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Runners Knee / Patello Femoral Syndrome

Runners Knee / Patello Femoral Syndrome. Enrique Saguil, MD Sports and Family Medicine. Wounded knee. Knee Pain. Iliotibial band syndrome Pes anserine bursitis Patellar tendinitis Meniscus tears Acl tears Osgood schlatter disease (gpi) Patellofemoral syndrome

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Runners Knee / Patello Femoral Syndrome

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  1. Runners Knee / Patello Femoral Syndrome Enrique Saguil, MD Sports and Family Medicine

  2. Wounded knee

  3. Knee Pain • Iliotibial band syndrome • Pes anserine bursitis • Patellar tendinitis • Meniscus tears • Acl tears • Osgood schlatter disease (gpi) • Patellofemoral syndrome • Referred pain (pinched nerve) • Bone pain (tumor-fracture-growth plate)

  4. Patellofemoral syndrome • Irritation to the articular cartilage • Sinding Larsen Johansson(osgood) • Irritation to the patellar tendon (mistaken)

  5. Reasons for irritation • Weekend warriors • Running through the pain • Attacking hills/incline • “Steps”/open chain • Two’s- fast, far, long, soft, tight • Trauma (sticking it, dashboard, work) • Overuse

  6. Angles that effect the knee • Q angle • Patellar glide • Patellar tilt • Pes planus • Recurvatum of the knee • Muscular Imbalance

  7. Q angle

  8. Q angle

  9. High q angle “rubbing”

  10. High q angle rubbing

  11. Rubbing leads to friction

  12. Chronic friction = Edema/fracture weeks

  13. Edema on edema rubbing = Months + cutting Chondral fracture

  14. Pes planus (pronation)

  15. Pes planus = “flat feet”

  16. Pes planus = “fallen arches”

  17. Pronation “fixes” alignment

  18. “Fixes” • Low dye tape • Endurance to intrinsic foot muscles • Stabilizing running shoes • Orthotics More next time…..

  19. Recurvatum • Patellar instability • No control to motion • Patellar sledge hammer (outside straight)

  20. Muscular Imbalance • Quads • ITB • hams

  21. Dominant muscle wins

  22. Sinding Larsen Johansson

  23. Osgood Schlatter Disease

  24. Osgood MRI

  25. Patellar Tendonitis

  26. Fixes • Irritation to the articular cartilage • Sinding Larsen Johansson • Irritation to the patellar tendon (mistaken) Px: It hurts when I do this…… Doc: So don’t do this……. -Henny Youngman

  27. Acute fix “The Saguil Approach” • Ice 10 min/hour for 24-48 hrs • Antiinflam • Steroid • Acupuncture • Immobilization-”relative rest” • Diet/supplement • Aspiration/compression

  28. -Role of ICE • Vasoconstriction for 24-48 hours • Blood vessel develops rebound vasodi • Prevents influx of white blood cells • Can “choke off” broken vessels • WATCH FOR FROSTBITE!

  29. -Antiinflammatories • NSAIDS • Stop the cascade of inflammation • Help with decreasing prostaglandin • Dull pain (relafen) • WATCH FOR ULCER! • WATCH FOR KIDNEY AND HEART DS!

  30. -Steroids • No, no roids! • Catabolic • Works fast for BIG suffering • Oral or injectable • WATCH FOR INSOMNIA AND SUGAR!

  31. -Acupuncture • 3000 years old and still the same • Can work on the opposite knee • Uses meridia (chinese medicine) • Uses trigger point and electric stim (western medicine) • CAN”T HURT, WATCH FOR FALLING TREES

  32. -RICE • Rest • Ice • Compression • Elevation

  33. -Diet • Dr Weil’s Antiinflammatory Diet • Fruits and veggies • Fish • Omega 3 • Turmeric • Glucosamine sulfate • Low GI carbs

  34. -Big Needle • Aspiration for pain relief and ROM • Diagnostic and therapeutic • Steroid injection • Prolotherapy • Trigger point therapy

  35. Long term fix • Muscle training • Orthotic • Shoe evaluation • Training method/surface • Soft tissue mobilization • Flexibility • surgery

  36. -Muscle Training • Sports medicine ortho/primary • Physical medicine and Rehab • Podiatrist • Chiropractor, ND • Sport specific trainer • “Gifted” physical therapist • Experienced running guru • On line, dvd,

  37. -Dr Robert Weil • Sports medicine podiatrist • Ortho group with podiatric • “Gifted” physical therapist • Dick Ponds “guys” • Buy and try

  38. -Soft tissue mob - flexibility • Yoga • Massage therapy • “Gifted” physical therapist • Raike therapist • Reflexologist • acupuncture

  39. -”Heal with Steel” • Sports medicine orthopedic surgery

  40. Thanks • www.herbal411.com

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