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Evidence-Based Treatment Options for Common Knee Injuries in Runners,…
Evidence-Based Treatment Options for Common Knee Injuries in Runners, Simeon Mellinger (2019) Week 5
Patellofemoral Pain Syndrome (PFPS)
Charateristics
Anterior/retro knee pain under loading
Common cause of PFPS
Muscle Imbalances, e.g. hip flexors
Lower extremity malalighment
Running mechanics and GRF
Interventions
Modalities
McConnell taping
patellar alignment
Therapeutic exercise
Electrical stimulation (systematic review)
Isolate Vastus Medialis Oblique
Knee + Hip strengthening
hip rotation/abduction strengthening
Orthotic management
Manual therapy
Joint mobilization is effective in decreasing pain when conjucnted with other interventions
Dhinu Jayaseelan et al (2018)
IASTM
Triggered Point Dry Needle
Lacking Evidence
Neuromuscular re-education
Mirror cuing
RW Willy et al (2012)
Conclusion
Determine the root cause
Changes in exercise frequency or intensity
Strengthening and motor retraining (priority) with other manual therapies
Iliotibial Band Friction Syndrome (ITBFS)
Charateristics
Pain in lateral aspect of knee moving from flexion to extension
loading, deceleration phase
Theories on ITB pain
Compression of distal ITB
Inflammation of posterior ITB when it travels to anterior aspect w/ knee flexion
Lumbopelvic alignment
Interventions
Modalities
NSAIDs
Therapeutic exercise
CKC
Involves minimal pain
High impact exercise
CKC exercise w/ higher intensity
OKC
activation of all muscluarture
Neuromuscular re-eduction
Cadence (tempo) training
Heiderscheit et al (2011)
Increase tempo by 5%, decrease hip ADD angle
Manual Therapy
IASTM
RCT: cross-friction massage is ineffective
Biomechanical analysis
Male
Increased knee ADD, hip IR
Female
Increased hip ADD, knee IR, femur ER
Conclusion
intake of subjective running mileage
Access muscular strength
Access running technique
Secondary lumbopelvic malalignment
Patellar Tendinopathy (PT)
Characteristics
Pain located at inferior pole of patella
P.S. PT is activity dependent (high intensity exercises)
Degenerative
cell death
Reactive
Thickened tendon leading to tendon dysrepair
Common factors
decreased motor control
faulty running mechanics
muscular atrophy
foot posture
Quadriceps overutilized eccentrically
Interventions
Modalities
Shockwave therapy
meta-analysis by Liao (2018), decrease pain and increase ROM
Acute phase, isolation not recommended
Phonopheresis
administer drugs to decrease pain
Infrapatellor strapping
Therapeutic exercise
Eccentric exercise
HSR
Lacking evidence
Perform w/ minimal pain
isometric contractions
Rio et al (2015)
Manual Therapy
TDPN
limit local pain
Tibiofemoral/patellofemoral joints arthrokinematics
Neuromuscular re-eduction
Activation of Quadriceps
Conclusion
Identify source of pain
CKC stability
anterior chain extensibility
Strengthening w/ manual therapy
External cues
Purpose of this paper