The KNEE: RUNNER'S KNEE

By Jennifer Bessel

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Whether you call it runner's knee, chondromalacia, patellar malalignment or patellofemoral pain syndrome (the correct clinical name), it may end your athletic life and it probably can be prevented.

If you have pain behind your kneecap when you sit, walk or run that may worsen when walking downstairs or running downhill, you most likely have runner's knee. You may feel or hear a snapping, grinding or popping in the knee. There may even be some swelling in the knee. This is a more common problem in athletes who over-pronate, have wide hips and/or have under developed thigh muscles.

The best prevention for the athlete is to wear the proper motion control shoes or get orthotics. If there is over-pronation, then training to strengthen the quads, especially the inside parts of this muscle group, should be added to the training program.

The treatment is no different than with most overuse athletic injuries--RICE---Rest, Ice, Compression and Elevation. The athlete may want to consider the use of an anti-inflammatory medication during recovery. The earlier this is diagnosed and RICE is implemented along with corrective action, the sooner the return to training. Training should not be re-started until there is a full range of motion of the knee without pain, there is no pain when jogging or doing 45 & 90 degree cuts or turns and jumping on the affected leg.

 JUMPER'S KNEE

Jumper's knee (Patellar Tendonitis) is pain, tenderness and/or inflammation of the band of tissue (the patellar tendon) that connects the patellar (the kneecap) to the tibia (the shin bone). The most likely cause of this problem is too much jumping. It can also be caused by any repeated leg activity such as running, especially downhill, or bicycling. Jumper's knee is also more common in athletes who over-pronate.

Gymboss Timers

This is an overuse injury and the treatment is basically the same as for runner's knee--RICE, plus perhaps an anti-inflammatory medication. After the rest and restoration, the addition of orthotics and or an intra-patellar strap. The intra-patellar strap is a band that fits just below the knee cap and supports the tendon. Strengthening the thigh muscles will help to prevent this condition.

OSTEOCHONDRITIS DISSECANS (OCD)--AKA: OSGOOD SCHLATTERS

Although OCD is most often seen in 13 to 21 year olds, it is sometimes seen in more mature athletes. A low grade pain in the anterior knee pain or centered in the medial femoral condyle is usually associated with OCD. Early on, it is often described as an "aching discomfort". Some of the suspected causes of OCD are knee trauma and repetitive impact of the tibia. A lateral rotation of the foot while walking will often reduce the discomfort.

If unattended, this will become a serious problem and will usually require surgery to reattach fragments in the knee. These will have to be pinned in place with surgical screws.

The Wilson Test will often detect OCD, however a radiograph may be required. Obviously, this is something that will require immediate rest if there is suspicion of or if it is diagnosed by a physician.

ACL

BETTER UNDERSTANDING OF ACL INJURY PREVENTION

BY: LETHA Y. GRIFFIN, M.D., GEORGIA STATE UNIVERSITY

The number of anterior cruciate ligament injuries in high-risk sports like basketball and soccer remains high, especially for women athletes. It has been estimated that one out of 10 collegiate women playing basketball will sustain an ACL injury during her college career.

Although 75 percent of ACL injuries are non-contact, the precise mechanism that results in an ACL injury is not clearly understood. Proposed risk factors for injury have included environmental, anatomic, hormonal and biomechani- cal factors. Although in the last several years there has been a fair amount of research attempting to relate hormonal levels (primarily estrogen and progesterone) to ACL injury, results have been conflicting. Similarly, since women have a greater rate of ACL injury than men do in certain high- risk sports, many feel those anatomic variables such as hip varus, knee valgus or foot pronation might be intimately linked to injury occurrence. However, no such relationship has been definitively shown in multiple studies looking for it.

Women more susceptible

In the late 1970s, the increased incidence of sport injuries in women appeared to be linked to inadequate conditioning or lack of playing experience; however, our collegiate women athletes are now well-conditioned athletes who are experienced in their sport Then what is the answer? Why is the rate of ACL injury so high in our women athletes?

The late Chuck Henning, a well-known orthopedist in the Kansas City area, after reviewing numerous tapes of women athletes sustaining ACL injuries, attributed the increased rate of injury to what he termed the "quad-cruciate interaction." When the knee is extended, the quadriceps exerts a significant anterior translational force on the tibia, stressing the anterior cruciate ligament, the major restraining force to such translation. When the knee is bent, the quadriceps exerts less of anterior translational force on the tibia, stressing the ACL less.

Bending the hip and knees

To decrease the "quad-cruciate interaction" and hence decrease the risk of ACL injury, Henning felt that athletes should practice cutting, landing, and stopping with their knees and hips flexed. He instituted a program in the Kansas City area based upon this principle and reported a decrease in injury rates.

Recently, a group of researchers in Cincinnati led by biochemanist Timothy Hewitt proposed adding to the normal preseason stretch and strengthening exercises plyometric drills, emphasizing proper landing techniques with the hip and knee bent and the body balanced over the lower extremities. Analysis of injury rates in high-risk athletes participating in this program demonstrated a decrease in the rate of injury.

An ACL injury prevention program developed for downhill skiers by the Vermont Safety Research group emphasized increasing awareness of situations that can potentially result in an ACL injury and pre-planning strategies if events, leading to these situations, begin to fall in place.

Last year, the NCAA, concerned about the high rate of injury in the collegiate athletes and realizing the significant physical and psychological consequences of this injury, helped sponsor the Hunt Valley Conference on ACL Prevention Strategies. This conference allowed orthopedists, biomechanics, family physicians, athletic trainers and physical therapists to meet and review risk factors for ACL injury and the existing prevention programs. They concluded that even though the risk factors for injury have not been fully defined, early trials of existing prevention programs based on altering biomechanical risk factors appear to have had reasonable success in decreasing injury rates. Therefore, it seems appropriate to continue to pursue such programs while further defining risk factors for injury.

Since this conference, physicians, therapists and athletic trainers from the Santa Monica, California, area have, with the help of others, organized the first sports specific (soccer), on-the-field, ACL prevention program that easily can be incorporated into pre-game and pre-practice drills. This five-part program, called the PEP program, consists of avoiding vulnerable positions, increasing flexibility and strength while incorporating plyometrics, and increasing proprioception through agilities. It incorporates many ideas from the earlier prevention programs.

 

LINK TO: The PEP Program: Prevent injury and Enhance Performance


LINK TO: Noncontact Anterior Cruciate Ligament Injuries-Risk Factors and Prevention Strategies

More information on existing ACL prevention programs can be obtained from the following sources:

Henning's Program--- Dean Griffis, T.S.O.A Medical P.O. Box 3346, Olathe, Kansas 66063

The Caraffa Program---A. Carraffa, Orthopaedic Clinic, S.Maria Hospital, University of Perugia, 1-05106, Terni, Italy

Sports metrics---Cincinnati Sports Medicine Research (The Cincinnati Program) and Education Foundation, 311 Straight Street , Cincinnati, Ohio 45219

Ski Awareness Program---Vermont Safety Research, P.O.Box50, Sand Hill Road, Underhill Center, Vermont 05490


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