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What can I do for my knee pain

 

Summer outdoor fun can often lead to the occasional aches and pains. Not every pain is worrisome and in non pandemic times you probably knew how to change your exercise routine to manage the occasional pain. But with gyms just starting to re-open and apprehension about in person classes, we’re getting a lot of questions asking about how to self manage knee pain.  From self diagnosing to icing and bracing, read on to learn more about how to manage your knee pain.

 

What caused your knee pain?

Your injury may have been traumatic with a memorable impact during a sport, training or awkward stumble. 

If you don’t recall an injury or painful event, then you may be experiencing a referral of symptoms from another area such as your ankle, hip or back. Weakness or stiffness of these areas may be overloading your knee. 

 

What does your pain feel like

Pain that feels like an ache is often being caused by muscle pain. Burning or stinging may be due to swelling or a nerve related symptom. Sharp and catching symptoms are often associated with injuries to structures within your knee. If your knee is locked, physically stuck either bent or straight, it can indicate that something is jamming the joint which could be cartilage fragments or a torn meniscus.

 

Where does your knee hurt?

The location of your pain will often give a good indication of what your  problem is. Joint pain can often refer down to the inner or outer calf. Local inner or outer knee pain that is the result of a trauma can be either your medial or lateral collateral ligament respectively. Pain at the front of the knee can be knee cap pain, the patellar tendon or an IT band pain.

 

What bothers your knee pain.

Knee cap pain often hurts when kneeling or sitting with your knees bent and feels better to sit with the knee straight. It can also be bothered with squatting or on stairs. 

Localized front knee pain below your kneecap is often the patellar tendon or a small inflamed fat pad and may have been related to ramping up your activity or training too quickly.

Pain from swelling, arthritis and meniscus often hurts with putting weight on your knee or pivoting on your knee.

 

Is your knee swollen?

Swelling will often be seen or felt as a bump in the back of the knee and with filling in of the dimples at the front of your knee.

Hot swelling will often indicate that you’ve injured something with a rich blood supply. The faster the swelling the more richly vascularized the tissue. That’s why an ACL injury or fracture will instantly swell but a meniscus injury may not bother you immediately. 

If your knee feels swollen but but doesn’t look swollen and if your knee isn’t warm you may be feeling mild generalized swelling for knee arthritis. 

 

 

Were you able to continue your activity?

When severe ligament or structural injuries have occurred, your symptoms will come on quickly and you shouldn’t have been unable to continue your activity. These include traumatic meniscal injuries, ligament injuries (MCL, LCL or ACL).

 

 

Have you had any change in your medical history or activity level in the past few months?

Your knee is a joint that does well with controlling bending forces. Problems tend to arise when it isn’t getting help from other areas that control twisting. This can include your foot or ankle, hip or back. Imbalanced exercise routines, previous pains in these areas or a more sedentary period of time can contribute to pain at the knee where no injury is recalled.

Some medications such as antibiotics can have the potential side effect of tendon pain or rupture.

 

 

What can I do for My Knee Pain?

If you have a swollen acutely painful joint then resting from the aggravating injury and icing are the first steps. Cross training with a non weight bearing exercise like swimming or cycling can help you maintain your conditioning.

 

What brace can I use for my knee pain.

If a traumatic ligament injury occurred, a knee joint brace with “stays” on the inner and outer part that control your medial and lateral mobility will help to reduce your pain.

Pain with running that comes on gradually and is above or below the outer knee can often be managed in the short term with an IT band strap that is applied above the area of pain.

A patellar tracking brace can help with your kneecap pain.  However, compression of the brace on your knee cap may cause an increase in pain so make sure that the brace feels like it’s helping.

A patellar tendon brace can often help to reduce the pain you’re having from a painful patellar tendon. 

Arthritic knee pain will often feel better with a general compression type of brace. These braces won’t give you support but help to retain heat and can help with mild symptoms. 

If your arthritic pain isn’t being helped with this type, braces that can decompress the painful area of your knee are the next step.  These “offloading” braces come in different models and price ranges depending on your need.  If you need help with one of these options, our team of physiotherapists can measure you and guide you towards the best bracing option for you.

 

Related Posts:

 

FAMILY PHYSIOTHERAPY, ASSESSING AND TREATING PERSISTENT INJURIES AND PAINS FOR THE RESIDENTS OF THORNHILL, MARKHAM AND VAUGHAN

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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I had the opportunity to sit down with staff physiotherapist Marven Bani to talk with him about his recent knee surgery experience and how it’s affected his health and fitness goals for the year.  

 

Q: I understand that you had a physically challenging start to the new year recovering from your ACL surgery. How did you first injure your ACL?

 

A: The ACL tear happened on the basketball court going for a lay up about 4 years ago, I landed on my left leg and had a sudden giving out of the knee, heat a loud pop and immediately knew that my ACL tore.  
Q: So why did you choose to manage the first injury without surgery?
click the image for our blog on meniscal tears

A: Based on a lot of research, initially I was hesitant since there was a lot of evidence that showed you were more prone to arthritis later on in life if you surgically repair an ACL and meniscus. However, I found my knee was giving out more playing sports (basketball) and eventually tore my meniscus playing through it. Once I got the locking due to tearing my ACL and wanted to continue playing basketball, I felt it was time to get it done in order for to me to play sports.  

 

Q: Makes sense. How did you make sure that you came out of the surgery in the best shape possible? A: I started working on a prehab program 6-8 weeks prior to surgery to ensure strength of specific muscles and build stability for both knees to help my recovery and limit atrophy post ACL reconstruction. It’s important to make sure the other knee is strong enough to take all the extra load during the recovery process. Following a healthy diet plan was essential to optimize recovery and going to the gym was crucial to build consistency.     Q: That’s great, and we can see you still putting the work in at the clinic.  With the surgery out of the way what are your fitness goals for the year A: This year my fitness goals is to lose 10 lbs in 3 months by going to the gym 5 times per week, following strengthening and cardio program and of course a strict diet. Later this year; I want to return to playing basketball by November.  In order to make a successful comeback I need to ensure full strength and stability of my left knee prior to returning to avoid re-injury.    
A: Yeah I’ve been increasing my time on the bike (built it up to 20 mins), doing stairs (ensuring no hip hike), speed walking on the treadmill, I’ll be progressing it to jogging on the treadmill, eventually more sport specific conditioning (focused on basketball).
 
 
Q: Having gone through this process, has it in any way changed your approach in managing sports injuries or post surgical patients?
 
A: Yes totally, I have more of an appreciation for our physiotherapy field, going through the process of being a patient is complete eye opening and it’s great to realize the power of rehab on recovery post surgery. Having been treated by my colleagues at the clinic and seeing results is very rewarding. The process of rehab does take discipline, hard work and patience! I have developed a passion for treating and assessing knees.  I also find that I’m able to relate to patients that have gone through the process.
 
 
and

 

 

Marven Bani

are two of the physiotherapists at Family Physiotherapy helping you recover from your knee injuries and helping you achieve your fitness goals.
 
 
 
 
   

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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Tennis Injuries

When tennis injuries are discussed, the term tennis elbow usually comes up.  However, at higher levels of the sport, elbow injuries aren’t the most common.  A study published in the British Journal of Sports Medicine reviewed the incidences of injuries and their locations in professional tennis players.  The injury incidence rate is summarized in the graphic below.

 

Looking for More?

Knowledge is power! So our team spends their down time putting together posts ranging from common injuries to injury prevention.  Some of the topics related to these injuries have included:

 

Not sure where to start?

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

In a long season, injuries are sure to add up.  Have you ever wondered what the most common basketball injuries are?  We’ve compiled the stats.  If one of these injuries has you off of your game, speak with one of our physiotherapists to get your game back!

 

 

 

 

 

 

 

 

 

 

 

 

 

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Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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Achilles Tendon Tears

By Susan Leung, PT

First, Kobe Bryant tears his Achilles tendon in 2013. And just a few months ago, it was announced that Marcus Decousins had done the same. What is happening to all these NBA stars? What is the Achilles tendon? Is there something that can be done to prevent these terrible injuries if I’m a basketball player? Well, you have just landed yourself on the right blog. Prepare to be enlightened.  

The Achilles Tendon

We have talked about tendons in the past, click here for a refresher on tendons.

We have a few calf muscles: the gastrocnemius and soleus. The gastrocnemius muscles are primarily responsible for plantarflexing the ankle (pointing the ankle down into the ballet pointe position) with the knee is straight, and secondarily helps to bend the knee. The soleus, on the other hand, is found deeper to the gastrocnemius; it primarily causes plantar flexion of the ankle while the knee is bent, and secondarily helps to stabilize the knee. The Achilles tendon itself can absorb and store potential energy, which can later get released to help us perform plyometric movements. And since basketball is such a fast-paced sport with a lot of lateral cutting, jumping, and quick sprints up and down the court, it’s no wonder why so many basketball players end up with ankle and Achilles tendon injuries.

Individuals who have Achilles tendonitis or tendonosis are more likely to develop either a partial or complete Achilles tear. Check out our previous blog post on tendonosis and tendonitis if you are unfamiliar with said terms.

 

Preventing an Achilles Tear

There are a few factors which may increase ones’ risk of developing Achilles tendonitis – poor calf strength and ankle dorsiflexion range of motion (Mahieu & Witvrouw & Stevens & Van Tiggelen & Roget, 2006). Therefore, it may be wise to incorporate gastrocnemius and soleus strengthening exercises into your current strengthening routine if you’re looking to prevent an Achilles injury from occurring. Examples of these may include standing heel raises with the knees straight, as well as standing heel raises with the knees bent. The next progression would be to complete the exact same movement off a step to allow your heel to drop below the level of your toes. This allows for greater dorsiflexion to occur at the ankle joint, thereby creating more tensile stress along the entire length of the Achilles tendon. Such stresses will cause microtrauma within the tendon itself, which will later manifest itself as a stronger tendon. Please note that this eccentric strengthening approach may be particularly useful for someone who is in the subacute or chronic phase of heeling.

Clinically Diagnosing an Achilles Tear

If you have a full thickness Achilles tendon tear, the above-noted exercises will not be appropriate for you. Most individuals may often recall hearing loud ‘pop’ at the time of injury, followed by the inability to bear weight or rise-up on their heels during gait. The Thompson test is often used to help diagnose a tear, where the patient is laying on the stomach and we squeeze the calf to see if the ankle goes into a downward motion. If the ankle does not move at all, then the likelihood of a tear is increased.

Therefore, it is important to seek timely care to resolve your Achilles pain before it manifests to become a full-blown tear. You may not want to procrastinate on this one if you play sports that involve a lot of quick bursts of movement. If you have already tried these exercises and still experiencing symptoms in the Achilles tendon, then book an appointment and let us get you back to your usual self!

 

Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

References

Mahieu, N. N., Witvrouw, E., Stevens, V., Van Tiggelen, D., & Roget, P. (2006). Intrinsic risk factors for the development of achilles tendon overuse injury. The American Journal of Sports Medicine. Available at: http://journals.sagepub.com/doi/abs/10.1177/0363546505279918

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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Form Is King

By Chris Chee, PT

There’s more to exercise than repetitions

Exercising provides us with numerous benefits; they can make us stronger, make us faster, make us more flexible, give us more energy, and help with pain to name a few. But to get the most out of our exercises they need to be performed correctly. An exercise performed improperly will not give us the benefits we are looking for but more importantly can lead to injury.

Compensating is a common cause of performing an exercise improperly as your body is trying to use areas that are not the primary targets due to a lack of strength and/or mobility in other areas. If you have ever done an exercise and not “felt it” in the areas you expect chances are looking at how you are performing the exercise, or your form, would help to address this.

 

Squats are a common complaint

As an example, if you have ever done a squat and felt mostly your low back tightening up and not much happening in your hips and thighs, correcting your form can help. Some common compensation patterns that we might see with squats include: rounding the shoulders forward, flexing through the low back, tucking your tailbone underneath you, having the knees buckle inward, and starting the squat by flexing through the knees instead of the hips.

Can you spot the squat errors? It’s not always a matter of powering it up or engage the glutes

Form isn’t always just “stick your chest out”

If you’ve been trying to be conscious of your form and are not feeling your exercises in the appropriate location or if you are experiencing pain with an exercise, it’s likely that you may have muscle imbalances or joint restrictions that are getting in the way.  In these cases, the common cues of “stick your chest out” or “engage your abs” may not be appropriate for you.

 

Prehab is more cost effective than Rehab

Addressing the difficulty before the injury is usually much more cost effective than waiting for an injury to develop.  If you have already tried to be conscious of your form and are not seeing results the next step should be to consult with a physiotherapist that has experience in assessing sports injuries.  In addition to the manual, or hands on, treatment that you receive, our physiotherapists are well trained to assess posture and form and come up with an appropriate exercise plan to help you achieve your goals. So whether you have been working out regularly, are looking to get back into a regular routine again, or are looking to start working out, the team at Family Physiotherapy is ready to help you achieve your health and fitness goals!

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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Climbing to the top of your health: Elbow Talk

By Susan Leung, PT

Rock Climbing Injuries

Rock climbing has gained immense popularity over the past few decades. Last year, it was announced that rock climbing will be featured as a new Olympic sport in the upcoming Tokyo 2020 Olympic Games. This is an exciting time for both novice and expert climbers alike! But with every sport, there are risks. The most common injuries sustained in this sport include those affecting the shoulder, elbow and fingers. Studies have shown that more experienced climbers who are attempting harder routes and problems are more likely to develop injuries (Jones & Asghar & Llewellyn, 2008). That said, it is important to know when to keep climbing, and when to close that chalk bag to call it a day.

 

Rock Climbing Mistakes that lead to Injury

Can you recall how you felt a day or two following your first climbing experience? If you were like me, you would’ve felt as if your entire upper body had been run over by a massive truck (especially around the forearms). Most of us start off by “muscling it up the wall” using our biceps, constantly pulling in with our elbows when we should really be using more of our legs to push and ascend the walls. Overgripping is something that happens to all of us newbies. By gripping each hold for our dear lives, it gives us a false sense of security that if our foot were to slip, perhaps our arms would allow us to stay on the wall. However, not all of us have Spiderman’s genes, and the repetitive overgripping may later develop into an overuse injury that may prevent us from becoming better climbers. Depending on the type of hold that is present on the wall, you may want to try hanging your fingers and palms off it to decrease the amount of stress applied to your forearms, wrists, finger joints and tendons.

 

Rock Climbing and Elbow Pain

With all the repetitive gripping that is inherent to the sport, many rock climbers may develop what we call medial epicondylitis or medial epicondylosis (otherwise known as golfer’s elbow). Both conditions will cause pain along the inner part of the elbow and forearm. This is often noticed with gripping activities or lifting objects in a palm up position. These two conditions may sound quite similar, but will differ greatly in the way that they are managed therapeutically.

Medial Epicondylitis

Medial epicondylitis is an inflammatory condition whereby “itis” stands for inflammation in Latin. It affects the inside aspect of the elbow, where the muscles that are mainly responsible for gripping, transition to become a tendon (a rope-like structure). The tendon will eventually attach onto the medial epicondyle, which is a point on the arm bone. Since the actual tendon is actively inflamed, modalities and NSAIDs may be appropriate for use. A systematic review done by Hoogvlet et al. in 2013 found stretching and strengthening to be effective short-term relief (Hoogvliet & Randsdorp & Dingemanse & Koes & Huisstede, 2013).

Clinical treatment may include the use of ultrasound and acupuncture but should also focus on factors contributing to the injury including workspace ergonomics and muscle imbalances.

How this may affect your climbing

Early return to sport may:

  • prolong the inflammatory phase of healing to cause increased warmth, swelling, and point tenderness
  • hinder your ability to grip holds, and increase activation of your neck and shoulder musculature to compensate
  • initiate pain either immediately during, or shortly after your first climb

Therefore, consider taking a break from climbing, and spend your time cross-training instead! Try to chose activities that won’t involve too much repetitive gripping (e.g. ease off those pull-ups and deadlifts). You may want to opt for cardiovascular exercises to improve circulation, mobility work to remain loose and limber, and try resistance band exercises to target the shoulder girdle.

 

Self Treatment of Medial Epicondylitis

Ice packs can be used on the painful region for 10 minute on-and-off intervals, for 3-4 times in total.

Stretching the wrist flexors and extensors can also be beneficial.  This can be accomplished by keeping your elbow straight, try pulling your wrist up and hold for 30 seconds. Do the reverse by pulling your wrist down, and hold for 30 seconds. Repeat this 5-6 times. Now repeat the above with your elbow slightly bent.

Strengthen your rhomboids by having your arms straight in front of you to begin. Squeeze your shoulder blades to pinch them together nice and tight, and slowly pull your hands apart. Hold this for 5 seconds, and take at least 3-5 seconds to return to the starting position. Try this for 2-3 sets of 8-10 reps, or as tolerated.

 

 

Medial Epicondylosis

With medial epicondylosis inflammation is absent. This means that non-steroidal anti-inflammatory medications (NSAIDs), and the application of ice may not be of much benefit. Symptoms may begin more than a week after climbing.  Exercises that are aimed at lengthening and loading of the common flexor tendon will be appropriate during this stage of healing, such as eccentric wrist curls. Cervical and thoracic manipulation were also found to offer both short-term and mid-term relief as an adjunct therapy when combined with wrist and forearm mobilizations (Hoogvliet et al., 2013). Clinical treatment involves modifying the aggravating activities, specific strengthening emphasizing eccentric training, scar tissue mobilization/massage and functional training. Additionally, the use of proliferative therapies such as ultrasound therapy shockwave therapy and acupuncture may be considered to progress healing.

 

How this may affect your climbing

Early return to sport may:

  • cause adhesions to form around the muscle belly and/or tendon of the forearm extensors, secondary to repetitive strain
  • hinder your ability to grip holds (whether they be jugs or crimps)
  • initiate pain midway through your climb, near the end of your climbing session, or even the day following climbing

Therefore, consider picking routes or problems that are easier than what you normally attempt, and concentrate more on using more of your lower extremities. Traverse routes would be a great way to work on your technique and balance, without having to constantly use your maximal grip. So, stay away from dyno moves, and your body will love you for it!

 

Self Treatment of Medial Epicondylosis

Strengthening the weakened tendons is crucial to resolve your pain. Try holding a small dumbbell or a can of soup, and stabilize the forearm by resting it on top of a table. Slowly allow your wrist to drop, taking around 3-5 seconds to descend. Repeat 2-3 sets of 8-10 reps, or as tolerated. It is fine to feel a bit of pulling or discomfort around your elbow, but never pain.

Another eccentric training exercise for the forearm muscles is to use a bar with a weight. Place your hands around the handle bar, and slowly drop your wrist down using 3-5 seconds. Let the rope come completely undone, and drop the weight down on the floor to rearrange the rope back around the handle bar. Repeat 3-5 times, or as tolerated.

 

 

Don’t let Elbow Pain Limit You!

So, if you are currently suffering from an elbow injury (whether it be medial epicondylitis or epicondylosis), there are different treatment options and management techniques to help you feel better, stay better, and get you back to the crag with a smile on your face. Book an appointment to speak to one of our associates today!

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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id I Tear my Meniscus?

 By: Darryl Viegas, PT

 

Knee pain is a common presentation to physiotherapy clinics.  A common source of knee pathology presenting to physiotherapy clinics is a meniscal injury of the knee.  Injuries can result from sporting events, daily event or can even result from an unknown origin.  While surgery can be indicated for non healing and functionally limiting meniscal tears conservative management including physiotherapy to improve strength and proprioception can ensure that you regain your preinjury function and return to the day to day and sporting activities that you love to do.

Anatomy of the Meniscus

The meniscus (plural menisci) of the knee are cartilage crescents that attach to the broad upper surface of the tibia (shin) bone. The menisci are anchored to the top of the tibia but are still capable of small amounts of movement as the knee moves.  Every knee joint has two menisci, a medial and lateral meniscus.

The medial meniscus is found on on the inner portion of the knee (shown in blue on the accompanying image). The medial meniscus is more C shaped and at it’s periphery it has attachment to the medial collateral ligament (MCL).

The lateral meniscus is more “O” shaped and covers a larger amount of the tibia than the medial meniscus.  The areas where the meniscus do not form a complete circle known as the horns.  The anterior horn is towards the front of the knee and the posterior horn is at the back of the knee.

Seen from above, the menisci have a crescent appearance. However, since they are thicker towards the outer portions they also have a the appearance of a wedge.  The combination of the wedge and crescent shape give them a cup like shape that helps the very rounded end of the femur articulate easily with the flat shaped tibia.

Blood Supply to the Meniscus

At birth all portions of the menisci have a blood supply.  This continues for the first year and a half of life.  As we continue to age, the blood supply to the menisci reduces.  The outer third of the meniscus continue to receive a blood supply and the horns of the menisci tend to maintain a good blood supply.  The inner two thirds does not receive a blood supply.  This reduced blood supply limits the ability of the meniscus to heal from an injury.

 

Function of the Meniscus

The meniscus is has an important role in the properly functioning knee.  Some of these important role include:

Increasing Joint stability

The cup like shape of the meniscus improves the ability of the rounded end of the femur to match up with the flattened upper portion of the tibia.

Assist Proprioception

Some of the nerve receptors that have been identified in the meniscus are involved in sensory feedback.  It is thought that these receptors have a proprioceptive role, that is they give feedback on the subtle movements that are occurring at the knee so as to properly react and prevent injury.

Assist with transferring forces and shock absorption

When the knee is in an extended position, 60% of the load taken through the knee is absorbed through the meniscus.  When the knee is flexed, this percentage jumps to 90%. An intact meniscus also improves the shock absorption of the knee by 20%.

 

Injury to the meniscus

Meniscal injury is a common source of pain in men and women.  Injuries can occur throughout a person’s lifetime, however meniscal injuries tend to occur between with greater frequency between the ages of 11-20 in women and between 21-30 in men.

Sporting event tears are usually the result of loading forces, in a weight bearing position with rotational forces.    These traumatic tears are more common in younger populations.  This mechanism is not commonly seen in sporting events with a sudden stop and attempted change in direction as occurs in attempting to evade an opponent.  Sporting meniscal tears may or may not have contact occur at the time of injury.

Tears can also occur with non sporting movements such as squatting, and with nonactivity.  One studied showed that 32% of meniscal tears are sports related, 39% non sports related and 29% could not identify an injury that caused the event (Drosos 2004).  Some of these unidentified injuries may be associated with a degenerative tear of the meniscus.

 

Symptoms of a meniscal tear

The most common symptom with an acute meniscal tear is pain.  Mild swelling may be noticed, however since the blood supply to the meniscus is poor the swelling is not as quick to develop or as much as is seen with injuries to other structures such as with injuries to the ACL.  Occasionally there can be complaints of locking or grinding, but these are not as common.

 

Categories of Meniscal tears

Meniscal tears are named for the location and shape of the tears.  They can include:

  • Vertical tears (commonly traumatic)
  • Longitudinal tears (usually traumatic)
  • Radial (or transverse) tears
  • Horizontal tears (cleavage) more frequently seen in older patients
  • Complex (degenerative) tears (2 or more tear configurations)
  • Bucket Handle tears
  •  

Tears can also be identified by where they are located in the meniscus.  A tear to a part of the meniscus with a blood supply is often known as a red tear.  A tear in a non vascular region is often know as a white tear.

 

Exercise or surgery?

Not all meniscal injuries require surgery.

Degenerative tears are often treated and do well with conservative treatment which includes targeted strengthening, proprioception, and stretching techniques with progression towards functional activities.  The treatment of traumatic tears, often seen in sports injuries, starts off the same.  However, with continued improvement more sport specific training and drills should be included in treatment to prevent a recurrence of the injury.

Appropriate assessment by a physiotherapist that is trained in sports injury management and assessment should be performed to identify areas that may have contributed to the initial injury.  These can include past areas of injury to areas that perform or absorb rotational forces such as the thoracic spine and ankle, but should also include an appropriate strength and neuromuscular patterning of the hip and lumbar spine.

If pain and limited improvement in function persist, MRI is often indicated to determine the location and type of meniscal injury to determine which surgical intervention is required.

Even if surgery is indicated due to lack of progression, prehab of the painful knee becomes an important factor in a faster return to daily activities and sport.  One study showed that when comparing patients with degenerative meniscal tears that either received surgery or did not, the conservative (non surgery group) had better strength in short term and both groups achieved similar function and outcomes.  Surgical techniques often require the attempt to repair or remove the non healing tear.  Surgery to remove portions of the meniscus (meniscectomy) changes the knee’s ability to absorb forces which can lead to future dysfunction.  Benefits of surgery are often present for 1-2 years before harms of surgery are seen.

Exercise therapy and meniscectomy yielded similar results for patients with degenerative meniscal lesions on knee pain, function and performance but exercise theory was more effective on muscle strength in the short term

Exercise therapy was more effective than no exercise therapy on after meniscectomy on function.

 

What does that mean for you?

The first step after a knee injury should be to start appropriate management of the injury.  This should include a thorough physiotherapy assessment by a therapist with experience in assessing and treating sports injuries.  Initial treatment should include exercises to maintain conditioning level, improve underlying movement restrictions that may have led to the injury and local treatment for the knee itself.  As initial exercise are achieved, they should progress to include functional and sport specific exercises with the goal of returning you to your pre-injury level.

Related Posts:

 

Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References

Drosos GI, Pozos JL “The causes and mechanisms of meniscal injuries in the sporting and non-sporting environment in an unselected population” Knee 2004

Fox A., Wanivenhaus F. Burge A., Warren R. Rodeo S.  “The Human Meniscus: A review of Anatomy, Function, Injury and Advancements in Treatment”  Clinical Anatomy (2015)

Meserve, Cleland JA, Boucher TR “A meta-analysis examining clinical test utilities for assessing meniscal injury” Clinical Rehabilitation (2008)

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

Sports Injury Series: meniscal tears

 

 

Acute Injury

An acute sports injury usually occurs suddenly when exercising.  Acute injuries usually are associated with a mechanism of injury.  There is often a sudden and severe pain that is noticed.  Swelling is also often present.  The extent of swelling and how quickly it is seen depends on what type of tissue was injured.  Tissues with a good blood supply, such as bone, muscle and ligaments, will often swell more quickly than cartilage injuries which has a more limited blood supply.  Often the movement of the area is affected as well as a feeling of weakness.  In extreme cases visual deformities may be noticed in the affected area.  Examples of acute injuries include sprained ankles, a dislocated shoulder and a tear of the anterior cruciate ligament (ACL).

 

Chronic Injury

Chronic injuries happen after you play a sport or exercise for a long time.  Chronic injuries often present during the exercise or the activity.  An aching symptom is often described and there may be swelling observed or felt.  Chronic injuries generally are associated with symptoms that have exceeded expected tissue healing time.  Prior to sustaining the injury, there may be indications that a problem is developing which can include an increased recovery time after the sport or activity.

 

Managing the Sports Injury

The initial treatment for a sports injury is to stop the activity.  Never try to play through the pain of a sports injury. Continuing to exercise with pain can cause further damage resulting in a longer recovery time.

 

Some injuries can be managed safely on your own

Some injuries require immediate attention and should be checked by a qualified physiotherapist or medical professional that has had training in assessing sports injuries.  If your injury is causing

  • Severe pain,
  • If you can’t put weight on the area,
  • If an old injury starts to swell or hurt as you start to increase your activity level or
  • If you are starting to develop changes in sensation in the area a feeling of giving way or being unstable on the area

If you have not noticed the above problems then you may not require immediate attention.  The common advice provided for years has been that treatment of an acute injury should include:

Resting the injury

Different injuries will require different degrees of rest.  Severe injuries may require a brace or crutches.  Milder injuries may require only avoiding the aggravating movements.

Ice

Although called into question for routine treatment of all injuries, in the first 48 hours ice can be the treatment of choice especially if there is a significant amount of heat and swelling in the injured area.  Ice has a pain numbing effect and will reduce swelling in the area to reduce the pain in the injured area.  Care should be taken when using ice on areas with poor blood flow as this can result in a delayed healing response.  Maximum cooling is generally achieved within 15-20 minutes of application.  Icing can be repeated as symptoms dictate.

Compression

Putting a compression bandage such as a Tensor or using a compression type brace can help to support the injured area and to reduce swelling.  Your physiotherapist can help you choose the one that’s most appropriate for you and your injury.

Elevation

Elevating the acute injury assists with reducing swelling.  Keeping the injured area above the level of your heart when possible helps to prevent swelling from accumulating in the area, this helps to reduce swelling and pain.  The combination of Rest, Ice , Compression and Elevation are often abbreviated to RICE.  

 

RICE or MEAT

RICE  is the most common advice given for an acute injury.  The belief was that inflammation and pain need to be reduced to allow for a better outcome.  This guideline has been called into question with recent evidence showing the benefit of early movement, exercise as tolerated, analgesics to treat pain and treatment focused on improving blood flow to the injured tissues and restoring early movement.  This combination of Movement, Exercise, Analgesics and Treatment is abbreviated to MEAT.  Research shows a faster improvement with symptoms and earlier return to play with the MEAT protocol for ankle sprains.

 

Physiotherapy for your Sports Injury

Sports injury assessment and treatment
Sports injury assessment

Appropriate assessment by a physiotherapist with training in assessing and treating sports injuries is important to get you back to the activities that you love to do.  Acutely injured areas are assessed using techniques to determine the injury source and to rule out injuries requiring further medical intervention.  Treatment may be specific to the injured area but may also involve providing you with exercises that will maintain fitness level and conditioning without aggravating the injury.  As your pain symptoms reduce more aggressive exercises will get you back to sport conditioning level and will address the flexibility, strength and control of movement required to reduce the chance of re-injury.  Your physiotherapist can help you at all phases of the injury.

 

Prehab before the injury happens

Often flexibility, muscle imbalances and movement restrictions can be contributing factors to the chronic injury or reasons for poor healing from the acute injury.  Once an injury has occurred, return to play is determined in large part by the ability of the injured tissue to heal and for pain levels to reduce.  It’s often more advantageous to address some of the predisposing factors to injury before starting a new activity, sport or in your sports off-season.  Remedial exercises and stretches can often resolve underlying problems before the injury starts so that long absences from your sport and activities can be avoided.

 

Not sure where to start?

If your pain is not responding to traditional approaches there may be additional factors or compensations that are involved.  Our physiotherapists, massage therapists and naturopathic doctors have the training and experience to identify these factors and get them resolved.  Get in touch with us to get back in control of your symptoms!

 

Serving Thornhill, Markham, Vaughan and surrounding areas

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

 

Shoulder pain

By Peter Poon, PT

 

Have you ever experienced jabbing pain in the front of shoulder when reaching up, out or across your body?  Interestingly, between 7%-34% of adults have shoulder pain at some point in their lives and the level of discomfort can range from annoying to debilitating (Diercks et al., 2014).

Shoulder impingement and pain syndromes

The above pain pattern can be a symptom of SAPS or Subacromial Pain Syndrome. SAPS is defined as all non traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion (top part of shoulder), often worsening during or subsequent to lifting of the arm (Diercks et al., 2014). The above scenarios fall under the external impingement subtype, which include compression or abrasion of muscle under subacromial space. People with impingement type pain often have altered shoulder blade movements as well. If left untreated, it will lead to more severe rotator cuff diseases.

 

Anatomy of the shoulder girdle complex

The shoulder refers to the union between scapula (shoulder blade), humerus, clavicle (collar bone) and its ligaments plus overlying muscles.

 

Here are some important bits you need to know:

  1. The humeral head – This is the top portion of the bone in your upper arm. Normally it should stay snugly fit centered into its socket, the glenoid fossa
  2. Acromion, Coracoid and Coracoacromial ligament – These structures sit above the humeral head and provide a small space aptly named the subacromial space.
  3. Supraspinatus Tendon (part of the rotator cuff), long head of the biceps tendon and a bursa – These structures sit between the humerus and the subacromial space.  These are the structures that get impinged upon with this syndrome.
  4. Shoulder muscles important for normal shoulder movement: deltoid, biceps, rotator cuff muscles
  5. Scapular muscles important for normal shoulder movement: (upper/mid/lower) trapezius, serratus anterior and pectoralis muscle group

 

Efficient movement of the shoulder

While it may look like reaching up consists of the head of the humerus rolling upwards within the socket, the scapula and the clavicle actually plays an immensely important role in helping us reach. While the humerus rolls within the socket, the scapula upwardly rotates, posteriorly tilts, and the clavicle posteriorly rotates. Furthermore, shoulder girdle muscles (rotator cuff, trapezius, serratus anterior, pectoralis and biceps) have coordinated contraction and relaxation to help us with reaching. Certain muscle tendons will need to cross under the subacromial space in order to complete the motion.

Muscle imbalances and impingement pain

As mentioned above, patients with impingement pain often have different shoulder blade movements. Part of the problem can be due to the scapular muscles controlling the movement.  These include an overactive upper fibers of trapezius, tightness in the pectoralis and/or weakness in the serratus anterior.  Not only do changes within the scapular muscles cause changes to the movement of the scapula, they can also alter the orientation of the humeral head in its socket, thus decreasing the subacromial space during shoulder movement.  This can lead to compression of the rotator cuff tendons, bursa and the biceps tendon resulting in tendon pain.

 

Risk Factors for impingement pain

There are many common factors that influence the scapular muscles and can increase the chance of developing shoulder impingement syndrome.

Muscle timing issues

Full flexibility of the joints may be present, however there can be a problem where the muscles are not firing in the proper sequence.  This can be a result of muscle weakness or muscles that are too short and overpowering or too long and functioning as weak muscles.

Thoracic and cervical posture

Postural problems that affect the neck and thoracic spine can result in changes in the length/tension of muscles surrounding the spine.  This change in starting posture can affect the efficiency of scapular muscles.

Age and hand dominance

As we get older, our dominant hand’s shoulder girdle complex may also undergo degenerative changes which could increase the chances of developing SAPS.

Occupation

Jobs that require heavy labour and/or repetitive movements can predispose individuals to repetitive strain injuries in the shoulder girdle or scapular muscles, which can also lead to SAPS. Furthermore, sedentary workers could be at risk of developing SAPS if their desk is not setup ergonomically. Simple changes can be done to help alleviate these problems.

Previous traumas or injuries

Certain shoulder girdle injuries (ie. frozen shoulder, fractures and dislocations) can cause stiffness in the shoulder joint and its surrounding ligaments/capsules, which will have detrimental consequences to the efficiency of the scapular muscles.

Anatomical differences in the shape of the acromion

There are 3 common varieties of acromions found in the population. Certain types of acromions will decrease the subacromial space and may increase the chances developing SAPS.

What can be done?

Luckily, research has shown conservative treatments have favourable results in combating impingement type pain. Rehab professionals can help to identify underlying sources of why your shoulder isn’t moving the way it should. Part of the assessment should include a detailed history pertaining to previous injuries, medical conditions, occupation and social factors; followed by a careful analysis on how you move your shoulders.  A physiotherapist would then be able to offer a series of exercises to help restore the movement pattern. Often, this will be enough to reduce the initial pain. As your symptoms reduce, it will be important to address the next areas of mobility restrictions, postural changes or muscle imbalances that may have caused the initial symptoms in the first place.  Making positive changes in predisposing factors to injury will help prevent future re-injury.  Some of the possible interventions could include body weight exercises, flexibility programs and/or lifestyle modifications.

 

Not Sure Where to start?

You’re not alone. There are a number of risk factors that can prevent “traditional” shoulder and posture programs from succeeding.  Our physiotherapists and massage therapists have the experience and training to evaluate and diagnose your current status and the tools to get you started and progressing towards better health.  Contact us to get started on your goals!

 

Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References

Ludewig, P.M. & Braman J.P. (2011). Shoulder impingement: Biomechanical considerations in rehabilitation. Manual Therapy, 16, 33 – 39

Diercks, R., Bron, C., Dorrestijn, O., Meskers, C., Naber, R., de Ruiter, T.,  Willems, J., Winters, J., & Van der Woude, H.J. (2014). Guideline for diagnosis and treatment of subacromial pain syndrome, Acta Orthopaedica, 85:3, 314-322

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today