Preven-ng Knee Problems. Where and When? Ilio-bial Band Fric-on Syndrome The importance of the hip and ankle in preven-ng knee injuries

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1 Preven-ng Knee Problems The importance of the hip and ankle in preven-ng knee injuries Where and When? Prevalence of knee injuries as a result of hip or ankle dysfunc-on This presenta-on includes common knee pain syndromes that can elude standard orthopedic assessment and diagnos-c imaging focused on knee pathology. The pain or symptoms are in the knee but the cause is elsewhere. Ilio-bial Band Fric-on Syndrome Most common cause of lateral knee pain in runners (22.2%) (CJSM 2006;16: ) 1

2 ACL sprains and tears (Cruciate Ligament) 70 to 80% of ACL injuries are from non- contact mechanisms (J. Athl. Training: 2007;43:76-83) Patellofemoral Pain Syndrome More owen in females than males Generalized knee pain, deep to the knee or superficial over the knee cap. OWen involves pain above or below the knee itself, ankle, leg, hip and low back. ~25% of knee pain cases in sports injury clinics (JOSPT: 2007;37: ) Lateral Ankle Sprain 70 to 80% are inversion type Injury to lateral (outside) and top of foot/ ankle OWen leads to delayed onset knee pain (awer healing of the primary injury) as result of the primary cause of: Hip dysfunc-on/ instability and poor foot ankle propriocep-on and mechanics. (JAT: 2007; 42: ) 2

3 Popliteal tendinosis Pain in the posterior knee and to the lateral side (outside and behind). Structures: Lateral collateral ligament and popliteal muscle/ tendon) Can occur with lateral meniscus (car-lage) tears. Medial (inside) Knee Pain/ Injuries Sprains and strains MCL and capsule of the knee Meniscus (car-lage) tears Medial or MCL. Other: bursi-s, nerve involvement (referred pain). Medial Knee cont Medial Collateral Ligament and Capsule MCL sprain is most prevalent in general popula-on. (JAT 1999) MCL knee injury in soccer and basketball (JAT 1999) Combined with ACL injury comprises nearly 90% of knee injuries. (Amer. J of Knee Surgery. 1991;4(1):3-8) 3

4 The Key to the Lower Extremity Build them a Buf! Weakness to hip musculature ROM loss Key to the Lower Extremity Causes Lifestyle/ Occupa-on Posture Overuse and muscle imbalance SoW -ssue and joint dysfunc-on: ankle, hip, pelvis spine Ilio-bial Band Fric-on Syndrome Decreased hip abductor muscle strength results in : Adduc-on of the knee toward the midline Reduced pelvic stability during stance or load Increased quadriceps muscle ac-vity to compensate Over training and hip abductor weakness = ITBFS 4

5 1. ACL Sprains and Patellofemoral Pain Syndrome (PFPS). 1. Predisposi-on of injury due to LE alignment ACL Sprains and PFPS Increased hip abductor strength = decreased knee valgus when landing from a jump Ac-va-on of quadriceps and hamstrings improved as result (TIMING to support the knee) AJSM:2005; 33(4) Chronic Lateral Ankle Sprains Weakness in hip abductors on the involved side Preven-on needs to address proximal stability Also seen in high arched feet (cavus) 5

6 Popliteal Tendinosis Overuse syndrome where the body afempts to stabilize the knee because of an inability to stabilize above or below the knee. Key Axiom: The body owen uses healthy -ssue to compensate for weakness and/or dysfunc-on to a -ssue or joint complex Loss of medial arch support Pes Planus, flat foot, hyperprona-on Loss of medial arch support Low arches result in greater rear foot (calcaneus and talus) speed and range of mo-on excursions. Low arches tend to develop a higher incidence: Medial injury: medial knee, Medial thigh/ adductor/ medial ankle/ foot injury/ OA at the knee SoW -ssue injuries Clin Biomech. 2001;16: Evidence best suggests hip strengthening exercise with ortho-cs compared to ortho-cs alone Am J Sports Med: 2007;31:1-5. 6

7 High Medial Arch Cavus foot type High Medial Arch Cavus Greater ver-cal or compressive forces present Greater Prevalence: Bony injury (stress fractures) Lateral injuries: hip bursi-s, ITBF syndrome, lateral ankle sprain Clin Biomech. 2001;16: ITB Syndrome: Even though this is extremely common in individuals with high arches, it occurs in people with low arches as well. The underlying mechanism is different. Key point: Most important factor in development of this syndrome is owen weakness to the hip abductor musculature. J Orthop Sports Phys Ther. 2010;40:

8 Principles Observa-on Iden-fica-on of Dysfunc-on Preven-on It is always easier to prevent than to fix! Dynamic Valgus Dynamic Valgus 8

9 Dynamic Valgus Dynamic Valgus Dynamic Valgus 9

10 Squat Squat Sit like you stand/ squat like you sit! Squat Good the bad and the ugly 10

11 Squat poor form Squat Excellence Squat Perfec-on 11

12 Lunge Lunge faults 12

13 Balance Lunge Quad dominant Forward J Gluteal dominant Proper J 13

14 Squat Progressions Ball Squat Ball squat with bands Preven-on Single leg ball squat Unassisted squats With or without bands With or without weight Lunge Balance Lunge Preven-on 14

15 Preven-on Bridging Bosu Ball Tables Preven-on Hamstring curl Fixed surface Ball TRX Side to Side Walk Preven-on 15

16 Preven-on Clam shell and leg raise progressions Hip hike Thank You! Thank You! Valleyview Chiropractic Clinic Dr. David Urness, B.Sc., D.C. Treatment Protocols Manipulation Active Release Technique Mobilization & SASTM Evaluation with consult Vestibular Rehabilitation Back School 160 Valleyview Road Kelowna, BC V1X 3M4 Tel: Fax: