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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.

 

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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

Contact Us Today

 

 

 

 

 

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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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

 

 

How to Run Injury-Free

By Peter Poon, PT

Running injuries

Now that summer is in full swing, many of us will want to enjoy the sunshine by going for a casual jog or more vigorous run around the neighbourhood. Some may think running is not an exact science: just pick up a pair of (brightly-coloured) running shoes and…go. However, poor running form can lead to injuries down the road, much like how riding a bike with misaligned wheels will eventually wear down the bike and the rider. It has been estimated that between 4 – 18% of individuals have some kind of running injury at any given time.[1] Common injuries such as patellar tendinopathy, tibialis posterior tendinopathy, tibial stress syndrome (shin splints) and achilles tendinopathy are usually due to improper loading during lower body exercises and may not yet be impacting you enough to seek out a physiotherapist.  

 

Can technique be resulting in painful runs?

If you have been experiencing pain either during or after a run, ask yourself the following:

  • Where is my pain? What does it feel like?
  • I am in pain during my run. Does it go away quickly (with rest) or does it linger for days?
  • I am in pain after my run. How long after does the pain start?
Pain with running can be improved with a proper assessment and treatment plan
Pain with running can be improved with a proper assessment and treatment plan

The above are all plausible signs that your body is not agreeing with your running routine. When your body experiences pain, it is generally a sign  that it cannot cope with the stresses from that activity.  You can reduce your risk of ending up with severe injuries if you identify subtle movements or habits that could lead to injuries and develop a proactive long-term injury-prevention strategy.  During an assessment, physiotherapists can identify these factors and prescribe individualized exercises and tips to get you moving efficiently.

 

Could previous injuries be causing me running pain?

Imagine you have just sprained your ankle, instead of walking with a heel-toe pattern, your body compensates by doing a stutter step. Compensations are one of your body’s natural defense mechanism. Short term compensations are necessary to keep you moving with less pain. However not all compensations are ideal; in the previous example, walking with a stutter step will lead to decrease use of your calf and hip muscles to propel you forward. If left unchecked, it will lead to future muscle imbalances which could affect your running form. Even though you may feel no pain from your previous injuries, you could have developed subtle compensations, which could have abolished the pain but only “band-aid” the problem. During a gait assessment, physiotherapists can identify these changes and give you specific advice to keep you running on all cylinders.

 

Am I a heel, midfoot or forefoot striker (am I pounding away at the pavement or landing light as a feather)?

Different landing patterns will create different stresses on your foot and body; some patterns are better at absorbing shock than others and some can lead you susceptible to injury.

 

Am I taking laboured or big strides?

Taking laboured or big strides is an inefficient method to run or to run faster. This is due to a greater energy loss from lifting your leg (versus shorter strides) which decreases forward propulsion. Not surprisingly, big strides will increase impact on your feet when you land. While it may be okay for some sprinters, imagine the impact on your feet if you were to repeat this for 5-10km. Physiotherapists can easily identify this fault and give you specific tips to help improve your efficiency.

 

Did I suddenly change or increase the volume (time, distance or # of runs per week) or intensity of my run?

Sudden increase in volume of training is a catalyst for sprains and strains. Daily to weekly adjustments of the applied mechanical stress (either volume, or intensity) is the best way to avoid injury.

 

Calluses or getting black toes can be a sign of inappropriate shoes

The fit of the shoe is essential to stay injury free. Shoes that are too small or too narrow could lead to unwanted bunions and black toes. 

 

Am I running the same circles in a track or same route every time? Do I run on different types of surfaces?

Not only does cross training on irregular surfaces or trails keep your muscles guessing, but it also helps improve balance and adds variety to your workout. The variation will increase strength and endurance in your foot and ankle muscles, which leads to less repetitive strains in the future.

 

A few final thoughts on Running

These are all valid questions to consider whether you are just picking up running, coming back from an injury or wanting to stay injury-free. A running gait assessment by a physiotherapist can help you with answers to the above questions. Not only do we conduct an interview at the beginning to find out your running routine, we look at your running form from head-to-toe to identify possible areas that need to be addressed. With this information, physiotherapists can assist runners in developing individualized long term solutions to stay running injury free.

As always, contact us if you need any tips or advice.

 

Family Physiotherapy serving 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.

Peter Poon is a registered physiotherapist at Family Physiotherapy.

[1] Lopes A, Hespanhol JLC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012; 42(10): 891-905