Last time I did a post on the knee we focused on the hip as the source of pain even though the site of pain was further down in the knee .
Today we will explore just below the knee more specifically the Tibia . Healthy joints like to be cent rated which means they slide and glide smoothly because the bones fit onto each other perfectly.
Tibial external rotation syndrome is a condition in which the Tibia rotates externally on the femur instead of maintaining a neutral position .
Over time this can lead to medial knee pain as the supporting structures are strained and can cause meniscus tearing and ligament damage . This is not limited to medial knee pain , lateral and anterior knee pain can also be present .
The Q angle is a line taken from the ASIS to the tibial tuberosity . A combination of the femur rotating internally and the tibia rotating externally can contribute to an increased Q angle .
The technical term is VALGUS COLLAPSE when the knee caves in and the tibia rotates externally . There are some tests we can do in a dynamic setting to see weather our client does display this valgus collapse and if they came in complaining of knee pain we may be able to help them .
- Thomas test
- Lunge forward
From watching the entire leg during the lunge forward you may notice the foot following the knee and collapsing into pro-nation . REMEMBER IT IS THE HIP THAT CONTROLLS THE KNEE AND FOOT . So even though we are looking further down the chain we go back to the hip to solve the problem .
Once you have established a tibial rotation syndrome you need to stabilise the tibia and see if it reduces the pain . If it does then you need to make your client aware of what causes pain and what reduces pain .
For clients with acute or extreme pain you want to try taping the tibia back into neutral . A taping job is only temporary but it allows the nervous system to uptake the new joint position and fire the muscle necessary to stabilise it .
In this case the tape is helping the three muscles ( sartorious , gracillis and semitendinosus ) that converge to make up the pes anserine to prevent tibial rotation .
The tape also helps to control the tibial tuberosity and prevent grinding of the patella . There is no such thing as a patella that tracks laterally only a femur or tibia that rotates causing scuffing and damage to the patella .
Once you are happy with your tape job get the client to perform the movement that produced pain . If you have correctly diagnosed the movement dysfunction then the pain should be greatly reduced and you will have a happy client .