Knee Pain

Our Approach to Treatment of Knee Pain

Our treatment of knee joint pain begins with complete ultrasonographic and dynamic evaluation of the kinetic chain of the lower extremity by technological Gait analysis which includes the hip and the foot. The hip and foot misbalance directly affects the knee since foot placement and hip alignment determines movement at the knee. In such cases, repairing movement dysfunctions of hip and foot will reduce stress overload to the knee and encourage its tissue healing. This strategy is combined with direct treatment of the injured knee tendons and other affected tissues. Avoidance strategies in the daily activities are introduced at that time to minimize habitual harmful movement in the affected limb. Patient-specific home exercise programs are designed and trained to secure conditions for optimum healing.
At Dynamic Neuromuscular Rehabilitation we use variety of diagnostic and treatment methods to deal with all types of knee pain. We treat multitudes of disorders ranging from various overuses in the sports activities, post surgical ACL rehab, to treatment of arthritic knees. We are proudly the first outpatient Gait analysis lab in New York City.
The key to our successful treatment lies in our expertise in conservative orthopedics, use of diagnostic modalities such as real time ultrasound, Gait analysis, surface EMG and, most importantly, using functional movement diagnosis.
We use variety of treatment methods including above mentioned approaches and techniques, surface EMG biofeedback training, force plate video feedback training, ESWT (Extracorporeal Shockwave Therapy) for degenerating tendons, and Myofascial release techniques to eliminate myofacial trigger points.
We also use vibration therapy and a revolutionary knee rehabilitation technology AlterG, the gravity reduced treadmill.
We offer the most advanced and comprehensive treatment for variety of running knee injuries, patella-femoral pain syndrome and ACL post surgical rehabilitation.

Knee Conditions We Treat

  • Meniscus Tears
  • ACL/PCL Tears
  • MCL/LCL Sprain/Strain
  • Patellofemoral Syndrome
  • Anterior knee pain
  • Patella-tendinitis(jumpers knee)
  • Prepatellar Bursitis
  • Pes Anserine Bursitis
  • Chondromalacia patella
  • Illiotibial Band Syndrome
  • Peroneal neuropathy
  • Hamstring Tendinosis

Please check out our pages for the running gait labthe alter-g treadmillBiofeedback motor control training with real time force plate analysis, and shockwave therapy to see how these technologies can help you.

Various factors predispose people to developing pain in the knee, a frequent and severe musculoskeletal concern that affects all age groups. Most commonly the joint pain results from structural misalignments and muscle misbalance that occurs in the knee joint area or in the entire lower extremity.

Knee Joint

A computer-analyzed image of runner's knee that causes knee pain

Runner’s Knee

Knee joint is one of the more complex joints in the human body. Injuries to the knee joint are amongst the most common and understanding the anatomy of the joint is fundamental in understanding any subsequent pathology.
The knee is made up of four bones – the femur (thigh bone), the tibia (shin bone), fibula (outer shin bone) and patella (kneecap). The main movements of the joint occur between the femur, patella and tibia. The joint-forming end of each bone is lined with the articular cartilage, which is designed to decrease the frictional forces between the bones.
The joint capsule wraps tightly around the entire knee and provides support and nourishment to the joints structural components. Intra-capsular structures include the infrapatellar fat pad and bursa, both functioning as cushions against the exterior forces on the knee.
Strong surrounding ligaments further ensure the stability of the knee. Each ligament has a particular function in helping to maintain optimal stability in various positions:
Medial Collateral Ligament (MCL) runs between the inner surfaces of the femur and the tibia. It resists forces acting from the outer surface of the knee.
Lateral Collateral Ligament (LCL) travels from the outer surface of the femur to the head of the fibula. It resists impacts from the inner surface of the knee.
The Cruciate ligaments (anterior and posterior) form a cross in the middle of the knee restricting movement of the structural elements of the joint.
Two crescent-shaped menisci line the inner and outer edges of the tibia bone. They act as shock absorbers for the knee as well as allow for correct weight distribution between the tibia and the femur.
The two main muscle groups of the joint are the quadriceps and the hamstrings. Both play a vital role in moving and stabilizing the joint.
The structural misalignments of any of these elements lead to abnormal biomechanics , altered motor control and muscle misbalance around the joint. These factors ultimately lead to the disturbed tissue homeostasis, which eventually causes pain through wear and tear of the cartilage, tendons and other soft tissue structures.
In another scenario, altered tissue homeostasis leads to the hyper mobility or structural instability that eventually causes either repetitive trauma or a spontaneous traumatic event in which tearing of the ligaments, bone dislocations and even fractures can occur.
Compression is yet another common cause of the knee joint pain. In this type of dysfunction the tightening of the soft tissues around the joint due to muscle misbalance lead to the soft tissue contractures and fasciae adhesions that create abnormal pressure inside the joint.
Whatever the cause, the result is the ultimate outcome of any type of knee pathology osteoarthritis progressive degenerative condition in which the joint cartilage gradually wears away, exposing the bone underneath. Deprived of the protective cushioning, the bones surfaces grind against each other with every move, causing excruciating debilitating pain.

Knee Pain Physical Therapy

Our physical therapy approach combines traditional and innovative orthopedic and neuromuscular rehabilitation features, such as: gait evaluation, computer assisted rehabilitation environment (CAREN), and extracorporeal shockwave therapy.
Gait analysis tests show how your knee moves while walking in proper conditions. Gait analysis allows visualization of movement dysfunction beyond what is visible to human eye. Computer assisted rehabilitation environment (CAREN) can be used on its own or in combination with other physical therapy methods. This is a very progressive way of treatment and proudly presented in a unique way in our clinic. CAREN is especially effective in treatment of: front knee pain, ACL injury, meniscus injury and osteoarthritis.
For runners and athletes, besides gait and running analysis we provide state of the art test called return to sports and injury prevention. The advance technology used in this test combines force plate, high speed cameras and sophisticated software which allows analysis of forces absorbed by the knee during jumping and other high impact movements such as running and cutting. This system allows immediate real time feedback for correction and training. The obtained data allows objective information on risk for injury in the lower extremity. This system is also extremely useful in diagnosis and rehabilitation of non-athletic front knee pain.
ESWT (extracorporeal shockwave therapy) is a regenerative treatment for tendons as well as myofascial pain syndrome around the knee. ESWT stimulation therapy passes high frequency sonic wave to increase blood supply to affected area. Patellar tendonitis as well as hamstring tendonitis is very effectively treated by this modality. At DNR we always use the most comprehensive and individual approach for treatment of orthopedic or sports injury in the knee.



PREVENTING KNEE PAIN AND KNEE INJURY

  • Always warm up before exercising
  • Strengthen your hip muscles
  • Achieve balance in your thigh musculature by doing Pilates or Yoga
  • Train balance exercises
    1. Do not overdevelop your quadriceps muscle
    2. Keep balance between your quads and hamstrings