Knee/Thigh

Arthritis is inflammation of one or more joints. The most common type of arthritis is osteoarthritis and involves wear-and-tear damage to the joint’s cartilage. Cartilage normally protects a joint, allowing it to move smoothly, and provides shock absorption when pressure is placed on the joint, such as when walking. If enough of the cartilage degenerates, it can result in bone grinding on bone, which can cause pain, inflammation, stiffness and restricted movement. This wear and tear can occur over many years, or it can be triggered by a joint injury or infection.

Arthritis often causes pain during movement. In order to avoid the pain, many individuals will avoid movement of the arthritic joint. Unfortunately, lack of movement in the joints can make the condition worse. Joints were meant to move! Movement helps to flush out inflammation, lubricate the joints, and condition the muscles. Successful treatment to help manage arthritis involves maintaining strong muscles, joint mobility, flexibility, endurance, and a healthy weight – all of which can be accomplished through conservative treatment.

Iliotibial band syndrome is a repetitive strain injury that occurs when the iliotibial band (ITB) becomes inflamed causing knee pain. The ITB is a thick band of fibrous tissue that runs down the outside of the leg. It attaches at the hip and to the tensor fascia latae muscle, and extends down the leg, inserting on the outer side of the tibia (shin bone), just below the knee joint.

The band functions in coordination with several of the thigh muscles to provide stability to the knee and to assist in flexion of the knee joint. The main problem occurs when the tensor fascia latae muscle and iliotibial band become tight. This causes the tendon to rub against the outside of the knee, at the lateral epicondyle, which results in inflammation and pain. ITB syndrome can be caused by overload, as is the case with endurance athletes or those who rapidly increase their activity levels, or by biomechanical inefficiencies, such as uneven leg length, tight or stiff muscles in the leg or hip, muscle imbalances, foot structure problems, or gait and running problems.

Patellar tendonitis, also known as Jumper’s Knee, is an acute injury that occurs when the ligament connecting the patella (knee cap) to the tibia (shin bone), becomes inflamed and irritated. Patellar tendonitis causes pain at the front of the knee joint, just below the knee cap. This condition is most often seen in athletes involved in activities that require a lot of jumping or rapid change of direction, which are actions that are particularly stressful to the patellar ligament. Participants of basketball, volleyball, soccer, and other running related sports are particularly vulnerable to patellar tendonitis.

Patellar tendonitis can also result from a sudden, unexpected injury that can damage the ligament, such as landing heavily on your knees. Patellar Tendinosis, on the other hand, is a chronic condition that develops gradually. Instead of the ligament becoming inflamed and irritated as it does with tendonitis, tendinosis is characterized by microscopic tears and thickening of the ligament. This degeneration means that the tendon does not possess its normal tensile strength and is at increased risk of rupture with continued activity. Conservative treatment can be very effective in helping the tendon regain its tensile strength.

Injuries to one or more of the ligaments in the knee results in pain and a significant loss of stability. Ligament injuries are most associated with athletes who participate in high demand sports like soccer, football and basketball. Ligament injuries can be caused by twisting your knee with the foot planted, getting hit in the knee, hyper-extending the knee, jumping and landing on a flexed knee, stopping suddenly when running, or suddenly shifting weight from one leg to the other. Complete tears to the ligaments often require surgery to correct, especially if the athlete hopes to return to high demand sports. However, partial tears and sprains do not usually require surgery and can be successfully treated with conservative treatment methods.

There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

• Cruciate Ligaments are the two major ligaments located inside the knee joint, which control the back and forth motion of the knee. They cross each other to form an “X.” The anterior cruciate ligament (ACL) is in the front and posterior cruciate ligament (PCL) is in the back.
• Collateral Ligaments are located on the sides of the knee and control the side to side motion and brace it against unusual movement. The medial collateral ligament (MCL) is on the inside and the lateral collateral ligament (LCL) is on the outside.Knee sprains occur when the ligaments are injured and are graded on a severity scale.
• Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
• Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
• Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus.

When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. There are two menisci located in the knee joint between the femur (thigh bone) and the tibia (shin bone). The C-shaped medial meniscus is on the inside part of the knee, while the U-shaped lateral meniscus is on the outer half of the knee joint. The meniscus act like shock absorbers in the knee, forming a gasket between the femur and tibia to help spread out the forces that are transmitted across the joint and keep it stable.

A meniscus tear is usually the result of either a traumatic incident or degeneration. The meniscus receives very little blood flow (only to the outer 1/3 of the meniscus), which makes recovery extremely difficult. Additionally, the cartilage that makes up the menisci weakens and wears thin over time. In younger people, the meniscus is a fairly tough and rubbery structure. Tears in the meniscus in patients under 30 years old usually occur as a result of a forceful twisting or sudden impact injury, commonly sustained during sport activities. Older individuals are more likely to have degenerative meniscal tears, as aged and worn tissue is more prone to tears.

Conservative treatment for a torn meniscus focuses on decreasing pain and swelling in the knee, as well as regaining normal movement of the joints and muscles. This treatment is especially effective when the tear occurs on the outer edge of the meniscus, which does receive a blood supply. However, surgery to trim away the torn cartilage may be recommended if the knee locks up and normal movement is not restored through conservative methods.

Patellofemoral pain, also known as Runner’s Knee, is associated with a dull, aching pain under or around the front of the knee. The pain occurs when walking up or down stairs, kneeling, squatting, and sitting with a bent knee for a long period of time. This condition includes anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella. Patellofemoral pain may be caused by soft cartilage under the patella (kneecap), soft tissue around the front of the knee, or referred pain from another area such as the back or hip.

Some patellofemoral pain results when the patella is misaligned (patellofemoral malalignment), which can cause excessive wear on the cartilage of the kneecap. This can lead to softening and breakdown of the cartilage on the patella (chondromalacia patella) and cause pain in the underlying bone and irritation of the synovium (joint lining). Strained tendons are another cause that is common in athletes. Other contributing factors can include inflammation, muscle imbalances such as weak quadriceps muscles, tight hamstrings or calf muscles and pronation, or flat, feet.