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Runners Knee, Patellofemoral Pain and Tibial Torsion

Recently read an article on Runners Knee AKA Patellofemoral Pain Syndrome (PFPS). Common among runners and occurs when there is a kneecap (patella) tracking issue. The author of the article and his source, a sports podiatrist, were unsure as to why this happens. Now it's my chance to enlighten the professional world with my vision about PFPS.

Mistracking of the patella can be caused by several factors, the most common a misalignment of the tibia to the femur.  The patella tendon extends down from the quads and engulfs the patella then exits the patella changing its name to the patella ligament. This ligament then anchors on to the tibial tuberosity or big boney lump on the top front of the tibia bone. As the tibia twists externally (Tibial Torsion) this pulls the patella toward the outside of the groove. Can't quite put my finger which Chiropractor taught me this, but there you have it, mystery solved.

Now as to why the tibia is twisted (subluxated), that is the fact finding mission and for the answer we head south. My guess is that most of these runners have sprained their ankles before. As the ankle rolls out over the collapsing foot the tibia just keep on going, that is until the over stretched pain signals kick in from the GTOs (golgi tendon organs). The foot internally rotates (supinates) and the tibia drives right past the foot into external rotation. Tight personal muscles may be a factor, I always seem to find them with tibial torsion.

Treatment Goal

Check alignment of the tibia bone to the femur, unwind tibial torsion with chiropractic extremity adjustment and soften the peronial muscles with muscle stripping or ART. Check feet for subluxations and adjust accordingly. Adjust the posterior fibular head if found. Tape the foot into supportive neutral arch, tape tibia into correction, both proximal and distal ends. Train runner to run with feet in proper alignment. Fit runner for orthotics. There is more to this but by following these guidelines you should get a quick recovery

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