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Runners Knee / Patello Femoral Syndrome Enrique Saguil, MD Sports and Family Medicine.

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Presentation on theme: "Runners Knee / Patello Femoral Syndrome Enrique Saguil, MD Sports and Family Medicine."— Presentation transcript:

1 Runners Knee / Patello Femoral Syndrome Enrique Saguil, MD Sports and Family Medicine

2 Wounded knee

3 Knee Pain  Iliotibial band syndrome  Pes anserine bursitis  Patellar tendinitis  Meniscus tears  Acl tears  Osgood schlatter disease (gpi)  Patellofemoral syndrome  Referred pain (pinched nerve)  Bone pain (tumor-fracture-growth plate)

4 Patellofemoral syndrome  Irritation to the articular cartilage  Sinding Larsen Johansson (osgood)  Irritation to the patellar tendon (mistaken)

5 Reasons for irritation  Weekend warriors  Running through the pain  Attacking hills/incline  “Steps”/open chain  Two’s- fast, far, long, soft, tight  Trauma (sticking it, dashboard, work)  Overuse

6 Angles that effect the knee  Q angle  Patellar glide  Patellar tilt  Pes planus  Recurvatum of the knee  Muscular Imbalance

7 Q angle

8

9 High q angle “rubbing”

10 High q angle rubbing

11 Rubbing leads to friction

12 Chronic friction = Edema/fracture weeks

13 Edema on edema rubbing = Chondral fracture Months + cutting

14 Pes planus (pronation)

15 Pes planus = “flat feet”

16 Pes planus = “fallen arches”

17 Pronation “fixes” alignment

18 “Fixes”  Low dye tape  Endurance to intrinsic foot muscles  Stabilizing running shoes  Orthotics More next time…..

19 Recurvatum  Patellar instability  No control to motion  Patellar sledge hammer (outside straight)

20 Muscular Imbalance  Quads  ITB  hams

21 Dominant muscle wins

22 Sinding Larsen Johansson

23 Osgood Schlatter Disease

24 Osgood MRI

25 Patellar Tendonitis

26 Fixes  Irritation to the articular cartilage  Sinding Larsen Johansson  Irritation to the patellar tendon (mistaken) Px: It hurts when I do this…… Doc: So don’t do this……. - Henny Youngman

27 Acute fix “The Saguil Approach”  Ice 10 min/hour for hrs  Antiinflam  Steroid  Acupuncture  Immobilization-”relative rest”  Diet/supplement  Aspiration/compression

28 -Role of ICE  Vasoconstriction for hours  Blood vessel develops rebound vasodi  Prevents influx of white blood cells  Can “choke off” broken vessels  WATCH FOR FROSTBITE!

29 -Antiinflammatories  NSAIDS  Stop the cascade of inflammation  Help with decreasing prostaglandin  Dull pain (relafen)  WATCH FOR ULCER!  WATCH FOR KIDNEY AND HEART DS!

30 -Steroids  No, no roids!  Catabolic  Works fast for BIG suffering  Oral or injectable  WATCH FOR INSOMNIA AND SUGAR!

31 -Acupuncture  3000 years old and still the same  Can work on the opposite knee  Uses meridia (chinese medicine)  Uses trigger point and electric stim (western medicine)  CAN”T HURT, WATCH FOR FALLING TREES

32 -RICE  Rest  Ice  Compression  Elevation

33 -Diet  Dr Weil’s Antiinflammatory Diet  Fruits and veggies  Fish  Omega 3  Turmeric  Glucosamine sulfate  Low GI carbs

34 -Big Needle  Aspiration for pain relief and ROM  Diagnostic and therapeutic  Steroid injection  Prolotherapy  Trigger point therapy

35 Long term fix  Muscle training  Orthotic  Shoe evaluation  Training method/surface  Soft tissue mobilization  Flexibility  surgery

36 -Muscle Training  Sports medicine ortho/primary  Physical medicine and Rehab  Podiatrist  Chiropractor, ND  Sport specific trainer  “Gifted” physical therapist  Experienced running guru  On line, dvd,

37 -Dr Robert Weil  Sports medicine podiatrist  Ortho group with podiatric  “Gifted” physical therapist  Dick Ponds “guys”  Buy and try

38 -Soft tissue mob - flexibility  Yoga  Massage therapy  “Gifted” physical therapist  Raike therapist  Reflexologist  acupuncture

39 -”Heal with Steel”  Sports medicine orthopedic surgery

40 Thanks 


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