Human Performance and Rehabilitation Centers, Inc.

Front of knee pain: How to treat Patellofemoral Pain Syndrome

If you’ve experienced pain in the front of your knee around the kneecap, it’s probably a condition called Patellofemoral Pain Syndrome. Known also as “runner’s knee” or “jumper’s knee,” this condition can occur at any age, but it’s most common in teenagers, young adults, athletes and those who have recently hit puberty.

Patellofemoral Pain Syndrome is typically not caused by trauma; instead, it can seem to just appear. Because no single incident is the culprit, a person experiencing it may be inclined to work through the pain, or keep participating in sports or activities. When the pain doesn’t resolve, and, in fact, it gets worse, everyday knee flexion and extension can become intolerable.

Younger athletes are particularly vulnerable to Patellofemoral Pain Syndrome. During puberty, a young person’s bones grow fast –  outpacing the growth rate of ligaments, tendons and muscles and putting more stress on the joints. In addition, females have wider hips compared to their male counterparts and this can change the alignment of the knee and impact the patella’s movement in the trochlear groove. Athletes who engage in running, soccer, volleyball, cheerleading and dancing could experience this kind of knee pain.

Other causes for Patellofemoral Pain Syndrome include muscle weakness, stiffness, fatigue, improper shoe wear and poor movement patterns. Other contributing factors include overtraining or poor training techniques. And, prolonged sitting behind a desk during the week coupled with extreme “weekend warrior” activities can create an opening for Patellofemoral Pain Syndrome.

Patients should avoid irritable activities and apply ice two-to-three times daily to decrease inflammation. Physical therapy plays a big part in getting back to normal. In PT sessions, we work with patients on improving flexibility, stretching the hamstrings and strengthening the quads and hips by using very specific exercises. I usually like to see patients with this condition twice a week for four to six weeks.

Because of the multitude of contributing factors for each individual experiencing Patellofemoral Pain Syndrome, it’s important to let an experienced PT evaluate your case and develop a therapy plan that fits.

 

Learn more about general knee pain by visiting our blog post, Knee Pain Explained.

Achilles Tendon Injury

The Achilles tendon is an essential part of daily life. Spanning from your heel bone to your calf muscle, this band of tissue allows you to participate in everything from competitive sports to recreational activities, or just simply getting around. While the Achilles is the strongest and thickest tendon in the body, it can also be vulnerable to injury.

How Achilles tendon injuries happen

Athletes certainly experience their fair share of Achilles tendon injuries, but so can the average person. A variety of issues can cause the tendon to partially tear or even rupture. These include an abrupt and incorrect stepping down movement, wearing high-heeled shoes over the long-term, contact injuries or overuse. A tear can occur anywhere along the tendon from the heel to the calf. Injuries are more common in middle-aged individuals, and generally effect men more often than women.

How to recognize a tear

Partial tears, which are vertically or horizontally oriented along the tendon, are much more common than ruptures, or complete tears. You can usually feel a tear when it happens. It will cause the area around the Achilles to feel sore, tender and it may cause swelling. When a patient experiences a complete tear, normal walking is instantly compromised since the tendon is severed and essentially rolls up like a Roman shade. A rupture will require surgery and follow-up physical therapy.

Treating a partial tear or a post-op rupture

A full recovery from an Achilles injury demands patience. Rest is key. If surgery is not indicated, some patients benefit from wearing a boot to keep the tendon in a neutral position. If surgery is indicated, the patient will be referred to physical therapy typically around the 6th post-operative week, but will remain in a boot until 12 weeks post-op, on average.

During therapy sessions, a PT will manually stretch the tendon to bolster blood flow and to improve the relationship between the tendon and the heel bone and/or the calf muscle. The PT will also issue home exercises to encourage healing while minimizing inflammation. When the patient is ready, the PT will introduce gentle exercises like seated calf raises and exercises using therapy bands to increase blood flow. Next, the therapist will guide the patient through a progression of walking activities and dynamic stretching like lunges and standing calf raises with the goal of an eventual return to the individual’s desired level of activity. Another important part of therapy is restoring – or improving – a patient’s sense of balance, so a therapist may also deploy exercises that improve biomechanics. As the patient builds strength and flexibility, it will be possible to once again run and jump.

Continued maintenance

A home exercise program is a key part of helping a torn Achilles tendon heal throughout therapy. Wearing proper footwear is also important. While active adults are always eager to jump back into their former routines, it’s crucial that they practice patience and allow the Achilles tendon to heal fully to prevent re-injury.

 

If you are experiencing pain, but do not believe you have an Achilles injury, you may be suffering from Achilles Tendonitis. Learn more about Achilles Tendonitis and the treatments available.

Cupping and Taping: Not Just for Elite Athletes

The 2016 Summer Olympics in Rio made folks aware of a couple of different physical therapy techniques popular among elite athletes. Remember the round bruises around the shoulders of five-time Olympian Michael Phelps? Those were from a process called “cupping.” And beach volleyball guru Kerri Walsh Jennings routinely competed with a pattern of tape on her shoulder. Not just for elite athletes, cupping and kinesio-taping are effective strategies for everyday PT patients experiencing a range of issues. Here’s what you need to know.

Cupping

This is an aggressive manual therapy technique meant to enhance range of motion and optimize muscle function. A physical therapist places a special plastic suction cup on the surface of the skin to effectively pull skin and fascial tissue away from the muscle. This releases adhesions that may have formed from a collagen fiber build-up. Over years of use and stress, a patient can develop scar tissue and adhesions within the muscle that limit range of motion, making the muscle feel tight and sometimes causing pain.

Cups come in different sizes for use on different areas of the body. A therapist will identify the proper placement of the cup by examining the skin for tautness and testing the muscle’s range of motion. While the process leaves a circular bruise, it actually invites more blood flow to the area and helps trigger healing. Avoid any kind of cupping that also includes skin laceration techniques because this can introduce infection. Cupping should not be used on patients with blood clots or those taking blood thinners.

Taping

The kind of tape you’ve seen on elite athletes is different from the common tape or bandage that holds a sprained ankle in place. Instead, this is a special type of stretchy tape meant to promote muscle function and guide the muscle into proper movement. A physical therapist places the tape in a deliberate pattern. As it guides the joint through motion, it sparks kinesthetic and proprioceptive feedback. In other words, it’s coaxing better function out of a muscle or joint because it’s showing it how to move correctly. This provides stability and helps prevent injury or re-injury. It also helps teach the muscles to contract properly.

Because they both show good results, cupping and taping are becoming popular therapy techniques for treating everyday patients.