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The exam will evaluate the stability of the kneecap as well as alignment of the leg.
These may also be performed to relieve abnormally high pressures between the kneecap and femur.For
additional information on runner's knee, check out this SportsMD video on "patellofemoral pain syndrome (PFPS)."Dr.
For this reason, inadequate muscle strength and/or stretching of the thigh and calf muscles can
predispose to "Runner's Knee" as well.What can I do to prevent Runner's Knee?While certain predisposing
factors such as kneecap and leg alignment are not in the control of an athlete,
other preventative measures can be taken to minimize the risk of "runner's knee". SportsMD is
the most trusted resource for sports health and fitness information for people engaged in sports
everywhere. More recently, however, it has been recognized that overloading of the underlying ("subchondral") bone
can be a substantial source of pain, as it has a rich nerve supply. High
heels can also worsen anterior knee pain and should be avoided if you have "runner's
knee" symptoms.o Plan for a good running surface - Running on a flat surface without
steep, downhill slopes can help to prevent significant stress on the knee cap. MRI is
useful to evaluate for softening or injury to the cartilage on the kneecap and femur.What
is the treatment for Runner's Knee?The first line of treatment for "runner's knee" is typically
nonoperative. Bedi did a sports medicine fellowship at the Hospital for special Surgery and completed
his residency at the Department of Orthopaedic Surgery University of Michigan Medical Center. o In
certain cases, taping of the kneecap ("McConnell taping") or use of stabilizing braces for the
kneecap can help. Orthotics to reconstitute the arch of the foot can help to alleviate
these symptoms. Fortunately, low-impact activities such as swimming or cycling can allow the athlete to
maintain their aerobic fitness while protecting the patellofemoral joint.o Avoid running down hills or down
steep slopes or stairs that increase pressure on the kneecap.o Ice and anti-inflammatory medications can
certainly help to relieve the pain in the front of the knee. He is currently
the Nike Requin Assistant Professor for Sports Medicine and Shoulder Surgery, at the University of Michigan Health
System. o Keep your weight down - the patellofemoral joint experiences forces that are 8
to 10 times our body weight, such that even small reductions in weight can significantly
reduce the forces on the kneecap. Even though it is difficult, the athlete must refrain
from competition until he/she is pain-free. Strength and tone of the quadriceps and hamstrings will
also be determined. This includes repetitive jumping sports like basketball or volleyball, as well as
skiing, cycling, and soccer. These are particularly useful in the setting of instability of the
kneecap.o If the athlete has flat feet ("pronation"), orthotic inserts to reconstitute the arch can
be extremely useful to alleviate symptoms.o When the knee is pain-free, a course of rehabilitation
for range-of-motion of the knee and strengthening of the quadriceps and vastus medialis muscle may
be useful.However, exercises that are performed with the knee bent should be avoided, as the
pressure beneath the kneecap is increased in this position. If instability of the kneecap is
suspected, CT scan can help to determine abnormalities in alignment and position. Kneeling, squatting, or
direct pressure on the front of the knees may be uncomfortable as well.What things might
predispose me to Runner's Knee?The kneecap and its cartilage is subject to very high forces
with daily activities, and any injury to the cartilage or factors which result in increased
pressure between it and the thigh bone ("femur") can increase the risk of "Runner's Knee".
When the pain of "Runner's Knee" prevents the athlete from returning to play, surgery may
be considered.The specific treatment will depend on the underlying cause for the pain. Arthroscopic ("minimally
invasive" camera-based) surgery can be pursued to manage softening or damage of the articular cartilage
of the kneecap and thigh bone. Recommendations include:o Stop running, jumping, or any of the
activities that cause pain in the knee. Ten pounds of weight loss can be as
much as 80 to 100 pounds less force of the kneecap when climbing or descending
stairs.o Stretch nike shox nz before running or jumping activities - Strains of the patellar tendon, quadriceps tendon,
or other soft tissues that stabilize the patella can cause significant anterior knee pain. Runner's
knee involves the kneecap, quadriceps tendon, patellar tendon, and the associated soft tissues that are
critical to extension of the knee. Historically, "runner's knee" was attributed to irritation and softening
of the cartilage lining on the undersurface of the kneecap ("chondromalacia"). Even, padded surfaces and
good running shoes can help as well.How is Runner's Knee diagnosed in athletes?Usually, the diagnosis
of "runner's knee" can be made in athletes based on the history and physical examination
of the knee by your sports medicine specialist. In rare circumstances, the knee will continue
to be painful and refractory to all of the nonoperative measures described above. While the
pain develops during athletic activity, it can often be most pronounced afterwards during a period
of rest. Instruction on preventative stretching exercises for the quadriceps, hamstring, and calf muscles is
very important as well. If there is accompanying instability of the knee cap, soft tissue
reconstructive procedures or re-alignment of the leg ("osteotomy") may be performed to improve the tracking
of the patella. Special views can show the position and alignment of the patella in
its groove on the thigh bone ("trochlea"). These include:o Malalignment of the kneecap and/or lego
Subluxation or dislocation of the kneecapo Direct trauma to the kneecapo Overuse with running and
jumping activitieso Wide hips and/or "knock knees" (valgus) resulting in maltracking of the kneecapo A
weak quadriceps/vastus medialis muscleo Flat feet ("pronated" feet)o Direct trauma to the kneecapo Overuse with
running and jumping activitieso Wide hips and/or "knock knees" (valgus) resulting in maltracking of the
kneecapo A weak quadriceps/vastus medialis muscleo Flat feet ("pronated" feet)In certain cases, runner's knee results
from irritation or injury to the soft tissue around the kneecap. The soft tissues and
fat pad in the front knee can be causes of pain as well.Who gets Runner's
Knee?While classically associated with long-distance running, any activity that places significant stresses on the front
of the knee joint ("patellofemoral") can result "runner's knee". Dr. Other terms that have been
used to describe this condition are "anterior knee pain", "chondromalacia patella", or "patellofemoral pain syndrome
(PFPS)". Bedi is a fellowship-trained orthopaedic surgeon specializing in Sports Medicine. He graduated from Northwestern
University with a Major in Biochemistry/Biophysics Summa Cum Laude and graduated from the University of
Michigan Medical with School Academic Honors and Research Distinction.For more information on sports related injuries
and issues please visit http://www.sportsmd.com. The repetitive pressure and stress between the femur and patella
in these sports can result in softening of the cartilage and abnormal loading of the
underlying bone.How does Runner's Knee present?Runner's knee presents as activity-related pain in the front of
the knee and around the kneecap. For the same reason, marathon runners will often paradoxically
complain of greater difficulty running downhill rather than uphill. Flexibility of the feet and loss
of the arch should also be noted as this will predispose to kneecap problems. X-rays,
MRI, and CT scans can all be useful adjuncts depending on the examination findings and
symptoms. Runner's knee is a term used to describe a constellation of symptoms of knee
pain that is frequently encountered in running athletes. Warming up and stretching both before and
after exercise can help to prevent strain injuries to these structures.o Wear proper shoes and
orthotics - Flat feet ("pronated" feet) can predispose to maltracking problems and knee pain. These
include:o Quadriceps and vastus medialis strengthening - a strong quadriceps and, specifically, the vastus medialis
muscle will improve the tracking of the kneecap and help to minimize contact pressures between
the kneecap and thigh bone. Signs of tenderness under the kneecap and/or instability will be
assessed. Tilting of the patella that leads to abnormal contact pressures can be appreciated. Pain
is also felt after sitting for a long period of time with the knees bent
- the bent position actually increases the pressure between the kneecap and femur. We have
assembled the sports industry's leading Doctors and health experts - each sharing valuable, practical advice
to keep you playing injury-free..
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