General findings for knee overload problems

All have a history of pain on squatting, walking up or down stairs and on hills, jumping, checking fast to stop, and kicking, both with the striking and the supporting leg. Resisted quadriceps, active straight leg raise and/or bent knee extension are painful. The one- legged squat test or a step down test may be the only positive finding if the lesion is mild.

Cause

Damage to the quadriceps, patella or patella tendon mechanism caused by the application of too much quadriceps work – both too long and too strong.

Treatment

a)      Overpronation produces a soft, mobile foot, which does not return to supination in time to firm up the forefoot for propulsion.  This is like running off jelly, and therefore knee extension has to produce the impetus. These individuals have a short stride and tend to run into midstance, rather than heel or forefoot strike. They work really hard to produce a heavy, laboured, running style, driven by the quadriceps, which become overloaded. Correction of the foot will enable a longer stride and more propulsion from the forefoot. In some people, an orthotic to correct the foot can totally correct the knee overload.

b)      In those with good anatomy, the inflamed lesion must be settled and then quadriceps loads are required, within pain tolerance. Rehablitation is started with low loads and the repetitions are incremented up to 30, at which stage the load is increased and the numbers reduced, gradually increasing until “30 reps” are reached once more. This incrementation is repeated until the expected competitive loads are reached. Pyramids can be used as an alternative, but again within pain tolerance. Muscles and tendons need time to adapt. The quadriceps and kicking ladders can be added.

c)      Surgery may be required in certain cases.

 

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English