Treatment Approaches

A few examples of our philosophy in assessing and treating certain ailments

Patellofemoral Joint Syndrome/ Runner's knee

The patellofemoral joint is formed by the articulation between the knee cap (patella) and the thigh bone (femur). The knee cap is imbedded into the tendon of the quadriceps muscle (front of the thigh). It tracks up and down in a groove on the femur. The patella tracks according to the tensile forces around the knee and position/ alignment of the lower extremity. If the tension surrounding the knee cap is balanced (equal pulling inward/ medial and outward/ lateral) and the alignment of the leg is "ideal" then the patella tracks properly and does not cause pain. However if there is a misalignment or unequal balance in tension around the patella, it will track inappropriately and cause pain and dysfunction. Chronic patellar tracking problems can lead to softening of the cartilage under the knee cap, called chondromalacia patella. There are many conservative treatment approaches to patellofemoral joint syndrome. Your PT will create a tailor made program to address specific issues revealed in your evaluation. The following list is an overview of some of our typical interventions.

McConnell taping and Bracing:
Tape can be used to alter the tissue tension around the knee to reduce pain and improve function. It is an effective tool during rehab that allows pain free strengthening and less pain throughout the day. Follow your therapist's advise on how and when to tape. If taping is effective, a tape kit will be issued to you for home use. Braces for the Patellofemoral joint can take several different forms (cho pat straps, neoprene sleeves, etc.). The effectiveness of bracing varies among individuals. Stretching and Strengthening:
Improving quadriceps strength helps to control patellar tracking. Adequate strength of the inside muscle belly of the quads (vastus medialis/ VM) is imperative to proper tracking. Often excessive tension on the outside of the knee (via the IT band and lateral retinaculum) can pull the patella out of alignment and needs to be addressed. Weakness in the deep glutes and core/ trunk muscles can cause reduced control of the femoral position and thus contribute to poor knee alignment and Patellofemoral pain. Your therapist will guide you in a specific home exercise program that addresses your impairments.
Orthotics/ Shoe Wear:
Alignment of the leg is greatly influenced by foot and ankle position. Excessive motion in the foot (such as hyper-pronation) can cause excessive torsion at the knee and hip. Poor shock absorption can also contribute to knee pain. Often custom corrective orthotics (special shoe inserts) with specific types of shoes are used to normalize leg mechanics. This is a powerful way to reduce ground reaction forces (improve shock absorption) and limit excessive motion.
Correcting Movement Dysfunction:
Certain movements cause remarkable increases in the compression between the patella and femur and can cause pain. One example is allowing the knee to travel much beyond the toes when squatting or descending stairs. Your therapist will help you to identify and correct movement impairments that contribute to your knee pain. A detailed biomechanical evaluation with gait analysis is often helpful in identifying certain movement impairments. Many treatment options are available. Your MD will help you to decide which approach(s) will be the most practical and effective for you.

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Low Back Pain

Your lower back, hips, legs, knees, and ankles all work as a single unit. When everything is working smoothly, the entire machine does its job. When one piece of the machine falters, the entire machine suffers. Misalignment, uneven motion, instability and limits to movement can all cause chronic lower back pain. Your body wants symmetry and balance.

The human body has an incredible ability to compensate for and adapt to dysfunctional tissues/ joints. However, the substitution creates increased stress on other areas of the body. Overloading any part of the system will cause greater wear and, eventually, pain.

KneeFootAnkle finds the pain generator as well as the forces that caused the tissue to break down in the first place. Once we have found that pain generator, we develop an individualized plan of care. We treat both the damaged tissue and the destructive forces.

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Custom Orthotics

Custom orthotics are shoe inserts created from a mold of your foot. Custom orthotics limit abnormal foot motions, provide pressure relief, and correct or accommodate structural deformities of the foot.

An orthotics evaluation includes:
Slow-Motion Digital Video Gait Analysis

The video-taping of gait allows a frame-by-frame analysis, to help determine what phase of the gait cycle abnormal motions are occuring. Also, we review the video with the patient so he/she may have a better understanding of the contributing factors to their complaints.

Foot plate pressure distribution/ Harris Mat

A foot print is used to identify the pressure distributions on the bottom of the foot during the stance phase of a gait cycle.

Biomechanical Examination of the lower half

The lower half of the body is scanned for abnormal motions in both unweighted and standing positions. Static alignments of the joints are then measured. Also, changes in alignment will be noted during various tasks such as squating, and single leg standing.

Heel in neutral with orthotic.	Relaxed stance without orthotic showing rear foot pronation.

Lower Half and Trunk Strength Testing

Muscle testing will be performed to find any related weakness. Also, the ability of the trunk musculature to stabilize will be assessed. We look at trunk stability because of its important role in ensuring efficent function of the lower half of the body.