To understand patellar tendonitis, it helps to know how and why the knee
works the way it does.
Take a look at your knee. What you probably think of as the kneecap is also
called the patella. Round and mobile, the patella is a bone responsible for
protecting the knee joint, called the patellofemoral joint.
The patella's main purpose, however, is to help the quadriceps (thigh
muscles) move more effectively. At both the top and bottom of the patella is a
tendon, which is a strong, connective tissue that attaches muscle to bone. At
the top of your patella, the tendon connects to the quadriceps. At the bottom,
it attaches from the patella to the tibial tuberosity, a bony bump on the tibia
(shinbone). When the quadriceps contract (tighten), they pull on the tendon and
the tendon pulls on the leg bones. This is how your body raises your leg.
When all the parts of the knee are working as they should be, bending the leg
causes the patella to move in a groove, much like a train on a track. When one
of several problems affects the patella's position, however, it can strain the
surrounding tendons and lead to patellar tendonitis.
One of these problems is a muscle imbalance, which occurs when one muscle is
significantly weaker than another and starts to stress surrounding tissues and
joints. This often occurs in the thigh, as it's particularly vulnerable to
muscle imbalances. Under normal circumstances, the muscles in the thigh work to
maintain the patella's position. When one muscle group becomes stronger,
however, it can tug the patella off track. The patella tendon then has to
stretch to keep it in place. Over time, this can cause tiny tears, resulting in
pain and inflammation.
Other problems can also cause such inflammation. One is subtalar pronation, a
dysfunction in the feet that causes them to turn inward. When this happens, the
leg bones rotate inward, placing abnormal stress on the knee and the patellar
tendons. Similarly, the angle of the thighbones can also cause increased strain
on the knee. In each leg, the thighbone attaches the pelvis (hip) to the knee.
Ordinarily, each thighbone comes down on a slight angle to align with the knee
joints. When the hips widen during the body's growth period (usually during
puberty), this angle can increase significantly. As a result, the thighbone
connects to the shinbone awkwardly, causing the patellar tendon to stretch and
partially tear. This problem is particularly prevalent in women, as they have
wider hips than men.
Because a number of factors can cause or contribute to patellar tendonitis,
your chiropractor's first goal in providing care for the condition is to
determine which factor or factors is responsible. Once this is established, he
or she can choose from a variety of management options to help improve your
condition.
Chiropractic Care
Your chiropractor's main goal in caring for patellar tendonitis is to reduce
inflammation and get the knee back to its optimal condition by rehabilitating
underlying problems. To do this, he or she may use joint adjustments, ultrasound
therapy, ice applications and rehabilitative exercises.
On your first visit, your chiropractor will likely recommend ice to reduce
inflammation, especially if you're in the acute or initial stage of the
condition. Ice works by constricting blood vessels and decreasing blood flow to
the area where you apply it, which reduces the body's release of painful
inflammatory chemicals.
Physiotherapeutic modalities such as ultrasound can also reduce inflammation,
as well as decrease pain, reduce muscle spasm, lessen nerve irritation, break
down scar tissue and speed healing. Ultrasound refers to any sound wave that has
a frequency above the range the human ear can perceive. To produce these waves,
chiropractors use a machine that channels electricity through a crystal located
at the end of an applicator. The crystal vibrates in response to electricity,
and the machine allows users to alter the electrical current to affect the
waves' frequency.
Your chiropractor may also assess your knee for joint restrictions, and
perform an adjustment if he or she finds any. Adjustments involve quick,
strategic thrusts to stuck or misaligned joints with either the hands or a
device called an activator to help decrease pain and inflammation and improve
mobility, flexibility and comfort.
Stretching and strengthening exercises can further improve joint health and
stability. As with many painful conditions that affect the knee joint, patellar
tendonitis can involve atrophy (degeneration) in the muscles around the knee. By
increasing the strength and flexibility of these muscles, you can help them
perform more efficiently. Once inflammation diminishes, you can also get
involved in a more aggressive exercise program that will help get you back to a
pre-injury state.
Remember, however, that while exercise is important you shouldn't overdo it.
Your chiropractor can determine when and how you should exercise, and may also
recommend a knee brace to compress the patellar tendon, providing support and
alleviating pain and tension. But even if you wear such a brace, choose your
activities carefully. Until your knee is completely rehabilitated, try to avoid
jumping, pivoting and other knee-dependent movements. Only when your strength
and flexibility are completely restored should you resume your regular
activities.
|
|
 |
