KNEE
ITB syndrome
What Is It?
The iliotibial band (ITB) is a thick band of connective tissue, or fascia, that runs along the outer side of the leg, from the hip down to the outer part of the knee. Its primary role is to support the lower limb during movement and provide an attachment point for muscles such as the gluteus maximus and tensor fascia latae. When the ITB becomes irritated or inflamed, often due to overuse, it can cause sharp, localized pain on the outside of the knee. This condition is commonly referred to as iliotibial band syndrome (ITBS) and is particularly prevalent among runners, cyclists, and other athletes who engage in repetitive leg movements.
How Does It Present?
Pain associated with ITBS is typically felt just above the knee joint on the outer side of the leg. The pain may intensify during activities that involve repetitive knee flexion, such as running, cycling, or walking, especially when going up or down hills. Although less common, pain may also be felt at the ITB's attachment point near the hip. Symptoms often worsen with continued activity, and there may be swelling or tenderness around the area.
Why Has It Happened?
ITBS is often the result of overuse, particularly from repetitive movements that place stress on the ITB, such as running or cycling without adequate recovery time. Several factors can contribute to the development of this condition, including:
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Poor footwear or shock absorption: Wearing worn-out or ill-fitting shoes can increase the impact on the lower body and put more strain on the ITB.
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Weak gluteal muscles: The gluteal muscles, especially the gluteus medius, play a crucial role in stabilising the pelvis and controlling leg movement. Weakness in these muscles can lead to imbalances, causing the ITB to become overworked.
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Overpronation: If the foot excessively rolls inward when walking or running, this can alter leg alignment and increase tension on the ITB.
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Sudden increases in training intensity: Rapidly ramping up mileage or intensity without proper progression can place excessive strain on the ITB, leading to inflammation.
How Can We Help?
An in-depth assessment of your foot, knee, and hip mechanics will help identify any imbalances or contributing factors leading to ITBS. For example, tightness in the tensor fascia latae or vastus lateralis muscles may be increasing tension on the ITB, while weakness in the gluteal muscles could be affecting proper movement mechanics. Treatment would involve a combination of:
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Manual therapy: To release tight tissues and reduce inflammation in the affected areas.
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Targeted stretching: To address tightness in the ITB, hip, and surrounding muscles.
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Strengthening exercises: Focused on improving the stability of the hip and pelvis, particularly by strengthening the gluteal muscles.
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Footwear evaluation and gait analysis: To ensure proper shock absorption and reduce excess strain on the ITB during movement.
By addressing both the symptoms and underlying causes, we can help restore balance and reduce the risk of recurrence.
ACL/PCL sprain
What Is It?
From an osteopathic perspective, the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are crucial structures located within the knee joint, working together to maintain stability and proper alignment. These ligaments prevent excessive forward and backward movement of the tibia (shinbone) in relation to the femur (thighbone), ensuring the knee moves efficiently during physical activity. Osteopathically, the knee's stability is also understood within the broader context of the body's biomechanical harmony, including the function of the hips, pelvis, and lower back, which contribute to overall movement patterns.
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How Does It Present?
Patients with ACL or PCL injuries often report pain at the front of the knee, which can be aggravated by activities such as squatting, climbing stairs, or engaging in any movement that places pressure on the joint. In cases of ligament rupture, the individual may experience a popping or clicking sensation at the moment of injury, sometimes accompanied by swelling and instability in the knee. From an osteopathic viewpoint, pain and dysfunction in the knee may also lead to compensatory patterns elsewhere in the body, such as in the hips, lower back, or feet, as the body adapts to protect the injured area.
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Why Has It Happened?
ACL injuries are more common than PCL injuries and often occur due to sudden twisting or pivoting movements, commonly seen in sports or high-intensity activities. Direct trauma, such as a blow to the knee, can also lead to ligament tears or ruptures. An osteopathic assessment may also consider how postural imbalances, gait issues, or dysfunction in surrounding joints, such as the hips or ankles, might contribute to the vulnerability of the knee ligaments. Poor biomechanics can place extra strain on the ACL and PCL, increasing the likelihood of injury.
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How Can We Help?
As osteopaths, we approach the treatment of ACL and PCL injuries with a holistic focus on the body's interconnected systems. The integrity of these ligaments can be assessed through specific orthopedic tests, allowing us to determine the extent of the damage. Rehabilitation will involve more than just strengthening the knee; we’ll also look at the surrounding musculature and joint function in the hip, foot, and ankle. Through manual therapy, we aim to improve the overall biomechanics of the lower limb, addressing muscle imbalances and joint restrictions that may have contributed to the injury. By restoring balance to the entire lower body, osteopathic treatment supports the healing process and helps prevent further injury.
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In addition to manual treatment, we may prescribe specific exercises to strengthen the muscles that support the knee, particularly the quadriceps, hamstrings, and stabilizers of the hip and pelvis. This integrated approach helps optimize the body's natural healing mechanisms while promoting long-term stability and functional movement.
Glenoid labral tear
What Is It?
From an osteopathic perspective, the knee joint is a complex structure that relies on the integrity of two menisci—crescent-shaped cartilaginous pads that provide cushioning and stability. These menisci sit between the tibia (shin bone) and femur (thigh bone), creating a more congruent surface for smooth movement. The medial meniscus, located on the inner side of the knee, primarily provides stability, while the lateral meniscus, found on the outer side, offers more mobility and adaptability. Tears can occur in either meniscus, though the medial meniscus is more commonly affected due to its reduced mobility and greater exposure to stress during weight-bearing activities.
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In osteopathy, the focus extends beyond the immediate structures of the knee. The knee is viewed as part of a larger kinetic chain, influenced by imbalances in the pelvis, spine, and feet. This holistic approach helps to understand how restrictions or dysfunctions in surrounding areas can increase stress on the knee, potentially contributing to meniscal injuries.
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How Does It Present?
Meniscal tears may present with a variety of symptoms depending on the severity and type of injury. In cases of acute trauma, such as a sports injury, patients often report a "popping" or "clicking" sound at the moment of injury, accompanied by pain and swelling. Tenderness is frequently felt along the joint line, and mobility may be restricted. In more severe cases, the knee may "lock" or feel as though it is getting stuck during movement, preventing full range of motion.
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From an osteopathic viewpoint, these symptoms might also be accompanied by compensatory changes in posture, gait, and muscle tone, as the body adapts to protect the injured knee.
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Why Has It Happened?
Meniscal tears can occur for two primary reasons: trauma or degeneration. Traumatic tears are often the result of sudden, forceful movements, such as a twisting motion during a tackle in football, or a rapid change of direction. Degenerative tears, on the other hand, are more common in older adults, as the menisci naturally wear down and become thinner over time. This gradual thinning weakens the cartilage, making it more susceptible to injury even with minimal strain.
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From an osteopathic perspective, improper biomechanics or misalignment in other parts of the body—such as the hips, pelvis, or ankles—can place additional stress on the knee joint, contributing to both traumatic and degenerative meniscal injuries.
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How Can We Help?
Osteopathic treatment begins with a detailed case history and thorough physical assessment, not just of the knee but of the whole body, to identify areas of dysfunction or imbalance that may have contributed to the injury. Once a meniscal tear is identified, conservative management is often effective, especially for less severe tears. Treatment may include manual techniques to restore mobility and function in the surrounding joints, as well as targeted exercises to strengthen the muscles around the knee, such as the quadriceps and hamstrings, which provide essential support.
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Osteopaths also take a holistic approach by addressing related structures that influence knee function, including the pelvis, spine, and feet. By improving overall alignment and movement patterns, we aim to reduce stress on the knee and facilitate a more complete recovery. Tailored rehabilitation exercises and guidance on posture and movement are essential in preventing further injury and maintaining long-term joint health.
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This approach supports the body's natural healing processes, promoting recovery while enhancing the knee's function within the broader musculoskeletal system.
Patellofemoral pain syndrome
What Is It?
From an osteopathic perspective, this condition involves the softening and inflammation of the cartilage on the underside of the patella (kneecap), leading to deterioration and discomfort. Known as patellofemoral pain syndrome or chondromalacia patellae, it is often seen in young, active individuals due to overuse but can also develop in older adults as part of arthritic changes. The imbalance between the mechanical forces acting on the knee and the structural integrity of the patella is a key factor in the condition's development.
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How Does It Present?
Patients typically report diffuse, dull, or aching pain at the front (anterior) of the knee. The pain is often exacerbated by movements that increase pressure on the patellofemoral joint, such as squatting, walking downstairs, running, or sitting for extended periods with the knee bent (sometimes called "theater sign"). The pain may not always be linked to a specific action but is frequently associated with activities that place additional strain on the kneecap.
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Why Has It Happened?
From an osteopathic viewpoint, the root cause often lies in biomechanical imbalances. Overuse and repetitive stress on the knee can contribute to this condition, but underlying issues with the foot, ankle, or hip can also play a significant role. Improper alignment or muscle imbalances may lead to patellar maltracking, where the kneecap moves abnormally as the knee bends and straightens. For example, tight quadriceps, weak hip abductors, or poor foot biomechanics can all alter the forces exerted on the patella, contributing to inflammation and wear of the cartilage.
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How Can We Help?
Osteopathic treatment focuses on addressing the body as a whole, identifying and correcting imbalances that could be contributing to the condition. A thorough assessment of the patient's gait, posture, and functional movement patterns will help reveal any biomechanical factors, such as foot pronation or hip instability, that may be predisposing the knee to dysfunction.
Treatment typically involves manual techniques to reduce tension in tight muscles, particularly the quadriceps, and improve the flexibility and mobility of the surrounding joints, including the hips, knees, and ankles. Osteopathic manipulative therapy (OMT) can be used to release fascial restrictions, improve joint mobility, and promote better alignment in the lower limb. Strengthening weaker muscle groups, such as the gluteals and core, can also help restore balance to the kinetic chain, improving patellar tracking and reducing unnecessary strain on the knee. Furthermore, patients will be given tailored exercises to support long-term recovery, improve stability, and prevent recurrence.