Patello-Femoral Syndrome   

Patello-Femoral Syndrome is a condition caused by the patella (knee cap) not tracking properly over the femur (thigh bone). The patella normally rides in a groove on the femur. The patella is really a fulcrum – it gives leverage to the big muscles on the front of the thigh. These thigh muscles are called the quadriceps. The quadricep muscles consist of four muscles. With Patella Femoral Syndrome, you get an imbalance in these muscles – usually the lateral or outside muscle over-powers the inner medial muscle – and this pulls the patella out of its normal groove. When the patella doesn’t track properly in its groove, it causes pain under the patella.

Signs and Symptoms: Pain under or around the knee cap which can feel like a pressure, Pain is often worse after activity that involves knee bending – running, stairs, squats, kneeling on the knee, Knee ‘cracks’ or needs to be cracked to decrease pain,  Patient cannot sit for long periods of time without straightening out the knee to make it crack. This is called ‘Theatre Sign’ – patients must sit in an aisle seat at the Theatre so that they can straighten out their knee frequently.
Often it is due to flat feet and rolling of the feet in causing the shine bone to roll out and the patella to change its alignment!

Treatment for patella-femoral syndrome can include: A full biomechanical exam to determine the cause. Then possibly: chiropractic to align the patella, feet, hips; Active release to break up adhesions in the tissues, massage therapy, orthotics, at home stretching and strengthening. A patient may be advised to ice or use a brace dependant on the problem.

A knee condition often first diagnosed in adolescents.
X-ray of the knee demonstrating fragmentation of the Tibial tubercle with overlying soft tissue swelling.
Osgood-Schlatter syndrome also called Osgood-Schlatter’s disease is one of the most common causes of knee pain in adolescent athletes. The condition is most common in active boys aged 10 -14 and is caused by stress on the patella tendon that attaches the muscle at the front of the thigh to the lower leg (Tibia). The tibial tuberosity, or bony bump on the shinbone just below the knee, swells and feels tender and painful when the knee is used. It occurs when, following an adolescent growth spurt, stress from repeated contraction of the quadriceps muscle is transmitted through the tendon to the tibial tuberosity, which is a growth center on the bone. 
Symptoms include: pain in one or both knees, pain when straightening the leg through the knee joint or full squatting, pain on running, or going up and down stairs, the pain eases with rest, the tibial tuberosity is swollen, and the skin over the tibial tuberosity is red and inflamed. Sometimes the quadriceps muscles can lose strength and bulk.
A thorough case history will reveal around half of all children with the condition report a prior knee injury. It is therefore important for the chiropractor to do a biomechanical assessment of the whole kinematic chain including all the joints and the muscles of the lower limb, the spine and pelvic joints. 
Treatment includes rest and ice and manual therapies such as Chiropractic adjustments to the foot, knee, and hip and back; Active Release Technique, massage therapy and stretching are very beneficial.  Acupuncture, ultrasound and laser therapy are also helpful in speeding up the recovery. Later at home stretching and strengthening exercises and possibly the use of an infra-patellar strap or brace.
Osteo-arthritis of the knee
If poor mechanics or traumatic injuries are not corrected at an early age, the tissues of the knee joint and especially the cartilage, will eventually begin to wear out. As a result the bones rub upon one another and changes such as bone spurs can occur. This painful condition is known as degenerative joint disease or Osteo-arthritis and is often progressive with age. Common treatment often involves medications such as NSAIDS (non-steroidal anti-inflammatory drugs).
Conservative treatment such as chiropractic can be helpful in alleviating the pain. 
Massage therapy is very helpful in helping to maintain the flexibility in the knee.  Active release can break-up the knots, adhesions, scar tissue that develops with Osteo-arthritis.  
Other treatments that are very helpful are acupuncture, the interferential current therapy, icing and fitting for the correct brace.
It is very helpful to determine the correct stretches, strengthening and physical sports to do to aid in maintaining the knee flexibility and strength.
There is some evidence that nutritional substances such as Glucosamine and Chondroitin can be helpful in the long term management. People can often help themselves by keeping their weight down, doing exercises especially in the pool, and wearing cushioned shoes, insoles or orthotics.  
Sometimes people with Osteo-arthritis will have to have a knee replacement. After the surgery it is very helpful to have treatment to restore the remainder of the motion of the knee. The surgery does cause scar tissue to develop and often people feel they have to live with the inflexibility after the knee replacement, they think this is as good as it will get! That is not true.
Are you living your life to the truest potential – do you have stiffness, pain, discomfort that limits your daily activities?