Case Study – Knee Pain: Importance of Orthotics & Glut Muscles Strengthening

March 24, 2013 | By READ MORE...

– Dr. Prajakta

CASE: 14 year old badminton player came with a complaint of right knee pain especially while playing deep forward shots (involving deep lunging) and post his games or tournaments since 6 weeks.

EVALUATION: Key observations were as follows:

  1. Both feet pronated or flat feet leading to an overload on the knee joint.
  2. Weak gluteal (buttock) muscles and weak Vastus Medialis Obliqus (VMO) muscle which is a part of the quadriceps muscle group.
  3. Weak core leading to decreased lumbo-pelvic-hip stability (decreased stability in low back & hip segment).
  4. Special tests positive for patello-femoral syndrome (signifying problems with the knee cap).
  5. Low Vitamin D3 levels.

The above key points revealed that as a result of the faulty biomechanics (muscular and bony alignment) there was an overload on his right knee joint causing an excessive friction between the patella (knee cap) and the femur (thigh bone), which over a period of time caused wear and tear of the corresponding articular cartilage.

This pain was more evident post the game as badminton involves a lot of jumping, lunging, squatting and quick running on the court. All this requires short and regular bursts of energy especially while playing power shots like smashes or drop shots placed at a considerable distance. These burst of energy, although provided by the arms and upper back, are further enhanced by a very strong core which is also known as the powerhouse of the body.

Thus the focus of the treatment was:

  1. Improving Vitamin D3 levels with supplements to aid calcium absorption and improve bone health.
  2. Correction of foot pronation with orthotic insoles.
  3. Strengthening of gluteal (buttock) muscles, VMO and core muscles to improve stability of the entire lower limb chain.

TREATMENT:

Gymball

Phase 1: Conservative Management

  • Ultrasound to reduce pain and inflammation.
  • Kinesiology taping to offload the knee cap and aid the weak quadriceps muscle. This proved effective especially during games as it avoided friction between the joint surfaces.
  • Orthotic correction with insoles to correct the lower limb alignment and biomechanics.
  • Basic strengthening of quadriceps and buttock (gluteal muscles).

Theraband

Phase 2: Strengthening

  • Involved strengthening of the quadriceps muscles and buttock muscle and the core muscles; the quadriceps muscles are the immediate stabilisers of the knee. Strengthening was done with help of weights and therabands in case of knee and buttock muscles.
  • Function of the buttock muscles:
    – Help propel the body ahead during walking or running, and offload the stress on the knee.
    – Ensure pelvic stability especially in frontal/vertical plane.
  • Function of the core muscles:
    – Helps in lumbo-pelvic-hip stability, and its initial activation is responsible for the power generation in the body.
    – Strengthening was done with the help of pilates exercises which encouraged core activation with limb movement ensuring stability over mobility.
    – Done on the mat first and then progressed to the gymball.

Phase 3: Specific Training

  • Eccentric training of the qaudriceps muscles to improve strength and stability during deeper squats and lunges.
  • Balance training.
  • Stepper training to improve endurance and multidirectional stability for quick running and change of directions on the court.
  • Agility and plyometric training to help the knee to take impact of the forces during the game and reduce on court injuries.

8 weeks later, the player reported of no pain during the game or post his tournaments. There was a visible and objective improvement in his condition an also his performance. This helped win the state championship. Thus a combination of the above treatments proved to be beneficial in alleviating knee pain.

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Category: Case Studies

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