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Running injuries; Runners Knee – Iliotibial Band Friction Syndrome. Achillies Tendonitis. Plantar Fasciitis Cold Laser Therapy.
Runner’s Knee Explained
Runner’s Knee is the common term for Iliotibial Band Friction Syndrome. Runner’s Knee is a painful overuse knee injury that affects the outer part of the knee. It is common in runners and cyclists. It affects around 5% of all runners, while knee injuries in cyclists 20% are diagnosed as Runner’s Knee.
Runner’s Knee to understand this condition its necessary to be familiar with the anatomy of the outer side of the thigh and knee. The Ilio Tibial Band is a tough length of fascia that attaches to the outer side of the pelvis (The Ilium), goes down the outer side of the thigh and inserts into the outer side of the shin bone (Tibia). The Ilio Tibial Band forms a length of taught fibrous tissue that connects the hip and knee.
The Lateral Epicondyle is a bony prominence that is the widest point of the thigh bone. When the knee is straight the Ilio Tibial Band is in front of the Lateral Epicondyle of the thigh bone and when the knee is fully bent the ITB is behind the Lateral Epicondyle of the thigh bone. During movements of the knee, the Ilio Tibial Band moves over the Lateral Epicondyle of the thigh, with maximum friction at 30 degrees of knee bend.
During activities such as running and cycling, where there is repeated bending and straightening of the knee joint, the Ilio Tibial Band can ‘impinge’ upon the Lateral Epicondyle and the resultant friction can lead to inflammation of the tissues. If the Ilio Tibial Band is tight then the degree of friction is increased and a tight Ilio Tibial Band can predispose people to Runner’s Knee.
Between the Ilio Tibial Band and the thigh there is a sac of fluid, called a bursa, which is meant to prevent friction. However, where there are repeated knee bending movements with a tight Ilio Tibial Band, the bursa can become impinged between the Ilio Tibial Band and the Lateral Epicondyle of the thigh. The bursa itself, as well as the Ilio Tibial Band, can become inflamed and painful.
Runner’s Knee Symptoms
Typically there is pain located on the outer side of the knee joint. This pain may radiate up the thigh or down the outer side of the shin and is exacerbated by running or cycling activities. Usually, the pain from Runner’s Knee is only present during activity and settles when the person rests. However, in some cases it can also be extremely uncomfortable going up or down stairs.
There is often severe tenderness when the Lateral Epicondyle of the thigh bone is palpated. There is usually maximum friction at the area of the Lateral Epicondyle when the knee is bent to around 30 degrees.
Achilles Tendonitis
Achilles tendonitis accounts for around 13% of running injuries. The Achilles tendon is the large tendon at the back of the ankle. This Tendon connects the calf muscles (Gastrocnemius and Soleus) to the heal bone (calcaneus) and provides the power and drive in the push off phase of the gait cycle. The Achilles tendon can become inflamed through overuse as well as a number of other factors. Achilles tendonitis may be acute or chronic. Acute Achilles tendonitis is a result of overuse.
Achilles Tendonitis the Symptoms
Achilles tendonitis symptoms include:
- Acute inflammation
- Achilles Tendonitis pain may increase gradually during exercise. l Swelling may appear over the Achilles tendon.
- Redness may appear over the skin in the area of the tendonitis.
- You may feel a cracking or creaking sensation when you press your fingers into the tendon while moving the foot.
- Chronic Achilles tendonitis will often follow on from acute Achilles tendonitis if the acute tendon injury is not treated properly and given time to heal. Chronic Achilles tendonitis is a difficult condition to treat. The pain experienced during the acute phase of the injury may well disappear after a warm session, and may return when training has stopped.
Symptoms for chronic Achilles Tendonitis are similar to those of acute tendonitis as well as:
- Stiffness and pain in the Achilles tendon are especially noticeable in the morning. This pain may be described has none specific or generalized pain of the area.
- Nodules or lumps may appear in the Achilles tendon, 2cm above the heel.
- Tendon pain may appear when walking up a hill or incline.
- Chronic tendonitis differs from acute tendonitis in that it is a much more of a long term problem.
Causes of Achilles Tendinitis
An Overuse are the main factor and the basic cause of this injury, however other factors can make an overuse injury more likely.
Running up inclines and hills will mean the Achilles tendon has to stretch more than normal. This exasperates and worsens this condition.
Overpronation, meaning feet which roll in, will place an increased strain on the Achilles tendon. As the foot rolls in and (flattens) the lower leg rotates inwards which then twists the Achilles tendon placing torsion stress along the length of the Achilles tendon.
Treatment of Achilles Tendonitis
Rest and apply cold therapy or ice (not directly onto the skin).
Wearing a heel pad, as a temporary measure, to raise the heel and take the strain off the Achilles tendon. Rest while the Achilles tendon is healing.
Listed in our cold laser section under conditions treated.
Plantar Fasciitis. Heel Pain, spurs and Injury, Foot Pain and injury, causes, symptoms and treatment with Tog GaitScan and/or Cold Laser Therapy.
Plantar Fasciitis . A common cause of heel pain in adults. A classic sign is pain that is particularly severe when the first steps are taken in the morning. Plantar Fasciitis is a self-limited condition, however many people can suffer with this problem for years. The symptoms usually resolve more quickly when the time between the onset of symptoms and the start of treatment is short. There are many treatment options including Cold laser therapy rest stretching, strengthening, orthotics and anti-inflammatory drugs.
Pain is usually caused by collagen degeneration at the origin of the plantar fascia at the medial tubercle of the calcaneus. The cause of the degeneration is repetitive micro tears of the plantar fascia that overbears the body’s ability to repair itself. Cold laser therapy has become a major player in helping the body’s ability to repair itself quicker.
Although the classic sign of Plantar Fasciitis is early morning pain, not every patient will have these symptoms. Symptoms vary from person to person, however the majority will notice pain at the beginning of activity which lessens as they warm up. Plantar Fasciitis pain may also occur with prolonged standing. In severe cases, the pain will increase towards the end of the day.
The Plantar Fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus and runs forward to form the longitudinal foot arch. The function of the Plantar Fascia is to provide static support of the longitudinal arch and shock absorption. Individuals with pes planus (flat feet) or pes cavus (high arches) are at increased risk of suffering Plantar Fasciitis.
What Causes Plantar Fasciitis
A history of an increase in weight-bearing activities is common, especially those involving running, which causes micro trauma to the plantar fascia that exceeds the body’s capacity to recover. Plantar Fasciitis also occurs in elderly. In these patients, the problem is usually more biomechanical, often related to decrease in strength of intrinsic muscle.
As mentioned above, people with faulty foot biomechanics are also at risk of developing Plantar Fasciitis. A large percentage of the population will over-pronate (i.e. the foot rolls inward when they walk) which overstretches the plantar fascia and causes irritation.
On examination, the patient usually has a point of maximal tenderness just under the front aspect of heel bone and on the sole of the foot. The pain may be worsened by having the patient stand on the tips of the toes.
Plantar Fasciitis is often called “heel spurs,” although this terminology is somewhat misleading because 15 to 25 percent of the general population has heel spurs, without any symptoms and many symptomatic individuals do not have them.
In general, Plantar Fasciitis is a self-limiting condition meaning it would resolve by itself usually within 6 to 18 months. Suffering for such a long time can lead to
Frustration for patients and Doctors.
Stretching and Strengthening
Stretching and strengthening programs address risk factors such as tightness of the gastrosoleus complex and weakness of the intrinsic foot muscles. Increasing flexibility of the calf muscles is particularly important. Frequently used stretching techniques include wall stretches and curb or stair stretches.
Other effective techniques include placing a two-inch 3 four-inch piece of wood in the areas where the patient stands for a prolonged time (workplaces, kitchen or stoves) to use in stretching the calf. Dynamic stretches such as rolling the foot arch over a can or a tennis ball are also useful. Cross-friction massage above the plantar fascia and towel stretching may be done before getting out of bed.
Exercises such as picking up marbles and coins with the toes are also useful. Towel curl involves pulling the towel toward the body by curling the towel with the toes while sitting with the foot flat on the end of a towel placed on a smooth surface. Toe taps involve lifting all toes off the floor and, keeping the heel on the floor and the outside four toes in the air, the big toe is tapped to the floor repetitively. Next, the process is reversed, and the outside four toes are repetitively tapped to the floor while keeping the big toe in the air.
Shoes.
Wearing shoes with thicker, well-cushioned arch supports decreases the pain associated with long periods of walking or standing. Thus, simply getting a new pair of shoes may be helpful in decreasing pain as studies have shown that with age, running shoes lose a significant portion of their shock absorption.
Some 14 percent of patients with Plantar Fasciitis stated that change of shoes was the treatment that worked best for them.
Orthotics and Arch Supports
The three most commonly used mechanical corrections are arch taping, over-the-counter arch supports and custom made orthotics.
Arch taping can be used as definitive treatment or as a trial to determine if the expense of arch supports or orthotics is worth per suing. Taping may be more cost effective in cases of acute plantar fasciitis while over-the-counter arch supports and orthotics may be more cost-effective for chronic or recurrent cases of plantar fasciitis and for prevention of injuries.
Over-the-counter arch supports are highly variable and depend on the material used to make them. In general, patients should try to find the densest material that is soft enough to be comfortable to walk on. Over-the-counter arch supports are especially useful in the treatment of adolescents where rapid foot growth may require a new pair of arch supports once or more per season.
Custom made orthotics are usually made by taking a plaster cast or an impression of the individuals foot and then constructing an insert specifically designed to control biomechanical risk factors such as pes planus, valgus heel alignment and discrepancies in leg length. The main disadvantage of orthotics is the cost, which may range from £50 to £200 or more. However, the strong advantages of orthotics are that they are made specifically to match your individual foot. Similar to having a prescription for glasses. You wouldn’t want to wear someone else’s glasses! Although the initial cost is more than an over the counter pair, they are more cost-effective as they will last longer. Orthotics are also an excellent corrective treatment.
( TOG Gait Scan and Cold Laser Therapy are below.)
Tog GaitScan™
Our GaitScan™ System is a revolutionary diagnostic tool for assessing patient’s foot biomechanics. GaitScan™ has an industry high 4096 sensors and scans at an industry high 300Hz (scans per second). These measurements provide today’s Healthcare Professionals with a sophisticated explanation of foot mechanics and assists them with orthotic and/or shoe solutions.
Corticosteroid Injections
Corticosteroid injections have the greatest benefit if administered early in the course of treatment but, because of the associated risks, they are usually reserved for treatment resistant cases.
Potential risks include rupture of the plantar fascia and fat pad atrophy. Rupture of the plantar fascia was present in almost 10 percent of patients after plantar fascia injection. Long-term consequences of plantar fascia rupture were found in approximately one half of the patients with plantar fascia rupture. On the other hand, another study found that most individuals with rupture of the plantar fascia had resolution of symptoms with rest and rehabilitation.
Cold laser Therapy/Treatment
The lasers used at Central Chiropractic, Physiotherapy Clinic are certified as Cold Laser. For the past 30 years the technology of Cold Laser Therapy (also known as Low Level Laser Therapy) has been formally accepted in North America and in many other parts of the world such as Europe, Russia and Japan. In all this time there have been no recorded long-term adverse effects from low level laser therapy. It is considered to be non-invasive, painless and safe.
Cold Laser Therapy uses laser light energy to stimulate cells to function optimally. In the body, light sensitive chromophores and other elements within the cell absorb energy initiating a series of important photochemical changes such as increased production of ATP. The mitochondria and Kreb’s Cycle stimulation initiates the production of ATP, providing the cell with the extra energy needed to accelerate the healing process and positively influence pain. These activities can occur in all types of cells and includes ligament, nerves, cartilage and muscle.
Low Level Cold Laser Therapy (LLLT) is a Handheld, non-invasive, light-emitting medical device which is used over different areas of the body. It provides an unmatched advantage in the treatment of conditions such as;
Athletic and Sports Injuries.
Shoulder conditions and injuries. Ruptures. Tears. Ligaments. Tendons.
Knee Ankle and foot Pain Conditions and injuries. Hip, Knee Bursitis.
Achilles Tendonitis. Bursitis. Plantar Fasciitis. Stress Fractures. Shin Splints.
Meniscus tears. Runners Knee Iliotibial Band Friction Syndrome
Chronic Neck and Back pain.
“Whiplash” (WAD) injury/ Neck Pain. Cervical Disc injury.
Upper and Lower Back Pain
Slipped disc. Prolapsed disc. Herniated disc. Bulging disc.
Trapped nerves.
Hip Pain Sacroiliac joint inflammation
Shoulder Injuries and conditions.
Carpal Tunnel Syndrome.
Arthritic Pain Relief.
Muscle Spasm
Relief of Muscle and Joint Pain
Skin infections.
Wound Management including Skin Ulcers, Pressure Sores and Burn.
Soft Tissue Injuries including Sprains and Strains, Tendonitis and Haematomas.
Joint Disorders including Arthritic pain relief and Tenosynovitis
Chronic pain such as Trigeminal Neuralgia and Chronic Neck and Back
Pain. “Whiplash” (WAD) injury. Neck Pain and injuries.
For further in depth information on Hip knee or Ankle pain including Back and Lower Back Pain, Sciatica. Please go to top left corner under “Pain” or “Conditions”.
