Presentation at a runners group with Dick Ponds Lisle

1. Runners Knee / Patello Femoral Syndrome
Enrique Saguil, MD
Sports and Family Medicine

2. Wounded knee

3. Knee Pain
 Iliotibial band syndrome
 Pes anserine bursitis
 Patellar tendinitis
 Meniscus tears
 Acl tears
 Osgood schlatter disease (gpi)
 Patellofemoral syndrome
 Referred pain (pinched nerve)
 Bone pain (tumor-fracture-growth plate)

4. Patellofemoral syndrome
 Irritation to the articular cartilage
 Sinding Larsen Johansson(osgood)
 Irritation to the patellar tendon (mistaken)

5. Reasons for irritation
 Weekend warriors
 Running through the pain
 Attacking hills/incline
 “Steps”/open chain
 Two’s- fast, far, long, soft, tight
 Trauma (sticking it, dashboard, work)
 Overuse

6. Angles that effect the knee
 Q angle
 Patellar glide
 Patellar tilt
 Pes planus
 Recurvatum of the knee
 Muscular Imbalance

7. Q angle

8. Q angle

9. High q angle “rubbing”

10. High q angle rubbing

11. Rubbing leads to friction

12. Chronic friction = Edema/fracture
weeks

13. Edema on edema rubbing =
Chondral fracture
Months
+ cutting

14. Pes planus (pronation)

15. Pes planus = “flat feet”

16. Pes planus = “fallen arches”

17. Pronation “fixes” alignment

18. “Fixes”
 Low dye tape
 Endurance to
intrinsic foot
muscles
 Stabilizing running
shoes
 Orthotics
More next time…..

19. Recurvatum
 Patellar instability
 No control to motion
 Patellar sledge hammer (outside straight)

20. Muscular Imbalance
 Quads
 ITB
 hams

21. Dominant muscle wins

22. Sinding Larsen Johansson

23. Osgood Schlatter Disease

24. Osgood MRI

25. Patellar Tendonitis

26. Fixes
 Irritation to the articular cartilage
 Sinding Larsen Johansson
 Irritation to the patellar tendon (mistaken)
Px: It hurts when I do this……
Doc: So don’t do this…….
-Henny Youngman

27. Acute fix “The Saguil Approach”
 Ice 10 min/hour for 24-48 hrs
 Antiinflam
 Steroid
 Acupuncture
 Immobilization-”relative rest”
 Diet/supplement
 Aspiration/compression

28. -Role of ICE
 Vasoconstriction for 24-48 hours
 Blood vessel develops rebound vasodi
 Prevents influx of white blood cells
 Can “choke off” broken vessels
 WATCH FOR FROSTBITE!

29. -Antiinflammatories
 NSAIDS
 Stop the cascade of inflammation
 Help with decreasing prostaglandin
 Dull pain (relafen)
 WATCH FOR ULCER!
 WATCH FOR KIDNEY AND HEART DS!

30. -Steroids
 No, no roids!
 Catabolic
 Works fast for BIG suffering
 Oral or injectable
 WATCH FOR INSOMNIA AND SUGAR!

31. -Acupuncture
 3000 years old and still the same
 Can work on the opposite knee
 Uses meridia (chinese medicine)
 Uses trigger point and electric stim
(western medicine)
 CAN”T HURT, WATCH FOR FALLING
TREES

32. -RICE
 Rest
 Ice
 Compression
 Elevation

33. -Diet
 Dr Weil’s Antiinflammatory Diet
 Fruits and veggies
 Fish
 Omega 3
 Turmeric
 Glucosamine sulfate
 Low GI carbs

34. -Big Needle
 Aspiration for pain relief and ROM
 Diagnostic and therapeutic
 Steroid injection
 Prolotherapy
 Trigger point therapy

35. Long term fix
 Muscle training
 Orthotic
 Shoe evaluation
 Training method/surface
 Soft tissue mobilization
 Flexibility
 surgery

36. -Muscle Training
 Sports medicine ortho/primary
 Physical medicine and Rehab
 Podiatrist
 Chiropractor, ND
 Sport specific trainer
 “Gifted” physical therapist
 Experienced running guru
 On line, dvd,

37. -Dr Robert Weil
 Sports medicine podiatrist
 Ortho group with podiatric
 “Gifted” physical therapist
 Dick Ponds “guys”
 Buy and try

38. -Soft tissue mob - flexibility
 Yoga
 Massage therapy
 “Gifted” physical therapist
 Raike therapist
 Reflexologist
 acupuncture

39. -”Heal with Steel”
 Sports medicine orthopedic surgery

40. Thanks
 www.herbal411.com