Threesixtyphysio may be a new name to have found its way to The Lab, but one or two of you may recognise a familiar face around the club come November. Having reluctantly left the Lab in 2018, I’m delighted to be returning, this time under my own company, Threesixtyphysio.
‘Why Threesixtyphysio?’, I often get asked. It's a name that I feel encapsulates what physiotherapy should be; holistic, comprehensive, engaging and complete. To me, physiotherapy goes beyond just tissue healing. It’s also about creating confidence with exercise, changing perceptions about what our bodies can and can’t do and finding solutions when there are boundaries, so we can feel empowered to move with greater freedom and less worry.
COVID-19 AND PHYSIOTHERAPY
For all of us, this year has brought its difficulties and as Lab members, having your usual exercise routines so heavily disrupted was undoubtably a very challenging process. We rely so heavily on regular exercise for all kinds of health benefits, from weight loss and cardiovascular fitness through to our mental health. So it’s been a time where we’ve had no choice but to adapt and for many of us, including myself, this involved taking up different forms of exercise. This may have included online virtual HIIT classes, PE with Joe Wicks or outdoor running to name a few. I’ve no doubt those who live in or close to Muswell Hill saw just how many runners were packed on the pavements around Alexandra Palace during the warm summer evenings!
Whilst our ability to adapt and change our exercise habits was a huge success, sudden shifts in our training patterns can also lead to overuse injuries. One thing that I have come across more often since lockdown is a knee injury called patello-femoral pain, or knee cap related pain. It is also commonly referred to as Runners Knee, but can equally occur in non-runners too and relates to the way the knee cap (patella) tracks over the thigh bone (femur).
Even before lockdown, patello-femoral pain was a complaint I saw a lot of. It represents around 6% of all injuries I see day to day and is characterised by pain at the front of the knee. It is typically made worse by activities that load the anterior knee, such as running, cycling, descending stairs and squatting. Sometimes people also complain that it feels worse after sitting
for any length of time.
WHAT CAUSES IT
Scientific evidence suggests that there are four main drivers to its development:
• Structure: This is less common but relates to natural variation in how our knee cap joints are built. This differs between individuals due to varying body compositions and genetics.
• Biomechanics: This is more to do with the way people move, on top of how we’re structured and is much more common. Here, we typically see people tend to have weaker hip muscles, which may then contribute to poor movement economy at the knee joint. We also commonly see a pattern where the knee deviates inwards relative to the foot during loaded tasks, creating inefficient movement patterns. Sometimes footwear choices influence this too.
• Activity levels are also a common driver of patello-femoral pain and relate to overload. Day to day our tissues undergo a process of wear and repair, relative to how much we use them. When the wearing process exceeds the capability to repair, we get overuse and this can happen when we suddenly change or increase activity.
• Sleep, stress and hormone levels can also amplify the pain signals from the knee to the brain, thus influencing our perception of pain.
More often than not, these drivers are often interlinked and influence each other. They can greatly vary in order of significance between individuals, so making an accurate diagnosis and finding the right physiotherapy led management plan is key.
WHAT CAN BE DONE ABOUT IT?
The good news is we know early intervention leads to more favourable outcomes. Similarly, we also know that the length of time you have symptoms is also a prognostic factor. In other words, the longer you leave it the more stubborn it is likely to be!
There is some strong scientific evidence that tell us exercise based interventions have a positive impact. This may involve a specific program targeting weaker muscles groups or making modifications to the way we move; for example, making small changes to our running form, or changing the way we squat or load the knee during certain tasks. One common pattern I see in runners is over-striding, whereby the foot lands too far ahead of the knee joint, distributing the ground reaction forces unevenly through the lower limb.
Complimenting interventions above with correct management of load, or activity is really important. Thankfully, most people are still able to take part in some form of regular exercise but a short term rest from running or high impact activity is often advisable.
We also know that when you understand your injury well, the more likely you are to manage it better on a day to day basis so its important you have a good idea of what is going on. Further adjuncts which have some good scientific support are the use of foot orthoses and taping techniques. A detailed assessment can provide clarity on which treatment choices will be
If you, like many others have picked up any frustrating niggles or stubborn injuries lately, speak to myself or contact reception at Muswell Hill to book a physiotherapy initial consultation. For the remainder of the year, all patients who are self-funding will also receive a discount of 25% off their first appointment. To find out more, including the safety precautions we’re taking for Covid-19, speak to the reception team or visit www.threesixtyphysio.com.