|We treat the following conditions when related to functional problems of the back and leg.
Chondromalacia of the knee is a condition found mainly in women. It results when the cartilage which lines the joint surfaces of the knee cap becomes inflamed from mechanical strain. Strain on the knee and knee cap will ultimately cause the cartilage to swell becoming irregular. Cartilage then begins to break off calcified behind the knee
cap. This can lead to the grinding and burning sensation associated with this condition. In fact an interesting term 'Theater sign' is given to the pain and burning in the kneecap region which results from sitting too long with your legs under you, as in a seated theater position.
Interestingly enough chondromalacia is one of those conditions that has everything to do with posture. Because women have wider hips for the purposes of child bearing they tend to have more angulation between the upper and lower leg than do men. Thus they stress the knee more. However few women seem to have problems here unless they also pronate excessively as well. Pronation, or inward rotation of the ankle while standing creates that little bit of extra stress that 'breaks the camels back', or in this case promotes chondromalacia. Correcting this stress can be accomplished with correct shoe orthotics and in many cases specific therapy and exercises to strengthen the lower back, legs, calves and other selective muscle groups. The biomechanics of the entire region and low back must be accessed.
LIGAMENT TEARS OR THE KNEE
Certainly due to its weight bearing characteristics and high mobility, the knee is an area for acute injury in such sports as skiing, football, soccer, running and other stressing activities. Due to its construction, lateral & medial collateral ligaments, which connect the upper leg bone (femur) to the lower leg bone (tibia), may become torn. As in all ligament tears these may be of three grades and usually do not require surgery. Rest proper therapy including ultrasound and bracing are key to the timely recovery of this injury.
CRUCIATE LIGAMENT TEARS
Cruciate ligaments are small ligaments inside the knee joint which stabilize the joint, holding it tight. When one of the two, anterior or posterior cruciate ligaments are torn, surgery may be necessary depending on the stability of the knee and the plans of the individual for future athletic use. This is not an injury prone to resolve with conservative means of care. Evaluating biomechanical stresses of the knee is a good idea whether surgery is required or not to insure that the knee remains pain free and has its best function since poor mechanics will undermine the stability of the knee and slow healing.
Two large cartilage pads cushion our knee joints and lie between the femur and tibia. In strenuous sport of accident these may be partially/mildly torn or torn more severely. The torn area may be stable or a fragment/flap of torn meniscus may shift and produce locking of the joint. The decision to have surgery relates to the degree of impairment experienced with these injuries. Having a chiropractic orthopedic evaluation of the mechanical stresses of the knee is a good idea whether surgery is required or not to insure that the knee remains pain free and has its best function.
Osgood-Schlatter's is a condition where usually due to enthusiastic sports play, the leg is stressed excessively causing the lowest attachment of the patellar tendon to pull and partially detach the immature growing bone where the tendon inserts at the tibia. This produces a sore, swollen and raised area on the front of the lower leg bone (tibia), about 2 inches below the knee cap. The area will usually heal on its own but may require reduction of activity and padding/bracing. One should not disregard this problem and continue to strain the area as complete detachment is possible.
Bursitis of the knee is a painful but usually harmless condition of the knee when bursa are bruised or strained. The condition is usually a temporary one but may signal mechanical problems with the knee if reoccurrent. Bursa by the way are tiny sacs that the body has positioned at multiple points where tendons must cross to allow for lubrication and ease of movement. Bursitis responds well to ultrasound and other conservative therapies.
SHIN SPLINTS & GROWING PAINS
Shin splints are common especially with prolonged standing and in athletic activity. Track and long distance runners often encounter shin splints and they are prevalent especially in the young. Often attributed to growing pain, shin splints are a true abnormal condition and no phase of growing should ever be painful. (Growing pain anywhere in the musculo-skeletal system indicates a problem which needs to be evaluated.)
The mechanics of shin splints are usually quite simple and are usually brought about when abnormal inturning of the ankle or flat feet produce excessive strain to the tibia (or lower leg bone). This strain produces swelling of the lower leg which becomes trapped under the very tight fascia or connective material of the lower leg. Such swelling is normal when the leg is stressed.
The answer to correcting shin splints is to remove the stress by correcting the posture of the ankle and foot. Orthotics, (prescription shoe inserts), are usually 100% effective in eliminating shin splints. However not all orthotics work. Many are fitted improperly and many are too uncomfortable to wear. A good orthotic must be supportive enough to correct the functional problem such as pronation and be comfortable at the same time. The chiropractic orthopedist prescribes orthotics to stabilize the lower back and correct mechanical problems of the lower extremities. In our office we use podiatric grade orthotics which are formed from an individual plaster cast of the patient's foot. This is the old fashioned method of making orthotics and in my opinion still the best method.