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Painful Knee cap

I have painful and noisy knee cap! Do I have arthritis?

Many people who suffer with knee pain, complain of a nagging pain that seems to arise from behind the knee cap . They don’t recall any precipitating injury, only that the knee has go sore and, now, affects daily activities such as climbing stairs crouching or sitting with the knees bent for long periods and sometimes it develops this grinding noise. 

painful knee cap

The knee is composed mainly of 2 joints: one between the shin bone and thigh bone (tibio-femoral joint) and another one between the knee cap and the thigh bone (patella-femoral joint).As the knee cap moves quite freely when the knee is straight, the patella-femoral joint relies on structures that stabilise the knee cap centred in

the femoral groove as it moves up and down when you bend and straighten the knee (i.e. going up the stairs, squatting).

painful knee cap

Sometimes, due to imbalances on these structures, specific weakness and poor stability in the hip or ankle joints or even an imbalanced workout at the gym, this tracking of the kneecap on the thigh bone, just behind it, goes wrong and you can hear and feel the friction, which will sooner or later lead to discomfort in the front of the knee. As demonstrated, this tends to be purely dysfunctional, therefore an appropriate course of Physiotherapy will help you normalising the function and balance of the knee and other lower limb structures in order to improve your symptoms .

Now, answering the question, there may be some wear and tear (i.e. osteoarthritis) of these surfaces that slide on each other, but it doesn’t mean your pain arises from it, as even people with some level arthritis tend to respond well to Physiotherapy.

Image on the left - different components of muscles ac on the kneecap3

Image on the right - - Illustration and MRI image demonstrating outside maltracking of the kneecap and increased contact area (red arrows)4

1. Smith B, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of
patellofemoral pain: a systematic review and meta-analysis. PLoS One. 2018; 13: e0190892. 10.1371/journal.pone.0190892 PMID: 29324820
2. Petersen W, Ellermann A, Gösele-Koppenburg A, et al. Patellofemoral pain syndrome. Knee Surg
Sports Traumatol Arthrosc 2014; 22(10):2264–2274
3. Kapandji ,I.A., The Physiology of the Joints, Volume 2: Lower Limb, 5Ed, Churchill Livingstone -
4. Norris, R. & Massey, D. (2018), Patellar Dislocation, The Knee Resource [WWW document] [accessed 9 th November 2018]


Tennis Elbow

Tennis Elbow? But I’ve never played tennis!

The elbow is the joint that, in simple terms, allows us to bring things towards us or to take them away from us.

However, it is in the elbow that the important muscles of gripping and some important fine dexterity hand movements attach. Therefore, depending on our daily activities, occupation and hobbies, whether they require holding a racket and channelling all the top spin you can to win the set point, painting the baby’s room or taking on that DIY project that has been sitting in the shed for a few months, these points of attachment can become irritated.

Tennis Elbow Lakky Physiotherapy Epicondilitis (when acute) and epicondylosis (when chronic) describe this irritation process that occurs on the outer bony prominence of the elbow (epicondyle) when there is overload or overuse of these muscles.
To manage this condition, it is very important to understand what has caused the overload (i.e. change in activities due to a new project, taking on some new sport that requires gripping, repetitive movements, repetitive and prolonged use of a keyboard, etc) and adapt the way we do it (swap between hands, give periods of rest). If the overload has caused lingering muscle tightness, sensible and specific stretches of these muscles and respective attachment may be useful to improve the symptoms. Apart from advice, Physiotherapy can help to address the symptoms and the underlying cause with bespoke and oriented exercises, along with manual therapy techniques.

More chronic conditions, usually with occupational causes, may fail to heal with the above approach due to the daily repetitive load put upon these structures over many years. If this is the case, there is recent evidence for the application of Extracorporeal Shockwave Therapy in the treatment of these stubborn cases of tennis elbow.

The good news is that all of these approaches are available for you, here at Lakky Physiotherapy!

Picture: adapted from AAFP

Kane, S.F.; Lynch, J. H., Taylor, J. C., Womack Army Medical Center, Fort Bragg, North Carolina, Am Fam Physician (AAFP). 2014 Apr 15;89(8):649-657.
Lee JH, Kim TH, Lim KB, Effects of eccentric control exercise for wrist extensor and shoulder stabilization exercise on the pain and functions of tennis elbow, J Phys Ther Sci. 2018 Apr;30(4):590-594. doi: 10.1589/jpts.30.590. Epub 2018 Apr 20.
Wong CW1, Ng EY1, Fung PW1, Mok KM1, Yung PS1, Chan KM, Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy, Asia Pac J Sports Med Arthrosc Rehabil Technol. 2016 Nov 24;7:21-26. doi: 10.1016/j.asmart.2016.10.001. eCollection 2017 Jan


Dry needling to improve hamstring muscle flexibility in athletes

Hamstring muscle flexibility is important because it optimizes musculoskeletal function and may prevent injury to the muscle. The most common way of improving muscle flexibility is through stretching, which has been shown to bring about viscoelastic and neurophysiological changes in the muscle.

In the clinical setting, acupuncture is routinely used to treat myofascial trigger points, which are commonly found in tight muscles. The aim of this study was to investigate whether the acupuncture technique referred to as superficial dry needling could improve hamstring muscle flexibility.

The literature reports that the hamstring is the most commonly injured muscle during sporting activity (O’Hora et al. 2011). Hamstring muscle flexibility is considered to be important in preventative and clinical rehabilitation programmes (Schuback et al. 2004; O’Hora et al. 2011).
Stretching exercises are recommended on the basis that they may prevent injuries (Schuback et al. 2004; O’Hora et al. 2011), improve athletic performance (Thacker et al. 2004), and improve muscle and joint flexibility (Thacker et al. 2004).

Flexibility varies between individuals, and it has been suggested that muscles spanning more than one joint are more at risk of injury (Davis et al. 2008).

The acupuncture technique known as dry needling is commonly used to treat myofascial pain and dysfunction (Baldry 2002a, b; Huguenin 2004). It is known as “dry” needling because no substance is injected (Baldry 2002a).

Acupuncture point selection:


Acupuncture Point Selection

Bladder (BL) 37 was selected as the acupuncture point employed in the present
study. In traditional Chinese medicine, the indications for using BL37 are sciatica, low
back pain, occipital headaches, and paralysis and numbness of the lower extremities (Ding 1991).

Bladder 37 was chosen because of its location over the hamstring muscle, and also because
it shows some correlation with the common MTPs of the hamstrings described by Travell & Simons (1992).

Acupuncture technique:
The acupuncture technique known as superficial dry needling was used.

The results of this research provide statistically significant evidence to support the use of this technique to improve hamstring muscle flexibility with stretching.


Bradnam-Roberts L. (2007) A physiological underpinning or treatment progression of Western acupuncture. Journal of the Acupuncture Association of Chartered Physiotherapists 2007 (Autumn), 25–33.

Baldry P. (2002a) Management of myofascial trigger point pain. Acupuncture in Medicine 20 (1), 2–10.

O’Hora J., Cartwright A., Wade C. D., Hough A. D. & Shum G. L. K. (2011) Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstrings length after a single session. The Journal of Strength and Conditioning Research 25 (6), 1586–1591.


Benefits of Kinesiotape for Sub acromial impingement

The shoulder is a true engineering masterpiece, which allows significant range of movement along with the possibility of high speed, which is very demanding to accomplish if we think of the stability required to combine these two factors.

Thus, the shoulder movement is the result of a combination of 4 (some people defend 5) joints coordinated movements. The main joint, the one we call the shoulder joint is between humerus (upper arm bone) and the scapula (shoulder blade), but the scapula itself glides on the thorax and it can be the source of some of your shoulder pain.

Shoulder impingement (medically known as sub acromial impingment) is a conflict of space that occurs under the acromion which is the hook of the scapula forming the ceiling of the shoulder, just above the top of the humerus. Between these two structures there are 2 structures: part of the rotator cuff tendons (supraspinatus mainly) and the sub acromial bursa, a sack of fluid that is meant to reduce the friction between the supraspinatus and the acromion.

If you follow this reasoning, these structures can be in a conflict of space if the acromion and humerus are closer together or if the bursa or supraspinatus get swollen, requiring more space to be comfortable.

As raised above, one of the reasons that may lead to this problem is a poor posture of the scapula that is tilted forward leading to a depression of the acromion, pinching and impinging the structures when the arm moves, especially upwards, to reach up.

Five research articles over the last 7-10 years show that ktape or kinesiology tape, a hypoallergenic tape with elastic properties may be used to improve and correct the position of the shoulder blade, offloading the impinged structures.

It is suggested that, instead of a physical correction with the ktape, the effects are due to an input provided by the sensation of having tape stuck to the skin that will change the muscle control and consequently the shoulder blade position, towards the correct position, facilitating the normal movement and reducing pain.
Lee JH, Yoo WG, Effect of scapular elevation taping on scapular depression syndrome: a case report, J Back Musculoskelet Rehabil. 2012;25(3):187-91

Shaheen AF et al , Rigid and Elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. J Electromyogr Kinesiol. 2015 Feb;25(1):84-92

Van Herzeele M et al, Does the application of kinesiotape change scapular kinematics in healthy female handball players?, Int J Sports Med. 2013 Nov;34(11):950-5

Luque-Suarez A, et al, Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial., Man Ther. 2013 Dec;18(6):573-7

Kim BJ, Lee JH., Effects of scapula-upward taping using kinesiology tape in a patient with shoulder pain caused by scapular downward rotation, J Phys Ther Sci. 2015 Feb;27(2):547-8.