There are knee conditions that occur that are less common that those that were discussed in the last blog. These conditions may be due to injury, weakness of structures in the knee due to repetitive overuse, dietary deficiencies, or even postural issues. Your chiropractor is well trained in not only diagnosing these issues, but also can be an important and integral part of the health care team that restores your knee to its full pain-free capacity.
I would like to delve into some of these conditions with you, but more importantly, offer you home care technics for treating those conditions. These tips can be effective in not only relieving immediate pain, but also be effective in shortening your repair/recovery time. Today’s discussion will focus on problems that occur near, on, or around the kneecap (patella).
Tendons and ligaments, oh my!
The patella is a bone that is completely encased in a tendon. The muscles in the front of your leg are attached to the lower leg at a bump you will feel just below your knee cap. The far end of the tendon that surrounds the kneecap is attached to that bump. The end of the tendon that is furthest away from that bone is attached to the thigh muscles. Muscles that are attached to bones by these tough fibrous tissues called a tendon. When tissue of this type is used to connect two bones, they are called a ligament. You have seen these tissues when you remove the skin from a chicken thigh and leg. The tissue appears in that situation as the white, shiny, tough to cut material.
A soft ligament called Chonromalacia patella
The first condition I want to discuss is chondromalacia patella. The root word chondro means cartilage and malacia means softening. Patella, you already know means kneecap. Chondromalacia patella (CP) is a condition that causes a dull pain around the kneecap that is aggravated by activity that stresses the knee. This is a condition that can cause knee noise. CP is best treated by avoiding the aggravating factors and using anti-inflammatory technics. Inflammation is not always bad because initially inflammation promotes healing. Treatment should include learning how to tolerate moderate levels of pain that should persist for less than an hour after activity with movement as well as using ice and massage. Chiropractic treatment is very effective in these cases and the utilization of custom orthotics has been proven to be beneficial.
A similar condition to chondromalacia patella is Osgood-Schlatter Disease (OSD). This condition was named for the researchers of this condition in 1903. This OSD is an irritation of the attachment lower end of the tendon of the leg muscles to the bump on the lower leg bone (tibial tuberosity). This condition occurs more in young athletes (aged 10 to 15 years). The tibial tuberosity is structurally weak due to not being firmly adhered to the tibia until bone maturity. Activities like soccer, gymnastics, basketball, and track are commonly referred to as causative activities. The young athletes will tell their parents about pain that is occurring on the tibial tuberosity. They will report that this pain is made worse with exercise. This condition initially will require avoiding the activity that aggravates the condition as well as obtaining x-rays to determine the severity of the condition. The athlete can be treated with ice, stretching of leg muscles, and initial use of NSAID over the counter medications. Chiropractic care provides excellent results in these conditions and custom fit orthotics to restore proper leg alignment and help reduce pain and speed recovery.
Pes Anserine Bursitis
The last condition I want to explore with you today is called Pes Anserine Bursitis (why do medical people use such weird names, right?). Pes anserine is Latin for goose’s foot. When the inside of the knee (where the inner thigh muscles attach to the knee) is viewed in dissection, it supposedly resembles a goose’s foot. I will be honest with you. I have done the dissection and looked at countless other pes anserine dissections. I don’t visually make the connection, but it has the name anyway. Bursitis means inflamed bag of fluid. Underneath the pes anserine is a small sac of fluid (a bursa) that reduces friction of the ligaments that slide over that part of the knee when it moves.
Pes Anserine Bursitis pain is found on the inside of the knee at about the level of the tibial tuberosity (see above). People with this condition will have mild to moderate pain when that spot is pushed on. They will also experience pain when going up or down stairs as well as when arising from a chair.
Massage of the inflamed tissue and stretching of the leg muscles will help alleviate the discomfort and promote healing in the area. Ice and NSAID use initially can be found to be effective. Chiropractic treatment is effective, and as in the previously mentioned conditions, custom fit orthotics can help as well. Avoid overuse of aggravating activities initially and gradually increase activity level as the person with the condition can.
These conditions are less common than those we discussed in our last blog on the knee but are no less painful or aggravating to the person that suffers the condition.