Knee Injuries
Iliotibial Tibial Band Syndrome (ITBS) is a common injury that affects triathletes, runners and cyclists. Using conventional treatments, this condition never completely resolves since these treatments typically do not address all of the key structures involved in the injury.
ITBS presents as:
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A sharp or burning pain on the lateral aspect of the knee.
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Pain radiating up the side of the hip or thigh.
ITBS is an overuse injury caused by the repetitive action of the iliotibial band as it moves across the lateral femoral epicondyle.
The primary functions of the Iliotibial Band are to:
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Provide static stability to the lateral (outer) aspect of the knee.
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Control adduction (inward motion) and deceleration of the thigh.
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During a run, the ITB performs this function about 90 times per minute, or 22,000 times during a four-hour marathon.
What Causes Knee Pain?
As a runner and sports medicine practitioner, I commonly see people with a variety of knee injuries. The causes of the knee pain are varied and often result from a combination of environmental, physical, and physiological factors. Knee pain can be caused by:
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Repetitive motion injuries
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Muscle imbalances
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Osteoarthritis
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Tendonitis
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Ligament injuries
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Meniscus injuries
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Illiotibal Band Syndrome
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Osgood-Schlatter Disease
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A variety of pathological processes. Pathological causes of knee pain are rare compared to the more common mechanical causes of knee pain.
These conditions, if left untreated, can often lead to an ongoing cycle of biomechanical imbalances which eventually lead to ongoing pain and degeneration of the knee, as well as hip, low back, shoulder, or neck problems.
Ligaments are strong bands of tissue that connect bone to bone. Ligament damage is a common injury we see at our clinic, most of these injuries are sports-related. Many are mild to moderate ligament injuries and can be treated without any need for surgery.
Grading Ligament Injuries
The types of traditional treatments prescribed for ligamentous injuries is dependent upon the degree of injury and the type of activities the patient will be involved in after the injury. Ligamentous injuries are classified into the following major grades:
Grade 1 describes microscopic tears of the ligament.
Grade 2 describes partial tears of the ligament.
Grade 3 describes complete tears or rupture of the ligament.
Grade 1 injuries typically respond well to soft-tissue treatments and rehabilitative therapies. Grade 2 injuries also respond well to soft-tissue treatments, and generally do not require surgical intervention if treated correctly. Grade 3 injuries require surgical intervention to correct the problem. In these cases tendons are taken from other areas of the body and used to replace the ligament.
Degree of Injury
How well a meniscus tear responds to non-surgical treatments will depend on the degree of tearing. In most cases the damage is not significant enough for surgery. The following symptom patterns may give you an indication of the severity of a tear. Remember these are just general guidelines, only a medical professional can make a definitive diagnosis.
Minor meniscus tear symptoms
You will experience only minimal pain, and you are still able to walk. Some degree of swelling exists, and increased pain is experienced during squatting motions. Most of these symptoms should diminish within 2-3 weeks.
Moderate meniscus tear symptoms
Pain occurs directly at the site of the meniscus (lateral or medial). Sharp pain occurs with any type of squatting or twisting motion of the knee. Often there is considerable stiffness with this condition. If these symptoms are ignored and rehabilitation is not implemented, it could take several months to a year before they go away.
More severe meniscus tear symptoms
Immediate sharp pain is experienced, including swelling and stiffness. The patient’s knee may lock into position. The patient is often not able to straighten their knee. This is often a case for surgical intervention.
Sciatica is a nerve compression syndrome that can be extremely painful and difficult to manage for both the patient and practitioner. Sciatic pain often affects the lower back, gluteal region, and various areas of the leg and foot. Often, the symptoms effect only on one side of the body.
Sciatica can be caused by a disc herniation, compression of the lumbar nerve roots, spinal stenosis, and/or entrapment of the sciatic nerve along its path from the lumbar spine down the leg.
Most cases of sciatica are mechanical in nature (98%) and are not secondary to some other pathological process (Infections, tumors, blood clots).
What Are Typical Sciatica Symptoms?
The sciatic nerve is a very long nerve that extends from the hips down the back of the leg, to the heels. Sciatica symptoms vary depending on just where the sciatic nerve is impinged or restricted. Symptoms include:
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Pain when you sneeze or cough
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Pins and needles in your legs
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Burning or tingling down the leg
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Pain in the rear of the leg that gets worse when sitting
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A continuous, constant pain on one side of the buttocks and leg
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Weakness, numbness or difficulty moving the leg or foot
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A shooting pain that makes it difficult to stand up
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Pain that feels like a bad leg cramp, but which can last for weeks