Is the Outcome of ACL Surgery really better than Conservative Management?
August 28, 2010
If you have sustained an ACL ( Anterior Cruciate Ligament of the knee) tear and is considering an ACL surgery, you would find it useful to know more about the latest research discussion on ACL surgery versus Physical therapy management.
Management for ITB friction syndrome
June 16, 2010
Training methods
Biomechanical Gait issues
Stretches For New Runners
March 20, 2010
It is important to include some stretching exercises before your running routine. If done correctly, stretches can help to improve your flexibility and joint range of motion, and can decrease your risk of injury to joints, muscles, and tendons while running. In this article, we will show you top 5 stretches to do before a run.
Disclaimer: Note that stretching is not warming-up. It is a common misconception that warming-up equates to stretching. ‘Warming-up’ literally means raising your core body temperature. It is advised that before you begin on your stretches and run, a general warm-up such as brisk walking between five to ten minutes be performed to prevent injury to your ‘cold’ muscles. (see To stretch or not to stretch before an event?
Top 5 stretches:
Hamstrings Stretch
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Calf Stretch
Quadriceps Stretch
Iliotibial Band (ITB) Stretch
Glueteus (Buttock) Stretch
Why is my MCL strain not getting better? Because it is Pes Ancerinus Tendinitis.
March 18, 2010
When long-distance runners complain about knee pains, it is often complaints about pain in the front of their inner knee, below the knee cap. Pain comes about especially when climbing uphill or up stairs. Given the location, this pain is sometimes misdiagnosed as a MCL (medial collateral ligament) strain when it is actually Pes Anserinus Tendinitis.
What is Pes Anserinus Tendinitis?
It is essentially a inflammation of the tendons between your shinbone and muscles that form parts of your hamstring and thigh, .Three tendons (Semitendinosus, Sartorius1 and Gracilis) join up to form the pes anserinus tendon. Pes anserinus in latin means 'goose feet' roughly describing the webbed look of the three tendon coming together.The pes anserinus tendon joins to the shin bone where the pain is usually felt.Is it often mis-diagnosed as MCL or medial-menicus strain because of the close location of the pes anserinus tendon to the MCL and medial menicus.
What strains the Pes Anserinus Tendon?
Things that strain the pes anserinus tendon are
- Severe pronation of the feet – this causes the tibia (one of the lower leg bones) to rotate inwards which strains the tendons
- Weak hamstring muscles – when combined with an intense running programme, the hamstrings may not be able to cope with the high workload. This is often an overlooked areas in a runner's strength training regime.
- Tight thigh muscles (quadriceps) – weakens the opposing hamstring muscle. Muscles tightness here is further encouraged if you have a deskbound job that requires you to sit at the your desk all day long.
- Sudden change on the volume and intensity of training
Diagnosing Pes Anserinus Tendinitis
Patients typically complain about pain climbing stairs, squatting, running and in severe cases, standing from a seated position.The pain would also appear gradually and for runners, following an increase in their training volume and intensity (uphill, or running faster).
However, even if your symptoms match those listed above, it is advisable to ensure that it is not other possible condition such as Patellar-Femoral Pain (PFP), MCL strain and medial-menicus strain
Treating Pes Anserinus
During the initial inflamed painful stage, your doctor may prescribe NSAIDs to help reduce the swelling and inflammation and recommend rest for the first 24-48 hours. Ice or cyrotherapy can help speed up the recovery by reducing the inflammation.
Once less painful, your therapist may suggest the following treatment depending on your cause of the tendinitis as list above.
- For severe foot pronation – orthotics can help correct over pronation of your foot
- To strengthen the weak hamstrings – see Hamstring Exercises for Long Distance Runners
- Release tight thigh muscles with sports massage and a stretching programme.
- A training programme that appropriately increases your training volume and intensity.
1 Ed note. The Sartorius is the longest muscle in the human body
Osteoarthritis Knee
December 25, 2009
Osteoarthritis (OA) of the knee is a degenerative condition where the cartilages of the knee wear away. Pain, stiffness and swelling are common symptoms of an OA knee. In this article, we look at the three factors that lead to the development of OA knee – Aging, Physical Attributes and Muscular Causes. Of which two of these factors, Physical Attributes and Muscular Causes, can be addressed with physiotherapy management. We will focus more in detail on the exercises and treatment for OA knee in a follow-up article.
Aging
OA Knee
Physical Attributes
The three key physical attributes are:
- Obesity - A heavier person will load their knee joints more, wearing out their cartilages faster than a lighter person.
- Knee alignment – A bow legged or knock-knee appearance will cause an uneven compression of the knee. Either the outer or inner compartment knee respectively will take up most of the load upon weight bearing and cause more wear and tear.
- Foot type -
- People with flat feet or whose feet over pronate tend to roll their knee inwards upon weight bearing similar to a knock-knee above.
- A person with high foot arch or whose feet under-pronate absorbs less impact with each foot fall. More impact goes up through the leg and the knee will have to work harder to cushion the impact.
Muscular Causes
When the muscles around the knee do not contract strong and fast enough in a coordinated fashion to absorb the impact of walking or running, the knee joint takes up the remaining forces of the impact.
- Tight muscles pull joints closer to each other.In an OA knee where the joint space is already reduced, tight muscles will increase the compression of the joint space. Muscles with reduced flexibility are also less coordinated and slower in reaction time. The muscles that tend to be tight are the quadriceps, hamstrings and calves.
- Weak muscles. The quadriceps muscles is the main muscle group that help to support the weight of the body and off loads the knee joint. It is very common for this muscle to atrophy because of disuse. The knee pain deters the patient from loading the knee and this will gradually lead to weakness of the knee which will affect the ability to cushion the impact. This pain, disuse, weakness cycle will continue without treatment.
Weak gluteus medius muscle can aggravate the degeneration of knee cartilage because its function is to keep the hip joint stable, especially in walking. This is often seen as a waddling gait where the hip sway with big movements side to side. The thigh muscle have to work a lot harder to stabilise the wobbly hip and if they are unstable, the knee joints will have to bear the weight.
The management of these factors are summarised in the following table. In our upcoming article, we will further discuss the specific exercises and treatment for OA knee.
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Physical Attributes |
Management |
| Weight | Weight loss programme |
| knee alignment | - training of muscles – orthotics |
| foot type | - orthotics |
| Muscular Causes | Management |
| Tightness | Stretch Quadriceps, Hamstring and Calves |
| Weak | Strengthen Quadriceps and Gluteus Medius |
Q angle and knee pain
November 25, 2009
What is Q angle?
The Q angle describes the angle of the knee from a frontal view. The Q angle gives an idea how the thigh muscles functions to move the knee and also how the knee cap (patella) tracks in the groove of the knee joint. A normal knee cap should move up and down within the groove with flexion and extension of the knee. When the Q angle is excessive, the knee cap tends to track out of alignment and hence causes wear and tear (degeneration) of the cartilage behind the knee cap.
What is the normal Q angle? The normal Q angle measured in standing is about 15 degrees and anything more than that is considered a risk factor for knee injuries. Ladies tend to have a wider Q angle due to their wider pelvis compared to their males.
Q-angle
How to measure Q angle? The Q angle is an intersection of two lines. First line joins the ASIS (bony protrusion in the front of the pelvis) to the middle of the patella. Second line runs from the protrusion on the top of the shin bone (tibial tuberosity) below the patella and upwards through the middle of the knee cap.
Common injuries related to a wide Q angle:
- Iliotibial band friction syndrome (ITBFS)
- Anterior knee pain or Patella Femoral Pain Syndrome (PFPS)
- Anterior cruciate ligament injury (ACL)
Injuries because of an excessive Q angle can be categorised into 3 main reasons.
1. Muscle imbalance :
A large Q angle pulls the knee cap outwards due to the stronger lateral pull from the quadriceps and tight ITB. Coupled with a weakness of the inner aspect of the quadriceps (Vastus Medialis Oblique, VMO) the knee cap will track laterally instead of smoothly up and down within the knee groove. This maltracking causes the cartilage behind the knee to wear off or degenerate and hence the pain.
2. Biomechanical compensation:
An excessive Q angle can alter the movement pattern especially in the foot. The knee will tend to point inwards (valgus or knock-knee appearance) which encourages the foot to roll inwards (pronates). Over-pronation can lead to a number of injuries especially in runners.
3. Joint laxity/instability:
When the knee point inwards, the ligaments on the inner aspect of the knee gets overstretched and lax, therefore compromising the stability of the knee joint. The Anterior Cruciate Ligament (ACL) also undergoes a lot of stress in this position. Interestingly the larger Q angle in females has been attributed as a main reason why females are at a higher risk of sustaining an ACL injury.
How to manage a wide Q-angle?
You can reduce the risk of injuries by targeting the reasons above.
Muscle imbalance: Stretching on the ITB, strengthening the VMO and Glut medius to enable proper tracking of the knee cap.
Biomechanics: Get a customised orthotics to control excessive pronation and reduce the stress to the knee.
Joint Laxity/Stability: Balancing exercises to train knee proprioception and stability.
ITB friction animation
November 20, 2009
Iliotibial band friction (ITB) syndrome is a common running injury due to a tight ITB. In a previous article, we explained the reasons why the ITB tightens up. To make it easier to understand how a tight ITB causes friction and inflammation, click here to see an animation of ITBS.
Ladies! Stronger Thighs, Lesser Knee Pain
September 30, 2009
Knee pain is one of the most common, if not the most common complain of pain in the elderly. In the USA, nearly 4 million sufferers of knee pain above the age of 45 are ladies.
Why are females more prone?
There are quite a number of reasons why ladies are more pre-disposed to developing knee pain. The reasons range from wider hips to increased Q-angle, tighter ilio-tibial band (ITB) to weaker physique. However, what is the most common cause of knee pain? The answer lies in the weakness of the quadriceps or thigh muscles. Read more
Warning! Is this how you stretch your hamstring?
August 5, 2009
Anterior Knee Pain in Runners
July 22, 2009
Do you feel pain in your knee on climbing stairs or even squatting after your run? Feeling weird that it doesn’t hurt while you run? Then, chances are, you might be suffering from anterior knee pain. Knee pain is the most common running injury, occurring in approximately 55% of recreational runners. Of this number, 65% will have severity of symptoms that will require them to seek medical attention or contemplate cessation of running. Anterior Knee Pain (AKP), otherwise known as Patellar Femoral Pain, has been found to be one of the most common condition resulting in knee pain. It has been estimated to have an incidence of 25% of all knee injuries.








