other structures in the knee of any involvement in the injury. Your appointment is spent 1-on-1 for the duration of the session to ensure you get the most out of your physio. A treatment plan will be provided to you so that you have a clear understanding of what needs to be done to get you back doing what you do best!

Don’t hesitate to contact us at Capital Physiotherapy!

Patella Tendinopathy

A lot of people come into our rooms at Capital Physiotherapy with knee pains. Specifically, pain around the front of their knees. There are a few structures in this area of the knee, but we will be discussing about the patella tendon. The tendon is a part of the quadriceps muscle. The quads originates from the pelvis and inserts into the upper part of the patella. From here, the patella tendon starts and finishes at the ischial tuberosity, located in the tibia (lower leg).

The patella tendon is important as it is part of a pulley system for the quadriceps muscle. This adds leverage and consequently power to the quadriceps muscle. This will allow you to do intensive activities, such as jumping and sprinting. In saying this, you can imagine how much stress is placed on the tendon! In fact, the most common cause of patella tendinopathy are jumping and sprinting based sports.

This stress can cause issues in the tendon which will then lead to pain and subsequently, reduction in your activities! When stress is placed on a tendon, there are some micro tears, which heals when you look after the body. However, if you continually place the load on your tendon over a prolonged period of time, there is more aggravation than healing; resulting in pain. 

Usually, people will come in not knowing what’s causing the pain in their knees. This is because the pain would only come gradually. The pain would initially be described as an ache, but as physical activity continues, the pain becomes sharper, until finally you have to stop your sport.

Our physios at Capital Physiotherapy are well experienced with knee pains. While it’s important to get rid of the pain so that you can go back to your physical activity, what is equally important is finding the exact cause of the problem in the first place. During your consultation, our physio will spend their time 1-on-1 with you, to make sure they understand not just your body, but your training routine. They will develop a treatment plan that will not only get you pain-free, but also ensuring you do not have the same problem again.

So don’t hesitate, and get that knee looked after now. The sooner you get the knee looked after by our physios at Capital Physiotherapy, the better your prognosis and the quicker you’ll get back to your game!

PCL injury

We’ve talked about the ACL, now we come upon its equally important cousin, the Posterior Cruciate Ligament (PCL). Like the rest of the knee ligaments, the PCL works with them all to provide stability within the knee joint. It originates from the anterior (front) part of the femur and attaches to the posterior (back) part of the tibia. The ACL, as mentioned previously, originates form the posterior part of the femur and attaches to the anterior part of the tibia.

The PCL is important in ensuring stability within the joint by stopping the posterior movement of the tibia in respect of the femur.

Injury to the PCL is less common than an ACL injury. PCL tears are usually due to direct blows to a bent knee. This could be when you have an accident and your knee receives a direct blow from the dashboard. You may also be tackled in certain ball sports, while having your knees bent. Another common method is through extreme hyperextension.

Regardless of the cause, it is imperative that you get your injured knee looked at by a trusted physiotherapist. Prolonged sport activity is usually impossible due to pain as well as instability within the knee. Patients would normally report of a poorly localized posterior pain that is deep within the joint. Depending on the severity of the injury, your rehabilitation will differ. Conservative management is usually done before surgical intervention is advised. However, please talk to your physio before you make your next move.

Our physios at Capital Physiotherapy will ensure that you are looked after from the start. This means making sure we not only confirm a PCL tear, but also rule out other injuries. We will also provide a treatment plan that will include the goal of you going back to your chosen sport. This plan will include what we need to do, what exercises you require and many more important details to get you back to your best. By getting your injured knee early, you will have the best outcome quickly!

If you have any questions, please do not hesitate to contact us and we would love to be a part of your journey back living your life the way you want it to be!

Meniscus Injury

The knee joint is a relatively complex joint with multiple structures that works together to provide both stability and movement in the knee joint. A part of the knee that is quite commonly injured is the meniscus. This is an injury that Luke Hodge had back in May 2016.

The meniscus are 2 structures within the knee joint. As you can see from the picture, you have a Medial Meniscus and a Lateral Meniscus, both shaped in a circular fashion.

These structures has a few important functions within the knee joint. The most important function is they act as shock absorbers and load distributor. They are sponges that reduce the stress going through the bones; thereby reducing wear and tear in the joint.

The meniscus can be injured in several ways. Injury to the meniscus can be due to a gradual build of stress, which may occur with repeated or prolonged squatting/kneeling. An athlete may also injure their meniscus if they try to turn/pivot on their knees too quickly; this will result in a partial or a total tear.

Once a tear has occurred, it is important that the knee is assessed to find out how severe the injury is. Depending on the severity, a period of conservative management may be enough to get you back playing your sport. However, more serious injury such as the ‘bucket handle tear’, may require you to undergo an arthroscopy. In saying this, if you have a knee injury, come visit us at Capital Physiotherapy. Our physiotherapists have a lot of experience dealing with these types of injury. They will spend the time with you to make sure they get the right diagnosis as well as give you the correct treatment plan that you need to get better quickly!

So don’t hesitate, and get that knee looked after now. Capital Physiotherapy is ready to help you!

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome, or PFPS, can be a very debilitating condition which can stop you from doing a lot of activities. At its worse, most patient will report of pain and inability to walk far.

PFPS is a term given to describe pain around the knee cap. This is usually due to repetitive damage around the knee cap as it contacts abnormally with the femur. Most patient will report of having a gradual build up of pain. Initially, the pain is niggling but does not stop a person from doing their exercises. Continued activity result in increasing pain which will in turn stop them from participating further. With rest, the pain would abate. However, returning to sport is usually short lived due to the returning pain.

There are multiple causes of PFPS. This include:

  • Foot and ankle misalignment
  • Poor hip control
  • Poor core strength
  • Leg length discrepancies
  • Poor training schedule (not enough rest, sudden increase in intensity)

Usually there are multiple factors that contribute to PFPS. It is important that you seek a trusted physiotherapist that can do a comprehensive assessment on your body. Taking the time with the assessment will result in identifying the causative factors, which means a better prognosis! You can trust our physiotherapists at Capital Physiotherapy to understand your body and get you back on track! Our initial appointments are industry-leading 1 hour. This gives our physiotherapists time to do full assessment, to make sure you are looked after!

Depending on what caused your PFPS, you may expect your physio at Capital Physiotherapy to:

  • Reduce any muscular tightness
  • Give exercises to improve muscle control
  • Suggest different types of footwear, or refer you onto our trusted network of podiatrists
  • Help plan an exercise program to make sure your body do not burn out

Our physiotherapists are trained at making sure all your concerns are listened to and provide you the best care you need.

If you have any questions, please do not hesitate to contact Capital Physiotherapy. Our physio clinics are located in Footscray, South Yarra, and Balwyn.