Knee pain is one of the most common ailments in humans. They are certainly a frequent complaint among those who consult Dr. Douglas Cancel and Performance Sport Care in Walnut Creek, CA.
Most people have had a minor knee problem at one time or another. Knee related problems may arise from everyday wear and tear, overuse, or injury. Knee injuries most commonly arise during sports or recreational activities, work-related tasks, or home projects.
The knee is the largest joint in the body. The upper and lower bones of the knee joint are separated by two C-shaped rings of fibrocartilage that resemble “washers.” These are called the menisci. The femur or upper leg bone of the knee joint along with the two lower leg bones of the knee joint, the tibia and fibula, are connected by ligaments, tendons, and muscles. The contact surfaces of the bones inside the knee joint are covered by articular cartilage which absorbs shock and provides a smooth gliding surface for joint movement.
Generally speaking, there are two basic mechanisms that cause knee problems: 1) sudden injuries, and 2) overuse. Sudden injuries are the most common cause of knee problems that result in a prompt doctor visit and include: direct blows to the knee, abnormal twisting, forced bending, or falls. Knee pain, bruising, or swelling may be severe and may develop within minutes. Overuse injuries develop over time and are instigated by repetitive activities or repeated/prolonged strain on the knee. Activities such as stair climbing, bicycle riding, jogging, or jumping stress joints and other tissues and can lead to irritation and inflammation.
As mentioned above, there are two C-shaped cartilage structures inside the knee. One is called the medial meniscus and the other, the lateral meniscus. A common knee injury is a tear of one or both menisci. Tears of the meniscus can arise from rotational injuries, degradation associated with age, or increased/chronic frictional forces related to knee osteoarthritis.
With the introduction of MRI scanning, meniscus tears were very readily identified and frequently resulted in arthroscopic surgeries to remove the torn portion of the meniscus. Over a period of time it was observed that some patients experienced pain relief from these surgeries, but others did not. Eventually, it became evident that a torn meniscus was not necessarily the pain generator in those patients who had undergone the ineffective surgery. In fact, there are many structures in the knee that are capable of generating pain. This realization opened the door for a range of conservative, non-surgical treatments and rehabilitative strategies that have now proven themselves to be effective first line measures for patients with apparent meniscus damage instead of immediate surgical intervention. This realization has also led those in the sports injury community to the conclusion that surgical decision making solely based upon MRI findings (in the absence of equal consideration of the patient history and physical examination findings) is not always in the patient's best interests.
Dr. Cancel and Performance Sport Care offer many of the same non-surgical rehabilitative protocols used in professional sports to help athletes and non-athletes alike deal with meniscus problems. If patients do not already have an existing relationship with an Orthopedic Surgeon, Dr. Cancel will often coordinate referrals to leading Orthopedic Surgeons in our community to ensure that all clinically indicated options are available to his patients.
Anterior Cruciate Ligament (ACL)
The anterior cruciate ligament is a stabilizing ligament located inside the knee joint. It is commonly torn by sudden changes in directions or hard landings on one leg. There is usually considerable and rapidly developing pain and swelling with these injuries. We generally advise immediate measures to control swelling and early consultation with an Orthopedic Surgeon whenever an acute ACL tear is suspected or confirmed. We will often order the confirmatory imaging studies to expedite these surgical referrals.
While prompt repair of acute ACL tears is usually in the best interests of most patients, the importance of post-operative rehabilitation cannot be overstated, particularly in regard to the athlete patient. Sadly, it turns out that many patients are under-served in regard to COMPLETE post-surgical rehabilitation. Dr. Cancel and Performance Sport Care offers many of the same rehabilitative exercise protocols used by professional sports teams to safely return their athletes to play in the shortest possible time.
Medial Collateral Ligament (MCL)
The medial collateral ligament is a vertically oriented ligament that is located along the inner side of the knee. It is a “check” ligament that prevents the knee from buckling inwards. Side impact forces directed to the outside or lateral aspect of the knee are the most common scenario with regard to tears of this ligament. The severity of the tear usually determines how these injuries are managed. Unless the tear is severe, surgery is not commonly performed for isolated MCL tears. Supportive and rehabilitation measures are, once again, key considerations in attaining optimum recovery from these injuries.
Osteoarthritis involves the inflammation and gradual deterioration of the joint cartilage. As the deformity worsens, this results in pain and immobility due to the diminished joint space and joint roughening. Other symptoms include swelling and locking of the joints.
Patellofemoral Stress Syndrome (“Runner’s Knee”)
This condition involves pain under or around the kneecap and is generally perceived by the public as a condition solely associated with running or jumping. However, there are many factors that may be at play in the production of patellar friction and consequent pain. These include, faulty foot architecture, over-tight thigh or gluteal musculature, strength imbalances between the hamstring and quadriceps muscles, angular position changes in the thigh or leg bones, arthritic changes, overuse, overtraining, fibrous bands, and low back problems. A classic finding in patients with this condition is stiffness when straightening the affected knee following a period of prolonged sitting (the so-called “theatre sign“).
We may have an ‘answer’ for those with “Runner’s Knee” (Patellofemoral Syndrome)
Our office offers for many, a distinctly successful protocol for “Runner’s Knee” sufferers that addresses some of the significant muscular/mechanical factors that cause this condition to be problematic. In many cases, particularly those uncomplicated by co-existing medical /orthopedic disease, we have observed positive results in as soon as 3-5 treatment sessions. We invite those who are suffering with this injury to arrange a consultation with us to determine if our protocols might be right for you.
Chondromalacia Patellae basically represents the progression of inadequately treated Patellofemoral Stress Syndrome to the point in which the now chronic knee pain is accompanied by softening or fraying of the articular cartilage beneath the kneecap.
Iliotibial Band Syndrome (I-T Band Syndrome)
Iliotibial Band syndrome is lateral knee pain related to irritation and inflammation of the distal portion of the iliotibial band. It is often seen in runners and is often due to training errors (e.g. sudden increase in distance, running on banked surfaces, speed work, hill running). It can be related to misalignments of the lower extremities such as uneven leg length or supination of the feet (look for excessive wear on the outside edge of the shoe or heel). ITB syndrome may also be related to muscle imbalances, such as weak hip abductors. There is increased tenderness to touch of the distal iliotibial band. Pain increases as the knee goes from flexion to extension.
We have Iliotibial Band Syndrome Treatment Options for You
Our office offers a distinctly successful protocol for many Iliotibial Band sufferers that addresses many of the significant muscular/mechanical factors that cause this condition to become problematic. In many cases, particularly those uncomplicated by co-existing medical /orthopedic disease, we often observe positive results in as soon as 3-5 treatment sessions. We invite those who are suffering with this injury to arrange a consultation with us to determine if our protocols might be right for you.
At Performance Sport Care, Dr. Douglas Cancel and team provide personalized care and extensive treatment to alleviate the pain and restore function and mobility in your spine and knee joints. We serve the residents of Walnut Creek, CA, and the nearby communities of Concord, Pleasant Hill, Danville and Lafayette.
Experience comprehensive treatment for knee pain at Performance Sport Care. Feel free to contact us at (925) 945-1155 or use our Request an Appointment form to schedule your consultation.