Pain at the front of the knee which comes on gradually over a period of time is often termed anterior knee pain. A more appropriate term is patellofemoral pain syndrome. This condition is common in teenage girls and women, although can also occur in men. A common sign noticed by walkers is pain that is only evident when walking down hill or steps.

Patellofemoral pain syndromeis thought to be caused by a number of biomechanical (movement) abnormalities and muscle imbalances. These cause the patella (knee cap) to move too far to the outside of the joint when bending the knee. If repeated over and over, this can cause damage to the cartilage on the back surface of the knee cap.

Treatment of this condition relies on correcting the underlying causes. In many cases, these include:

• Tight lateral knee structures (such as Vastus Lateralis and the lateral retinaculum (fascia))
• Weak medial knee muscles (Vastus Medialis)
• Weak hip abductor muscles (outer hip muscles such as Gluteus Medius)
• Tight groin muscles
• Overpronation (where the foot rolls in and arch collapses)
• High Q angle (angle between the patella tendon and the Rectus Femoris muscle) - often caused by wider hips and so more prominant in females.

Correcting these problems can be a long-term effort, using a rehabilitation program to strengthen those weak muscles and stretch the tight ones! Other corrections, such as the use of arch support insoles can be much more easily achieved.

To find out more about rehabilitating patellofemoral pain, visit sportsinjuryclininc.net

Shin splints is a commonly used term for pain at the front of the shin. However, it is both medically and often diagnostically incorrect!

True shin splints causes pain at the front, inside of the shin bone, usually in the lower half of the lower leg. Many people experience shin pain to the outside of the shin bone (Tibia) and think they have developed shin splints. This is not the case, and often this pain may be due to tight calf/shin muscles, trigger points in these muscles, referred pain from elsewhere or occasionally, compartment syndrome.

For those with pain on the inside of the Tibia, shin splints is no longer a term used by the medial profession. There have been many names used to replace it, with Medial Tibial Traction Periostitis and Medial Tibial Traction Syndrome being the most common.

This condition is caused by traction forces from the muscles of the lower leg causing inflammation of the periosteum of the Tibia – the membrane that covers the outer surface of a bone and to which the musles attach.  As well as the location of the pain, symptoms include pain occurring at the start of exercise, only to ease as you warm up and possibly return after rest, tenderness on touching the inner border of the bone and a lumpy feeling in this area.

Treatment, as with all overuse injuries, focuses on correcting the cause of the injury. Rest, ice and anti-inflammatories may be useful in the early stages, but until the underlying cause has been corrected the pain will only reoccur on returning to activity.

So what causes shin splints? It is usually a combination of factors such as:

• Overpronation (rolling in and flattening of the arch of the foot)
• Oversupination (rolling outwards and a high arch)
• Inappropriate footwear
• Reduced ankle flexibility
• Sudden increases in activity
• Walking/running on hard surfaces.

Find out how you can correct these potential causes using rehabilitation exercises, orthotics and sports massage at www.sportsinjuryclinic.net

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