Runners Knee

Runners Knee is a condition characterized by pain behind or around the kneecap. Poor kneecap tracking is believed to be the main cause this condition. The kneecap (patella) slides over a groove on the thighbone (femur) as your knee bends and straightens. If, for example, the front thigh muscles (quadriceps) are weak or imbalanced, the resulting muscle imbalance can pull the kneecap to the left or right of the groove, causing pressure, friction, and irritation to the cartilage on the undersurface of the kneecap when the knee is in motion.

Overuse/overload of the quadriceps - especially running, going up and down stairs - can cause this condition to flare up, as can poor exercise techniques, e.g. a poorly fitting bicycle, improper footwear etc.

Causes of Knee Maltracking
Muscle imbalances / weakness or inflexibility in the muscles that support the knee, and mechanical errors can cause poor knee tracking. There may be multiple factors involved.

Muscle imbalances in the lower body, especially the quads are common. Tightness of the muscles and tendons can also pull the kneecap toward one side. In females, the increased inward slant of the thigh towards the knee is believed to the reason they are at higher risk of developing Runners Knee / Patellofemoral Pain Syndrome

Mechanical errors include misaligned joints in the foot or ankle; a kneecap that is located too high in the joint; flat feet / over pronation. Pronation is the normal inward roll of the foot as the arch collapses after heel contacts ground during walking or running. Over pronation causes excessive internal rotation of the lower leg and knee.

MUSCLE WEAKNESS / IMBALANCES / TIGHTNESS CAUSING POOR KNEE TRACKING INCLUDE:

Weak Quadriceps:
Quadriceps (front thigh muscles) strengthening exercises are considered to the most important exercise, in most cases, for correcting poor knee tracking. The quadriceps controls the movement of the kneecap. (They are attached to the kneecap and then to the top of the shine bone by tendons).

Imbalanced Quadriceps:
Sometimes the quads (there are four divisions) are imbalanced. The inner quad pulls the kneecap inwards and the outer quad pulls the kneecap outwards. If the inner quad is weak, the stronger outer quad tends to pull the kneecap off center. In this case, exercises to strengthen the muscles of the inner quadriceps are particularly helpful

Weak Hamstrings:
Another imbalance can occur when the muscles in the front of the thigh are significantly stronger than the muscles in the back of the thigh (the hamstrings). If your hamstrings are weak, your quads have to work harder. Tight hamstrings cause increased pressure between the patella and femur.

Tight Iliotibial Band:
The iliotibial band (a fibrous band of tissue on outer thigh that extends from the hip to below the knee) also affects knee stability. If too tight, this muscle/tendon of the outer thigh can pull the knee to one side. A tight iliotibial band can also cause Iliotibial Band Syndrome.

Weak Hip Abductors:
The hip abductors (muscles on the outer thigh involved in moving leg to side) also help support the knee. Strengthening these muscles may also improve runners knee.

Runners Knee Symptoms
Pain, typically diffuse pain, in front, around or beneath the kneecap. More pain and/or feeling of joint instability after climbing stairs, jumping rope, running, or after a period of sitting.

There is extra pressure between the kneecap and thighbone when the knee is bent at a right angle as when sitting. The kneecap is pressed towards the femur. If there is already irritation of the cartilage on the underside of the kneecap, discomfort or pain results. Even sleeping in a curled up position can cause pain when the condition has flared up. Contracting the quadriceps, as when going up or down stairs, also causes increased compression of the knee joint.

Sometimes after activities that have activated the quadriceps, it feels the knee is being pulled to one side. Sometimes a clicking, cracking or crunching sound is heard when the knee is bent or straightened. This is the kneecap slipping back into the groove.

An X-ray or MRI of the knee can show if there is damage to the cartilage or if the patella is displaced or tilted. A tilted patella may be correctable with exercise if the tilt is caused by a muscle imbalance.

Runners Knee Treatment
Rest : (not total rest) Temporarily avoid activities that cause extra stress on the knees such as squatting/kneeling or high impact activities like running until the pain subsides. Swimming or low-impact activities such as working out on an elliptical trainer are fine. Avoid squatting/kneeling as a bent knee causes extra pressure between the patella and femur. Avoid leg presses where you support your weight with a bent knee. Straight leg lifts are safer. As you get stronger, partial squats are ok

Icing: Applying Ice to the knee, especially after exercise may reduce pain and swelling. Don't ice for over 20 minutes at a time to prevent frostbite. Elevating the knee above the level of the heart while icing helps in reducing the inflammation.

NSAIDs : non-steroidal anti-inflammatory drugs such as Aspirin or Advil, as recommended by your doctor. See Medications.

Exercise: Exercises, particularly exercises to strengthen and stretch the quadriceps (front thigh muscles) and hamstrings (muscles of the back of thigh). The exercises emphasized in the majority of cases are those that strengthen the quadriceps particularly the inner division of the quadriceps. This usually is very effective. Spending a few minutes, a couple of times a day on these muscles and gradually working up to 20 minutes per day are sometimes all that is needed. Be patient. It can take several weeks to notice an improvement. See Knee Exercises page.

Knee Taping : Taping is used to realign the kneecap and hold the kneecap in place. Although knee taping has not been scientifically proven to help stabilize the knee joint, it has been shown to significantly reduce pain. The relief is usually immediate. There are different techniques that a physical therapist (physiotherapist) can show you. The tape can be irritating the skin.

Knee Brace: a Patellar Stabilizing Brace helps keep the kneecap in the middle of the patellofemoral groove. This may be helpful when the muscles than support the knee are still weak. A knee brace can take some stress off the knee and help relieve pain. Wearing a brace does not replace the strengthening exercises that correct the root of the problem. Braces help some people more than others. (Wearing them during sports has not been shown to reduce knee injuries) They are expensive, and some people find them hot and bulky. Patellar stabilizing braces must be fitted properly to be effective. Not all knee braces are created equally. Ask a doctor or physical therapist whether or not knee braces are appropriate for your situation.

Proper Foot Wear: e.g. Shoes with an arch support to control over pronation, shoes with adequate cushioning in sole to help absorb shock. Orthotics may be required for those with severe over pronation. See Knee Pain, Overpronation, and Footwear. High heels throw your body forward and increase the pressure underneath your kneecap. Limit the time spent wearing high heels.

Surgery:
Surgery for Runners Knee should be a last resort, after an exercise program to correct muscle imbalances has been given a fair trial. It may be necessary if there are significant structural abnormalities.

Arthroscopy and Lateral Retinacular Release: If the knee-tracking problem is caused by excessive lateral pull (kneecap pulls toward outer side of knee), cutting the tight lateral ligaments to reduce the amount of pull can rectify the problem.

Patellofemoral Pain Syndrome / Runners Knee may lead to Chondromalacia Patellae.

Runners Knee is usually easy to treat. Doing the appropriate exercises, and avoiding exercises and activities known to cause undue stress to the knees are usually enough.

Resource from: http://www.bigkneepain.com/

http://www.aafp.org/

http://healthlibrary.epnet.com/

Sciatica / Slipped disc / Prolapsed disc

What is sciatica?
Sciatica is not a condition as such, but a symptom which can be caused by numerous conditions. The common sciatica symptoms involve pain that starts in the back and radiates down one (or both) of the legs. It is quite a common complaint and sciatica pain is caused by pressure on the sciatic nerve which runs down into the leg. The medical term is acute nerve root compression or radiculopathy.

 

The cause of pressure can be varied from a slipped disc (also known as a herniated or prolapsed disc), disc degeneration to muscle tension (Piriformis syndrome) or something less common such as a tumors, bony growths (stenosis) and infections.

 

A prolapsed disc or slipped disc as it is sometimes known is not simply a disc that has 'slipped' out of place. Intervertebral discs separate the bones of the spine (or vertebrae) and their function is to act as shock absorbers or cushioning for the spine and allow movement.

 

They quite happily allow flexion and extension (bending forwards and backwards), lateral flexion (sideways movement) and twisting. However a combination of the two can put excess stress on the spine and damage the discs. This is particularly common in people who may lift heavy objects and twist with them for example unloading heavy boxes off the back of a lorry.

 

The intervertebral discs are filled with a gelantinous substance in the middle called nucleus pulposus and when a disc prolapses this jelly-like centre squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.

 

Depending on where the sciatic nerve is pinched will determine where you feel the pain which can radiate to the front of the knee or right down the back of the leg to the foot. The L5-S1 disc is the disc most commonly damaged and the L4-L5 disc the next most commonly damaged. On the illustration opposite, L4 and L5 are the bottom two Lumbar vertebrae at the base of the spine. S1 is the top of the Sacrum

 

Sciatica Symptoms

• Acute low back pain (not always present, especially in piriformis syndrome)
• Pain radiating down the leg. This pain may be sharp and accompanied by pins and needles and / or numbness
• Sciatica pain is often triggered by a minor movement such bending over to pick something up
• Pain may be worse by sitting, lifting, coughing or sneezing
• Pain is usually relieved by lying down, often on one side
• Pain is often better in the morning after a nights rest
• There may be muscle spasm in the lower back
• Tenderness in the lower back when pressing in
• Pain on the straight leg raise test (video) which is not apparent when just stretching the hamstring only

Sciatica treatment

• Rest in bed if necessary in a position that is comfortable
• A doctor may prescribe NSAID's (non steroidal anti inflammatory drugs) such as ibuprofen. Should always be taken under the direction of a doctor and not if the patient has asthma
• Apply heat or a hot bath may help to relieve muscle spasm
• Use of a heat retainer or back brace can provide support in the early stages
• See a sports injury specialist or doctor
• Begin extension exercises as soon as pain allows

What can a sports injury specialist, physiotherapist or doctor do?Determine the cause of the sciatica

• Prescribe anti-inflammatory medication e.g. ibuprofen or muscle relaxants
• Use sports massage techniques to relax tight muscles
• Gently apply mobilization techniques to the spine
• Use traction or advise on the use of and Inversion Table
• Apply electrical stimulation in the form of a Tens machine or Interferential
• Apply ultrasound treatment
• Performa a simple operation called a discectomy on a slipped disk if neurological signs (nerve related symptoms) continue or worsen
• After the acute painful phase
• Restore pain free movement to the back through mobilization and stretching techniques
• Ensure posture and correct lifting techniques are learned and maintained
• Strengthen the core stabilizing muscles of the spine

 

Resource from: http://www.sportsinjuryclinic.net

Sciatica Nerve (Causes and Treatment)

resource from: http://www.righthealth.com/topic/picture_of_sciatic_nerves/images

Sciatica
Sciatica is a pain that shoots along the sciatic nerve, radiating through the buttocks and down the back of the leg and as far as the foot. The two sciatic nerves (one on each side of the lower body) are the longest in the human nervous system, running all the way from the lower back through the thighs and calves to the feet.

Sciatica is caused by different types of pressure on the sciatic nerve in the lower back or buttocks. It can also be the result of damage to the nerve roots that feed into the sciatic nerve. Sciatica is usually felt only on one side of the body. The pain can occur along the entire length of the sciatic nerve.

Sources: MedBroadcast, Mayo Clinic, RadiologyInfo.org 

Causes of Sciatica
Pressure on the sciatic nerve can have many causes, some serious and some more minor. Sciatica may be the result of something as simple as bad posture, muscle strain or spasm, pregnancy, being overweight, wearing high heels, or sleeping on a too-soft mattress. More seriously, it can result from pressure exerted on the sciatic nerve or its nerve roots by a slipped disc in the back. In some cases, sciatica is due to nerve inflammation caused by a form of arthritis, or is caused by the squeezing of the sciatic nerve by a tumour wrapped around the spinal cord in the lower back (the lumbar spine).

The spinal cord is a soft bundle of nerves that starts at the base of the brain and runs down the middle of the back. It's the main pathway for communication between the brain and the rest of the body. The cord is covered by the protective spinal column (the vertebrae). Nerves enter and exit the spinal cord all the way down its length, passing through small openings between each vertebra. Nerve roots also stick out through these openings, exchanging nerve signals with the rest of the body.

The vertebrae are separated from each other by discs made of cartilage, a substance like bone but softer. Each disc has a tough outside layer and a soft inside part that acts as a shock absorber, cushioning the vertebrae when the body moves around. If the disc is damaged by injury or through aging, the inner part can bulge or slip through the outer layer. The "extruded" or "herniated" inner part of the disc may then compress or inflame a nerve root sticking out between two adjacent vertebrae. The disc may even injure the nerve root. If this happens in the lower back area, it leads to pain travelling down the sciatic nerve in the leg.

Degenerative arthritis (osteoarthritis) is another common source of nerve root damage that may cause sciatica. Osteoarthritis is characterized by the formation of bone spurs - bits of protruding bone - that may press on the nerve roots. Sometimes, older people may also develop a condition called spinal stenosis, where the space around the spinal cord narrows and squeezes nerves. More rarely, infections like meningitis or spinal cord tumours can affect the nerves. It's also possible for the sciatic nerve to be compressed further outside the spinal column in the pelvis or buttocks.

Symptoms and Complications of Sciatica
The main symptom of sciatica is pain that radiates through the buttock and down the back of the thigh and leg. The pain may stop below the knee or continue right down to the foot. Pain from sciatica can change: it can be shooting or burning, sharp or dull, non-stop or intermittent. Pain is usually only felt on one side of the body. Some people complain of intense and acute pain. Others experience a numb and weak feeling in the parts of their leg where it hurts. This may sometimes indicate more serious neurological problems. Sneezing, coughing, straining, bending, or lifting can make it worse.

In rare cases, people suffering sciatica as a result of a slipped disc are confined to bed for a few days. Another uncommon situation is disturbance of bowel and bladder control as a result of pressure on the nerves in the lower portion of the spine. Consult your doctor immediately if this occurs.

Diagnosing Sciatica
Because of the many conditions which can compress nerve roots and cause sciatica, treatment and symptoms
often differ from patient to patient. Diagnostic tests can come in the form of a series of exams a physician will perform. Patients will be asked to adopt numerous positions and actions such as squatting, walking on toes, bending forward and backward, rotating the spine, sitting, lying on back, and raising one leg at a time. Increased pain will occur during some of these activities. Checking the spine for areas of tenderness. Tests for sensation, coordination, muscle strength, and reflexes may be performed, especially when a slipped disc is suspected. Straight-leg-raise test - lifting the leg to a 90-degree angle without bending the knee - to help locate the point of pain. Other tests may include an X-ray, or scans like computed assisted tomography (CT or CAT) or magnetic resonance imaging (MRI).

Treating and Preventing Sciatica
Sciatica can be relieved by treating symptoms and any specific cause that exists, such as a slipped disc. Your doctor may prescribe muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), painkillers, or corticosteroids to reduce inflammation. Moderate exercise is recommended if pain is minimal. When the symptoms have lessened, therapy to strengthen abdominal muscles and back muscles is important to prevent a return of symptoms.

Here are some other things that may help. Many of them are similar to ways of dealing with other common lower back problems:

• Sleep on a firm mattress on your side or back with knees bent.
• During bad attacks, sleep with a pillow under or between your knees.
• Try not to sleep on your stomach.
• Adjust the height of chairs so your feet are flat on the floor and the knees are a little higher than the hips.
• Keep your feet flat on the floor and do not cross your legs when sitting.
• Sit in chairs that have firm back support and sit up straight against the back of the chair.

Other Causes

Spinal stenosis
Other compressive spinal causes include spinal stenosis, a condition wherein the spinal canal (the spaces through which the spinal cord runs) narrows and compresses the spinal cord, cauda equina, and or sciatic nerve roots. This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or herniated disc which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that travel to the sciatic nerves.

Piriformis syndrome
In 15% of the population, the sciatic nerve runs through the piriformis muscle rather than beneath it. When the muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Conditions of this type are generally referred to as entrapment neuropathies; in the particular case of sciatica and the piriformis muscle, this condition is known as piriformis syndrome. It has colloquially been referred to as "wallet sciatica" since a wallet carried in a rear hip pocket will compress the muscles of the buttocks and sciatic nerve when the bearer sits down. Piriformis syndrome may be the major cause of sciatica when the nerve root is normal. 

Trigger points
Another source of sciatic symptoms is active trigger points of the lower back and the gluteus muscles. In this case, the referred pain is not consequent to compression of the sciatic nerve, though the pain distribution down the buttocks and leg is similar. Trigger points occur when muscles become ischemic (having low blood flow) due to injury or chronic muscular contraction. The most commonly associated muscles with trigger points triggering sciatic symptoms are: the quadratus lumborum, the gluteus medius, the gluteus minimus, and the deep hip rotators.

Pregnancy
Sciatica may also be experienced in pregnancy, primarily resulting from the uterus pressing on the sciatic nerve, and, secondarily, from the muscular tension and/or vertebral compression consequent to carrying the extra weight of the fetus, and the postural changes inherent to pregnancy.

Habits
The risk of self-inflicted sciatica has increased in recent years with, for instance, sitting on a wallet or feet for prolonged hours every day which can cause self-inflicted sciatica. Symptoms of numbness and or pain behind the knee cap are associated with this form of sciatica. Work-related sciatica may be caused by the use of tool belts which hang around the hips and cause significant misalignment of the sacral vertebrae over long time periods.

Source from: C.Health MediResource & Wikipedia

Hip Flexor Injury

Hip flexor strain – tearing hip flexor muscles, causes pain in the front of the hip or groin.
Muscles at the front of the hip are called the hip flexors - iliopsoas ( muscle originates from the lower back and pelvis and inserts into the thigh bone (femur).
Hip flexors - responsible for moving the knee towards the chest (bending the hip) during activity and are particularly active when sprinting or kicking.
Hip flexor strains - occur due to a sudden contraction of the hip flexor muscles (particularly in a position of stretch).

Signs and symptoms:
Sudden sharp pain or pulling sensation in the front of the hip or groin at the time of injury.  
Minor strains - pain may be minimal allowing continued activity.
Severe strains - experience severe pain, muscle spasm, weakness and an inability to continue the activity, may also be unable to walk without limping. Pain when lifting the knee towards the chest or during activities such as running, kicking or going upstairs, pain or stiffness after these activities with rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the hip flexor muscles.

Treatment:
Minimize activities which place large amounts of stress through the hip flexors particularly running and kicking activities - rest from aggravating activities - once can perform activities pain free, gradually return to these activities.
Ignoring symptoms may to lead to chronic condition - appropriate treatment for hip flexor strain is essential to ensure a speedy recovery – to avoid future recurrence.
Apply ice to the hip flexors in the initial phase of injury (first 72 hours) will speed up recovery time - apply ice for 20 minutes every 2 hours.
Massage therapy or Physiotherapy are essential to avoid injury recurrence.
Reconditioning the hip flexor muscles with flexibility and strengthening program – gradually return to activities
Minor hip flexor strain can usually recover in one to three weeks - larger tears, recovery may take four to eight weeks or longer depending on the severity - complete ruptures of the hip flexor muscles are rare and are usually managed conservatively, recovery may be significantly longer.


Factors to the development of a hip flexor strain
• muscle weakness (quadriceps, hip flexors or gluteals)
• muscle tightness (hip flexors, quadriceps, hamstrings or gluteals)
• inappropriate training
• inadequate warm up
• joint stiffness (lower back, hip or knee)
• poor biomechanics
• poor posture
• inadequate rehabilitation following a previous hip flexor injury
• decreased fitness
• fatigue
• poor pelvic and core stability
• neural tightness
• muscle imbalances

CORE FITNESS, CITY MALL
TEL: 088-448119