Runners Knee Patello Femoral Syndrome Enrique Saguil MD

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

Wounded knee

Knee Pain o o o o o 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)

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

Reasons for irritation o o o o 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

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

Q angle

Q angle

High q angle “rubbing”

High q angle rubbing

Rubbing leads to friction

Chronic friction = Edema/fracture w ks e e

Edema on edema rubbing = hs t n Mo tting u +c Chondral fracture

Pes planus (pronation)

Pes planus = “flat feet”

Pes planus = “fallen arches”

Pronation “fixes” alignment

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

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

Muscular Imbalance o o o Quads ITB hams

Dominant muscle wins

Sinding Larsen Johansson

Osgood Schlatter Disease

Osgood MRI

Patellar Tendonitis

Fixes o o o 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

Acute fix “The Saguil Approach” o o o o Ice 10 min/hour for 24 -48 hrs Antiinflam Steroid Acupuncture Immobilization-”relative rest” Diet/supplement Aspiration/compression

-Role of ICE o o o Vasoconstriction for 24 -48 hours Blood vessel develops rebound vasodi Prevents influx of white blood cells Can “choke off” broken vessels WATCH FOR FROSTBITE!

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

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

-Acupuncture o o o 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

-RICE o o Rest Ice Compression Elevation

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

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

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

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

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

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

-”Heal with Steel” o Sports medicine orthopedic surgery

Thanks o www. herbal 411. com