Hip & Knee

Your success in recovery from surgery depends on your willingness to work hard at home as well as with the therapist. Ideally, the surgery will take you a great deal of the way on the road to recovery, and then you and your therapist can work together to make the recovery the best possible. Our team at VTFC is committed to having the experience and knowledge necessary to provide you with a successful post-surgical rehabilitation experience and getting you back to doing what you do best.

Click here to review full recovery protocol for post-surgical rehab

Iliotibial Band (ITB) Syndrome describes pain in the lateral (“outside”) region of the hip, thigh, or knee. The ITB is a long tendon which runs from a muscle called the Tensor Fascia Lata (TFL) in the pelvis all the way down to the tibia (lower leg bone), crossing the knee joint. The ITB runs down the side of the thigh and you can feel the tendon on the outside of your thigh when you tighten your leg muscles. At the knee, the ITB crosses over a part of the femur. To protect the ITB from rubbing on the bone, there is a bursa. A bursa is a fluid-filled sac that cushions body tissues from friction. These sacs are present where muscles or tendons glide against one another.

Have you ever been told or noticed that one of your legs is a bit longer than the other?  Do you have incidences of lower back pain?  These two things could be related.  Most individuals have a small difference in their leg lengths.  For some, the discrepancy is small and negligible and will not be a contributor to lower back pain.  This is usually the case for people if their leg length is less than 5 millimeters.  However, a difference of leg lengths greater than 5 millimeters (1/4 inch) can contribute to lower back pain. If you have a leg length difference of greater than 9 mm, then you have a 6X greater likelihood of having an episode of lower back pain.

The anterior cruciate ligament is one of 4 knee ligaments that connect the upper leg bone (femur) with the lower leg bone (tibia). The ACL stabilizes knee movement by:

• Preventing the lower leg bone from sliding forward or turning inward when the leg is straight
• Preventing the knee from being stretched or straightened beyond its normal limits {hyperextension}
• Supporting the knee ligaments that keep the knee from bending sideways

ACL injuries are primarily non-contact and occur in sports that involve cutting, pivoting, jumping or landing. Athletes will often feel a tear or hear a ‘pop’ when they’ve injured their ACL, accompanied by small fractures or bone bruises at the top of the tibia. Pain, swelling, and loss of normal function are typical symptoms of an ACL injury.

The collateral ligaments are commonly injured parts of the knee. Ligaments are tough bands of tissue that connect the ends of bones together. There are two collateral ligaments, one on either side of the knee, that limit side to side motion of the knee. The medial collateral ligament (MCL) is found on the side of the knee closest to the other knee. The lateral collateral ligament (LCL) is found on the opposite side of the knee. If an injury causes these ligaments to stretch too far, they may tear. MCL tears are more common than LCL tears.

The meniscus is a commonly injured structure in the knee and can occur in any age group.

There are two menisci between the shinbone (tibia) and thighbone (femur) in the knee joint. The C-shaped medial meniscus is on the inside part of the knee, closest to your other knee. The U-shaped lateral meniscus is on the outer half of the knee joint. These two menisci act like shock absorbers in the knee. Forming a gasket between the shinbone and the thighbone, they help spread out forces transmitted across the joint. Did you know that walking puts up to two times your body weight on the joint and running puts about eight times your body weight on the knee? As the knee bends, the back part of the menisci takes most of the pressure. The menisci adds stability to the knee joint. They convert the surface of the shinbone into a shallow socket, which is more stable than its otherwise flat surface. Without the menisci, the round femur would slide on top of the flat surface of the tibia.

The patella, or kneecap, can be a source of knee pain when it fails to function properly in people of all ages. Alignment or overuse problems of the patella can lead to wear and tear of the cartilage behind the patella. This produces pain, weakness, and possibly swelling of the knee joint.

Several different problems can affect the patella and the groove it slides through in the knee joint. The patella (kneecap) is the moveable bone on the front of the knee. This bone has two tendons which attach onto it, the quadriceps tendon on top of the patella and the patellar tendon below the patella. Tightening of the quadriceps muscles on the front of the thigh pulls on the quadriceps tendon, which will cause a pull on the patella, and thus the patellar tendon. This action causes the knee to straighten. The patella acts like a fulcrum to increase the force of the quadriceps muscles. The underside of the patella is covered with articular cartilage, the smooth, slippery covering found on joint surfaces. This covering helps the patella glide (or track) in a special groove made by the thighbone, or femur. This groove is called the femoral groove.

Two muscles of the thigh attach to the patella and help control its position in the femoral groove as the leg straightens. These muscles are the vastus medialis obliquus (VMO) and the vastus lateralis (VL). The VMO runs along the inside of the thigh, and the VL lies along the outside of the thigh. If the timing between these two muscles is off, the patella may be pulled off track.

Osteoarthritis (OA) is a common problem for many people after middle age. OA is sometimes referred to as degenerative, or wear-and-tear, arthritis. OA commonly affects the hip joint. Articular cartilage is the smooth lining that covers the surfaces of the ball-and-socket joint of the hip. The cartilage gives the joint freedom of movement by decreasing friction. The layer of bone just below the articular cartilage is called subchondral bone. The main problem in OA is degeneration of the articular cartilage. When the articular cartilage degenerates, or wears away, the subchondral bone is uncovered and rubs against bone. Small outgrowths called bone spurs or osteophytes may form in the joint.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum and forms a deep cup that surrounds the ball of the upper thigh bone (femur), or femoral head. Thick muscles of the buttock at the back and the thick muscles of the thigh in the front surround the hip. The greater trochanter is the large bump on the outside of the upper end of the femur. This bump is the point where the large buttock muscles that move the hip connect to the femur. Where friction occurs between muscles, tendons, and bones, there is usually a structure called a bursa. A bursa is a thin sac of tissue that contains fluid to lubricate the area and reduce friction. The bursa is a normal structure. The body will even produce a bursa in response to friction.

Osteoarthritis (OA) is a common problem for many people after middle age. OA is sometimes referred to as degenerative, or wear-and-tear, arthritis. OA commonly affects the hip joint. Articular cartilage is the smooth lining that covers the surfaces of the ball-and-socket joint of the hip. The cartilage gives the joint freedom of movement by decreasing friction. The layer of bone just below the articular cartilage is called subchondral bone. The main problem in OA is degeneration of the articular cartilage. When the articular cartilage degenerates, or wears away, the subchondral bone is uncovered and rubs against bone. Small outgrowths called bone spurs or osteophytes may form in the joint.

Muscle and tendon injuries of the hip can happen to anyone for a wide variety of reasons.  Tendons are how our muscles attach to bone and therefore muscle and tendon injuries tend to happen together.  Most often injuries occur either from an overuse type of strain or a direct contact injury in which you have an isolated problem.  There are a lot of muscles and therefore tendons within our hip that all work together to produce very strong movements such as walking, standing up, or going up/down stairs.

Hip impingement is relatively common with studies estimating 15.9% of asymptomatic people have a cam type, 10.6% have a pincer type, and 3.1% have a combined type.  These are the general categories of impingement with others having no bony abnormalities but still having symptoms of impingement.  Hip impingement is generally noticed with end range of motion into flexion like a deep squat or trying to bring your knees towards your chest.  Pain is typically felt in the hip joint during these movements and can become increasingly painful over time.

Total hip replacement surgery is one of the most common and successful orthopedic surgeries.  Over 300,000 people undergo total hip replacements in the United States per year.