Clinical Edge - Anterior knee pain & the impact of load with Dr Lee Herrington Clinical Edge - Anterior knee pain & the impact of load with Dr Lee Herrington

Anterior knee pain & the impact of load with Dr Lee Herrington

Anterior Knee Pain & the impact of load with Dr Lee Herrington

Anterior knee pain (AKP) often develops in runners, cyclists and athletes during periods of increased training load, and leading up to a race or event. Our more sedentary patients also develop AKP with small increases in load such as starting a walking program or stair climbing. Why does anterior knee pain develop during these times? Which factors are the most important to address at each stage of your rehabilitation of AKP patients - biomechanical, proximal or distal control, load, pain inhibition or strength?

Discover how to structure and tailor your treatment, so you can help your AKP patients recover, improve their load tolerance and return to the sports or activities they love.

In this presentation with Dr Lee Herrington (PhD MSc MCSP), you will explore how load may lead to pathological changes within the patellofemoral joint and other related structures, creating AKP. You will examine the evidence for altered loading in patients with AKP, and be able to identify specific structures vulnerable to load.

This comprehensive 8 part webinar series will take you through the practical aspects and research around AKP, to help you feel confident with your next knee pain patient.

Dr Lee Herrington is a Senior Lecturer in Sports Injury Rehabilitation and Programme Leader, MSc Sports Injury Rehabilitation at the University of Salford, UK.

Lee's other roles include:

  • Clinical Research Lead in the Knee Biomechanics and Injury Research Group, University of Salford, UK Primary research focuses are:
  • ACL injury and post-operative management
  • Relationships between ACL injury and ongoing comorbidities such as OA
  • Patellofemoral pain management
  • Technical Lead Physiotherapist, English Institute of Sport
  • Physiotherapist, England Table Tennis
  • Consultant Physiotherapist, working with a number of Premiership-Championship Football & Rugby Union clubs

Previous roles include:

  • Physiotherapist for Team GB at Rio 2016 & London 2012 Olympic games and Baku 2015 European games
  • Physiotherapist British Swimming
  • Physiotherapist Great Britain Basketball
  • Physiotherapist Great Britain & England Rugby League
  • Physiotherapist Wigan Warriors Rugby league

Publications: Over 150 per reviewed journal publications in the field of sports injury rehabilitation and 7 book chapters

Part 1

  • Anterior knee pain (AKP) & loading
  • Why are Patellofemoral pain (PFP) patients sensitive to load and changes in load?
  • What biomechanical and muscular factors may predispose a patient to AKP?
  • What intrinsic and extrinsic factors may trigger AKP?
  • What does the evidence tell us about altered loading in AKP?
  • What are common limb alignment and movement patterns in PFP patients?

Part 2

  • Effect of hip adduction on patellar position and the length of the ITB
  • Is "ITB tightness" actually contributing to PFP?
  • What effect does running speed have on hip adduction?
  • What effect does tibial rotation have on PFP?
  • The relationship between knee flexion angle and patellofemoral load
  • Common running patterns in PFP patients
  • The effect of PFP on Quads activation, and why addressing quads strength may not be your initial treatment

Part 3

  • What is the evidence for altered loading
  • Optimised load vs asymmetrical load
  • Orientation of joint-tissue to decrease relative load
  • What structures are sensitive to changes in load?
  • Is subchondral bone stress a feature of AKP?
  • How can you identify when blood flow in local arteries around the knee may be involved, and how can you address this in your treatment?
  • What factors will help you identify patients with the likelihood of a poor prognosis?

Part 4

  • How can you identify when your AKP patients have features of increased bone stress?
  • What solutions for bone stress can you incorporate into your rehab?
  • How can you change load on your patients knee?

Part 5

  • How is the Fat Pad involved in AKP?
  • What signs & symptoms will patients with fat pad involvement have?
  • Treatment solutions for fat pad
  • Taping you can use for the fat pad
  • How to perform effective patella mobilisation & taping
  • Acute effects of mobilisation
  • Changing the movement pattern to change load

Part 6

  • How to incorporate verbal-visual feedback in your rehab
  • When are your exercises enough, and when do you need to retrain biomechanics?
  • What is verbal visual feedback, and how can you incorporate it in your rehab
  • Running factors to address in AKP patients
  • How running foot strike pattern and forward lean are related to AKP
  • Is losing body weight the answer to your patients AKP?
  • How can you progressively reload the PFJ?

Part 7

  • How can you identify and overcome muscle inhibition
  • Ice - When should you use it, and when should you avoid ice application?
  • How can we retrain the quadriceps?
  • Are VMO timing and strength actually important?
  • Should you target the VMO in your rehab, or is it a waste of time?
  • Does quadriceps strengthening improve AKP?
  • Should you use open chain or closed chain exercises? Does it matter?
  • Should you load your patient through their painful range?
  • Is eccentric strengthening helpful?
  • Is hip training or knee extensor strengthening most effective in rehab?

Part 8

  • Gluteal muscle activation-strengthening - does it work, and if so, how?
  • When do you need to incorporate jump training into your rehab?
  • When are clams and sidelying abduction useful, and when are they a waste of time?
  • What are the most effective gluteal exercises?
  • How can you put this all together into a successful rehab program for your AKP patients?

Anterior knee pain and the impact of load part 1 with Dr Lee Herrington

Anterior knee pain and the impact of load part 2 with Dr Lee Herrington

Anterior knee pain and the impact of load part 3 with Dr Lee Herrington

Anterior knee pain and the impact of load part 4 with Dr Lee Herrington

Anterior knee pain and the impact of load part 5 with Dr Lee Herrington

Anterior knee pain and the impact of load part 6 with Dr Lee Herrington

Anterior knee pain and the impact of load part 7 with Dr Lee Herrington

Anterior knee pain and the impact of load part 8 with Dr Lee Herrington

Handout - Anterior knee pain and the impact of load with Dr Lee Herrington

Audio - Anterior knee pain and the impact of load with Dr Lee Herrington

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