I had the chance to examine a young 27 year old women yesterday. She has knee pain that is triggered when she runs. Then it hurts to walk, run, squat and even go up and down stairs. She said it got so bad she needed a cane to walk. 27 years old and a cane! She had seen “doc in the box #1” at Kaiser. She said there was a meniscus tear and told her not to run. She managed to get a second opinion from “Doc in the box #2” who diagnosed Patellofemoral Pain Syndrome (PFPS). What does that mean. Well basically you go to the doctor and say “my knee hurts”. Then in Latin they repeat back to you “you have PatelloFemoral Pain Syndrome”. Let me expain as I used to teach Medical Terminology and Anatomy. The word, Patella means kneecap. The word Femur means thigh. Pain means……..pain. Syndrome implies that the issue is multifactorial (I wonder if doc in the box realizes this). Doc in the box #2 sent her to the Kaiser PT’s. They told her she was weak and needed to perform “grandma exercises”. These are exercises that might help strengthen your grandmothers knee……..not a 27 year olds. In fact any physical therapist who actually believes that these exercises will strengthen anything should have their license taken away and go back to PT 101………maybe work beneath a personal trainer at 24 hour fitness. They might learn something. Then they had her perrform an exercises which is known to actually cause knee pain in many who do it. Which it did to her (stand on a step on one leg and perrform a series of deep squats on that leg). Now she had knee pain on both sides! So here she was telling me her saga and she began to elaborate a little more. The genius PT aslo told her to “rub her knee which would lubricate it”. I started laughing and she was laughing as she was telling me. I assured her I was not lauging at her but with her. I knew she knew how ridiculous it seeemd to rub your knee in order to lubricate it. The PT also told her she has flat feet and should get insoles for her shoe. No referral to a competent practioner though. So the gril went to Road Runner Sports where the kid made her insoles. Did they help….not at all. Why would they? The kid molds a piece of plastic to your flat foot……..how does that help except to lighten your wallet by $80. She was now “Roadrunnered”.
After a thouough biomechanical examination and orthopedic testing of her knee we concluded she had an;
- Large Quadricep angle (Q-angle) due to having a large hip to knee ratio. In the world of biomechanics it is known as Malacious Malalignment Syndrome. It means she as pronated, falt feet, knock knees and a large Q-angle.
- Treatment options include making biomechanically correct, custom orthotics that are not only molded to her feet but then modifications are added that decrease pronation, increase arch support, reduce the severity of her knock knees which then decreases her Q-angle. This is accompanied by aggressive strengthening exercises that are age appropriate as well as biomechanically correct and appropriate for her condition.
Let me sum this up. I really hate to say this but it is true.
- If you have a running related injury and you go to a Kaiser doctor the chances of you getting a competent doctor, examination, diagnosis and treatment recommendations are about 0-1%. I know it is sad, but it is fact.
- If you go to a physical therapist that tells you you are weak and prescribes grandma exercises they are not competent or living in the same world as the rest of us. The laws of physics and progressive resistance have dictated that it takes more than a couple of knee raises to strengthen your knee enough to maintain alignment.
- If you go to a kid at Road Runner Sports to tell you what is wrong with your knee and then make orthotics to cure that problem you will get pretty much nothing out of it except being taken advantage of, lied to and your money siphoned right out of your pocket. Road Runner Sports is a shoe store that specializes in lying to customers about their running biomechanics then selling them shoes and insoles that will prevent them from injury………..total nonsense and the person over there responsible for this nonsense knows it. How sad.
- I am not 100% sure that what I will do wil fix this young womens knee pain. But I was honest about that to her. I am also aware of what she has and why she has it. Being aware and treating someone with your eyes wide open is totally different that making something up and treating someone with useless exercises and orthotics while having your eyes closed shut. She has an anatomical design that does not lend itself to repetitive running or jumping. Not everyone is cut out for every type of sport. That is why we are not all sprinters or long jumpers or ballet dancers. Some of us are given anatomy that helps us be successful at those sports. By using biomechanical, custom fit orthotics to reverse her large Q-angle and strengthening exercises to help reduce muscle fatigue hopefully we can get this young lady out of pain and allow her to run short distance.