Due to the design and anatomy of the knee, as described above, effective treatment focuses on decreasing / eliminating any excessive lateral and rotational stresses that exist, thus facilitating ‘straight-line’ mechanics of the knee. Identifying and treating underlying factors that drive these stresses, underpins the treatment process. Poor muscle control of the pelvis and hip joint region, when in single limb support, often manifests as a Trendelenburg sign and/or inward rotation of the knee, and is corrected with specific exercises to improve ‘brain to muscle’ activation and strength of the gluteal musculature. Subtle changes to foot shape and structure (something we refer to as skeletal drivers) such as external tibia torsion, forefoot / rearfoot varus, and Hallux limitus tend to drive excessive pronation of the foot resulting in excessive rotation of the shin bone and therefore the knee. Gait analysis performed by an experienced Podiatrist is required to identify these issues and to determine whether a combination of orthotic devices or running shoe advice is needed.
A comprehensive rehabilitation programme should also include strengthening exercises for all lower limb musculature (performed within a framework of sound lower limb alignment), core stability training, proprioceptive exercises, and sport / function specific exercises.