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

An ankle sprain is probably the most common injury sustained by both active, and non-active populations. Ankle sprains generally occur at a definable point in time, where the ankle is rolled over (usually to the outside). This causes damage to the ligaments at the outside of the ankle. This is known as either a lateral (location of the injury) sprain or an inversion (the movement causing the injury) sprain.

Injuries where the ankle is rolled inwards can occur, although are far less frequent. This is because the joint and the surrounding ligaments are more stable on the inside. This type of sprain is termed an eversion sprain or medial ankle sprain.

All sprains (be it ankle, knee, elbow, finger etc!) are graded 1-3 depending on the amount of damage caused. A grade 1 injury is a minor sprain, where less than 10% of fibres are torn. A grade 2 sprain consists of considerable damage (often called a partial rupture) and a grade 3 is a complete rupture.

There are three main ligaments on the outside of the ankle. The most commonly injured is the Anterior Talofibular (ATF) ligament and damage may occur to just one ligament, two or all three. A complete rupture of all three ligaments results in dislocation of the ankle joint.

Following a suspected ankle sprain it is always important to get an x-ray to rule out any associated fractures. Fractures such as avulsions (where the ligament pulls part of the bone away) are common in moderate to severe ankle sprains.

Treatment of ankle sprains should always involve immediate rest, taking the weight off the ankle and using ice, compression and elevation as soon as possible. A common mistake is to ice once only. In reality, ice should be applied for 10-15 minutes at a time, every 2-3 hours for the first 48 hours to help reduce swelling and inflammation.

Normal weight bearing should be encouraged as soon as possible (within the limits of pain) to help the ligaments to heal in the correct orientation. Other mobility exercises such as ankle circles can be introduced from day one to help maintain movement and reduce swelling (if performed in an elevated position). Calf stretches should also be used as soon as possible.

Once weight bearing has been achieved, start to add resistance band exercises into dorsiflexion (pointing the foot up) and plantarflexion (pointing the foot down) to improve strength. Later on calf raises and exercises into inversion & eversion can be introduced.

One important part of ankle sprain rehabilitation not to forget, is balance re-training, or proprioception. You may have seen people using wobble boards or cushions to balance. These can be used with great effect in a sprained ankle and are vital in trying to prevent the injury occurring again.

For more on ankle sprain injuries and rehabilitation visit www.sportsinjuryclinic.net

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Plantar fasciitis is a painful foot condition. It is an overuse injury which usually comes on gradually as you continue walking (or running etc).

The plantar fascia is a thick band of fascia which runs under the sole of the foot, from the heel bone (Calcaneus) to the forefoot. Its job is to support the arch of the foot.

The symptoms of plantar fasciitis include:

• Pain under the heel, often to the inside of the heel and also often radiating into the sole of the foot.
• Pain is usually present on walking and palpation (pressing the area).
• Pain is often worst first thing in the morning, or on standing after long periods of rest.
• Pain often eases as walking continues, only to become painful again afterwards.

Plantar fasciitis is often confused with a heel spur, but these are two different things. A heel spur is a formation of  bone which protrudes under the heel. A heel spur can occur on its own, can be completely pain-free, or it can cause plantar fasciitis. Similarly, having plantar fasciitis, does not mean you have a heel spur.

Plantar fasciitis is an overuse injury and so can be caused by a number of factors. One of the most common contributors is tight calf muscles. If the muscles of the lower leg are tight, this causes increased overpronation (rolling in and flattening of the arch) which places extra stress on the fascia. PF can also be caused by the opposite foot condition, known as oversupination, where the foot rolls outwards and there is a high arch. This results in a very rigid foot which doesn’t mold to the floors surface, or absorb shock well.

Treating plantar fasciitis should centre around correcting the cause of the injury. If tight calf muscles are suspected, stretch them regularly every day to help improve flexibility. You may require new walking shoes/trainers with arch support if you overpronate, or alternatively some insoles or custom orthotics may be necessary in more severe cases.

Other treatments which can be used include massage to the fascia and calf muscles and acupuncture.

To learn more about plantar fasciitis visit sportsinjuryclinic.net