1/13/2017 1 Comment
It’s not just any knee. It’s your knee. And when it hurts, you are not the YOU that you are meant to be.
Wouldn’t it be great to be like Clark Kent where you could step into a phone booth and immediately transform into Superman? Knee pain? What knee pain? When your knee is feeling great, you are unstoppable! You are once again the hero in your story.
Let’s get you pointed in the right direction and put a halt to your knee pain. Let’s get you back in your game and get you in shape to take on the world as only you can!
Allow me to be your guide. I’ve been a physical therapist for 25 years. And more importantly, I’ve had times when I too had knee pain that kept me out of the game. I used the tips I’ve outlined here for you, and they worked. Now I want to share with you the top 7 tips that put a halt to my knee pain and enabled me to get going again.
Ice is by far the best way to ease knee pain, especially within the first 3 days of an injury or onset of pain. If you miss that window immediately after the initial injury and now have a more chronic overuse injury, such as tendinitis, ice is really only helpful if you use it immediately after you re-aggravate the area. Apply the ice right after a run, practice, or especially active afternoon when your knee is aching or painful. If it’s a small area, use an ice massage. It’s as easy as grabbing an ice cube with a moist washcloth and rubbing the painful spot till its numb, usually within 3 to 5 minutes. For more general and diffuse knee pain, consider wrapping a cold pack on it for about 10 to 15 minutes. With an acute injury, you can ice as needed through the day with applications spaced an hour or two apart. With a more chronic injury, ice is only beneficial immediately after you re-aggravate that area, so you won’t ice as often throughout the day.
Even minimal knee swelling can be a problem. If it looks swollen, it is swollen. The knee joint is especially good at hiding swelling. If a third of the knee joint has swelling in it, it may not even be noticeable. So if swelling is visible, it’s really swollen! To offset swelling, spend time with your leg elevated by lying on your back with your leg propped on a stack of pillows. This coaxes swelling back into circulation to be drained out of your system. To aid this, pump your ankle back and forth, as though you are pushing and releasing the accelerator on your car. This activates the calf muscle to help pump out some of the extra fluid. You can also activate your thigh and butt muscles by contracting them and holding the contraction for 5 seconds. Repeat a few times here and there while you rest with your leg elevated for 10 to 15 minutes at a time. If the swelling continues, consider going online or to your local running or sport shop and purchase a knee-high compression running sock. This type of sock works much better than an ACE wrap, as the tensile strength of elastic fibers in the sock are such that they are in a uniform gradient, tighter at the bottom that the top, to keep swelling from settling in your lower leg.
Rest it Right
Isn’t rest . . . rest? Not these days. A sports approach to rest is what we call “specific rest.” It’s giving your knee time to heal, without taking a prolonged vacation from activity. Respect your knee symptoms, but don’t fear them. If it hurts or feels loose when you pivot in one direction, avoid that for a few days, but try biking, swimming, or walking on more even paths. Focus on getting out and doing your normal activities as best you can. If golfing, hiking, and workouts seem over the top right now, that’s okay. But don’t plant yourself on the couch and throw up your hands. Instead, choose some of the items on this list to reduce inflammation, get moving, and keep your muscles activated. As symptoms ease, begin to add in the higher level activities you enjoy. Think of this step in the process as an “active recovery,” where you are an active participant in your life. Activity helps with circulation and the release of anti-stress hormones into your system which will speed up the healing process.
Get it Moving
Now is the time to start regaining movement in your knee. When it’s swollen, you’ll likely feel tight when you try to fully bend your knee. Don’t force it. Instead, do some gentle heel slides: Wear a sock and lie on your back on a smooth surface, such as on your bed or couch. Begin to draw your heel along the surface toward you as you allow your knee to bend. Now slide your foot away from you until your knee straightens. Repeat 20 to 30 times and do this several times a day. You can also do this with your legs elevated on an exercise ball, moving the ball back and forth. Another important structure to keep loose is the knee cap: Just hold on to it and move it up, down, and from side to side. Do a few of these before or after doing your heel slide exercise. You can also try riding a stationary bike to loosen the knee joint. If you cannot get all the way around, just go in a half-moon motion from front to back, giving it a little stretch at both ends of the movement.
Activate Key Muscles
When the hurt is on, muscles that support the knee joint may stop working right. Some of these key muscles can actually shut off and start to shrink, known as atrophy, in as little as 24 hours. Knowing this, it’s vital to keep these nearby muscles active while you heal up. One is the inside thigh muscle, the VMO (Vastus Medialis Oblique). While seated and with your leg out in front of you, put a hand toward the end of your thigh. Now slide your head downward along the inside of your thigh until you are just above the knee. With your hand there, gradually make the muscle tighten so you feel it under your hand. You want to feel the inside quad muscle (VMO) tighten at about the same time as the rest of the muscle at the top and outer thigh. To help it work even better, imagine lifting your foot off the ground, while keeping the knee on the ground, or put a rolled up washcloth under the knee and press the back of the knee down into it. Hold 5 to 10 seconds, and repeat 5 times. Do this often during the day. The gluteals can sometimes shut off too. Try tightening your buttocks and holding the contraction similar to what you did with the quad. You can do this in any position throughout the day.
Knee Joint Connected to the . . .
Knee pain often is related to nearby joints being too weak or stiff, particularly the hip and the ankle joints. It’s important early on to do exercises that target these nearby joints to help strengthen the muscles crossing the knee. With any exercise you do, be sure to keep your limbs lined up. Put equal weight on the ball and heel as well as both edges of your foot. Align your knee over your second toe. Practice this as you do a bridge exercise. Here’s how. Lie on your back with your knees bent and with everything lined up. Keep your pelvis square and strong as you begin to raise your hips off the mat. Hold for 5 seconds. Then slowly lower your hips back to the mat. Do 5 or 10 at a time. The bridge exercise helps activate your gluteals, quadriceps, hamstrings, and core muscles. You can place a ball between your inner thighs if you are having trouble staying lined up. When you can do this without pain, try a supported wall squat. All you need to do is lean back against the wall. Again, get everything lined up, and slowly slide your back down the wall as far as you can comfortably while holding good alignment. Hold for 5 seconds, then stand back up and repeat.
Get the Right Help
Sometimes even superheroes need a power source outside themselves. At Alpine Physical Therapy, we know that. We’ve helped thousands of them, just like you. We have a core team of physical therapists who know what it takes to help resolve knee pain. But we don’t stop there. Instead, as your pain eases, we’ll work with you to ramp up your knee function to an entirely new level. Whether it’s getting you back to where you can reach down and lift up your kids, resume a workout program, hit the ski slopes, or get you back to competitive sport, we’re here to help.
There really isn’t a faster way to end knee pain than by working with a knowledgeable, hands-on physical therapist. Doing so means you get the fastest access to care that will soothe and relax your knee, while also maximizing your strength so you can get back to saving the world . . . or to whatever else a hero like you needs to accomplish.
Combine these 7 tips with a visit to one of our expert hands-on physical therapists, and you’ll see and feel the difference. It’s your knee. You are the hero. Let Alpine release your inner hero and get you back in the game!
Call us at 406-251-2323 for more information, to set up a free 15-minute consultation with one of our physical therapists, or to schedule your evaluation by one of our sport specialist physical therapists. And visit our website for more information by clicking here.
Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Physical Therapy.
Let’s face it, walking or climbing up and down stairs, moreover prolonged or pounding exercise can make our knees hurt. So why would anyone want to do more exercises to actually reduce knee pain?
Dr. Clijsen and is Swiss team of academic research scientists and physical therapists were determined to find the effectiveness of physical therapy exercises for reducing a knee pain, as there is limited research to the incidence of this prevalent problem. They were specifically interested in a common type of knee pain known as ‘Patellofemoral Pain Syndrome’ (PFPS) that hits 15% to 45% of active adolescents and adults under the knee cap.
Most people over the age of 13 have probably felt a twang of pain or a dull ache on the front of their knee under or under their knee cap when hiking down hills or stairs. The cluster of symptoms associated with PFPS is knee pain with running, squatting, stairs, or more strenuous weight-bearing exercise. It is more common in women than men. This syndrome is also known to be ‘self-limiting’, as reducing the provocative motions, naturally improves the knee’s unhappy status.
So what should you do to improve knee pain associated with squatting or stairs? What if I want to stay in shape by running or playing field sports, but my knees do not enjoy the impact? Often, people get in to see their physical therapist for assessing why the knee is in pain and then commit to improving their function with therapeutic exercises.
The cause for pain behind the knee cap can be coming from any number of problems or multiple issues combined. Faulty alignment of the leg joints, insufficient muscle strength, sport training errors and overly tight muscles are the bulk of the prevailing theories on why the knee is overstressed and pained. Correcting each individuals’ “patient reported measures of activity limitations and participation restrictions” by assessing their body mechanical and movement faults is often the goal of doing specific exercises to improve the PFPS.
This research study looked at a comprehensive review of 15 high-quality studies with a total of 748 male and female subjects with pain in their knee cap area. Based on the results of this systematic study, exercise therapy appeared to be an important plan of action to help achieve knee pain and functional improvements.
For example, could a 25 year old female with knee pain during and after track practice (or ‘activity limitation and participation restriction’) improve her discomfort with eight weeks of PT doing resisted leg extensions, hip girdle strengthening and using electrical stimulation over her quadriceps muscle? The verdict looks promising.
This study concluded that exercise therapy was effectively strong at reducing pain and getting participants back into their sporty activities. However, the question of which target exercises their therapist opted to use to yield the strongest effect to diminish their pain and boost their function remains unanswered.
Ron Clijsen, PhD, et al, Effectiveness of Exercise Therapy in Treatment of Patients With Patellofemoral Pain Syndrome: Systematic Review and Meta-Analysis. In Physical Therapy. 2014; 94:1697-1708.
For more information on this topic, view our clinical module on knee pain by clicking here.
Special thanks to star physical therapist Antara Quiñones of Alpine Physical Therapy for providing this write up on a recent article from the Journal of American Academy of Orthopedic Surgery.
Every 5 years or so the American Academy of Orthopedic Surgeons (AAOS), along with a cohort of other professions (like physicians and physical therapists) publish a guideline to treat certain conditions based on the latest and greatest evidence. These guidelines offer a quick look into what’s proven to work, what does not work, and what still needs to be further investigated. Below are the items that the AAOS recommends for the most up to date treatment of knee arthritis.
People with knee arthritis should:
1. Routinely take part in a strengthening program, neuromuscular education (or using techniques to restore balance, improve coordination and fine tune awareness of where your leg is in space), perform low-impact aerobic exercises, and keep physically fit to national standards in regards to heart health and body weight.
2. Maintain a body mass index (BMI) of less than 25.
3. Use nonsteroidal anti-inflammatory drugs (oral or topical) or tramadol to help with symptom management.
The following are NOT recommended for treatment of knee arthritis:
2.Lateral wedge insoles are not supported in the literature. This being said, however the recommendation is moderate and patient preference should be kept in mind.
3. The use of glucosamine and chondroitin.
4. The injection of hyaluronic acid into the knee joint.
5. Performing an arthroscopy with lavage and/or debridement in which the fluid of the knee joint is removed, the joint is washed, and any loose bodies or debris are removed.
6. The use of needle lavage where saline is injected into the joint and then removed in attempts to wash the joint and remove inflammatory factors and debris.
7. The use of free-floating (not cemented or screwed into place) interpositional devices in the inner knee compartment to alleviate pain and mimic meniscus function. (This was a general consensus recommendation due to the lack of research available for these devices.)
Evidence is inconclusive for the following due to either lack of available evidence or inconsistencies in the studies that have occurred. Practitioners should be on the lookout for future evidence, but in the meantime decisions regarding their use should be influenced by their clinical judgment and patient preference.
1. The use of physical agents, such as electrical stimulation and ultrasound.
2. Manual therapy.
3. Valgus knee brace (to unload the inner knee compartment).
4. The use of acetaminophen, opioids, or pain patches.
5. The use of injections into the knee joint of corticosteroid.
6. The use of growth factor injections and/or platelet rich plasma.
7. A valgus-producing proximal tibial osteotomy, or bone shaving that changes the direction of forces across the knee joint to relieve pressure at the inner knee.
As the evidence changes and our knowledge evolves, it is good to keep the AAOA standards in mind and to be on the look out for future recommendations.
David S. Jevsevar, M.D., MBA. Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition. Journal of American Academy of Orthopedic Surgery. September 2013. Vol 21, No 9. Pp 571-576.
For more information, visit our topic module on Knee Osteoarthritis by clicking here.
Special thanks to star physical therapist Leah Versteegen, DPT, of Alpine Physical Therapy for providing this write up on a recent article from the Journal of Bone and Joint Surgery.
ACL rupture affects an estimated 35 people per 100,000 and can increase based on gender and activity. Female athletes face a two to eight times increase in risk of ACL rupture compared to their male counterparts. With numbers like this, it is not wonder that the annual estimated health care cost for ACL repair is three billion dollars just in the United States. The most common treatment for ACL rupture is surgical reconstruction, though nonsurgical rehabilitation is also an option. The decision to reconstruct a ruptured ACL depends on many factors, including age, desired level of activity, episodes of instability and general health.
Before reviewing the surgical options for ACL reconstruction, it is important to understand the basic anatomy of the ACL, or anterior cruciate ligament. It is composed of two functional bundles of ligaments, the anteromedial and posterolateral bundle, which are so named due to their insertion sites on the tibia. Both bundles work together to stabilize the knee into flexion. The anteromedial bundle length remains constant throughout flexion and extension of the knee but is most taut at 45-60 degrees flexion. The posterolateral bundle is tight with extension but loosens with flexion in order to allow some rotation to take place at the knee joint.
Once the the decision to have surgery has been made, there are several factors to consider including timing of the surgery, technique used by the surgeon, and the graft site from which to build the new ACL. When making these decisions one must look at preoperative range of motion, swelling and strength as well as individual anatomy, post-operative activities and goals.
Timing of the knee surgery is one of the first factors to consider. There is evidence supporting early surgery, as it may lead to improved functional outcomes and decreased rate of future meniscal damage. However, delayed surgery can allow for potential avoidance of surgery all together if the individual is satisfied with their knee function. Allowing more time before surgery can definitely help an individual improve preoperative strength and range of motion.
Preoperative strength of at least 90per cent of the quadriceps, is correlated with improved long term functional outcomes. Preoperative swelling and limitations in range of motion are correlated with increased arthrofibrosis after surgery. Thus, a preoperative rehabilitation program focusing on decreased swelling, improved range of motion and quadriceps strength is beneficial.
There are two main surgical techniques utilized in ACL reconstruction, single or double bundle. Though the single bundle technique is far more common, with the double bundle technique being used primarily in Europe and Asia, the rupture pattern of the ACL in that individual and their unique anatomy should be considered by the surgeon when making the ultimate decision on which technique to use. Variations in the tibial notch, arthritic changes, multiligament injuries and bone bruising are all taken into consideration by the surgeon with the aid of a detailed flow chart. Outcomes measures detect no difference in long term functional outcomes between the two techniques, with the exception of fewer reported meniscal injuries with double bundle repair. Regarless, it is important that the surgery match anatomical placement of the ligament in order to help restore optimal biomechanics.
After the technique has been selected, the graft site is the next major decision. Typical graft options include bone-patellar-bone autograft, hamstring tendon autograft, quadriceps tendon autograft, and allograft. If a double bundle repair has been selected the bone-patellar-bone graft cannot be utilized. MRI scans can be helpful in allowing the surgeon to determine which tendon may be most useful based on graft size. The long term goals of the patient are also important in selecting the graft site. For example, an athlete that relies heavily on hamstring strength will not want to use the hamstring autograft. Similarly an individual who has to do a lot of kneeling will not want to choose the bone-patellar-bone autograft.
Once the surgery has been performed, several questions arise, including when one can return to sport, what is the chance of reinjury and/or developing osteoarthritis in the future. Return to sport is dependent on many factors including the healing of the graft, the individuals anatomy and the desired sporting level. For those who do not return to high level of sport, fear of reinjury is a common reason. Graft failure rate is about 11 percent and does not seem to be dependent of the choice of graft site. Several authors have actually reported a higher rate of ACL injury in the opposite leg compared to a reinjury of the repaired ACL. In general, those who do reinjury a repaired ACL are younger and returning to a higher level of activity. Arthritic changes and the development of osteoarthritis after ACL rupture is more common in those who have sustained some meniscal damage or lose range of motion in the knee joint.
Christopher D. Morawski, et al. Operative Treatment of Primary Anterior Cruciate Ligament Rupture in Adults. In the Journal of Bone and Joint Surgery. April 2014. Vol 96A. No. 8. pp 685-694.
For more information, visit our topic module on ACL injuries by clicking here.
Special thanks to star physical therapist Leah Versteegen, DPT, of Alpine Physical Therapy for providing this write up on a recent article from the Journal of Bone and Joint Surgery.
Anterior cruciate ligament injuries are one of the more common injuries impacting young athletes. The impacts are not only physical in nature but have psychological components and add financial stress as well. As the prevalence of youth participating in sports has increased, ACL injuries have also increased. Some research estimates that return to sport after ACL rupture and repair is as low as fifty percent in young athletes, while epidemiological studies estimate that females are four to six times more likely to suffer an ACL injury compared to their male counterparts. For these reasons, a considerable amount of attention has been given to programs aimed to decrease ACL injury rate, particularly in the female athlete.
Research supports the effectiveness of many ACL injury prevention programs that have been developed in the past decade. These programs typically involve an altered warm up and inclusion of certain fitness drills in practice that include core work, stretches, plyometrics, strengthening and sport-specific agility drills. The end goal is to optimize muscle balance and improve the athletes biomechanics, particularly with jumping and cutting type movements that typically stress the ACL.
Aside from these ACL injury prevention programs, more recently certain researchers have recommended screening programs to identify the young athletes that may be at higher risk for ACL injury. Medical screening tools ideally are desigend to be sensitive enough to identify only the high risk individuals so that interventions can target this population rather than those who do not need the intervention, thus saving money. With an effective ACL injury screening tool, the athletes that are at highest risk can then participate in an injury prevention program, rather than having all of the athletes in the program, again with a goal of saving time and money.
As finances for youth and college sports can be limited and injury rates continue to rise with increased sport participation, it is important to find the most cost-effective program to implement that also provides the best results. It necessary to take into consideration the cost and accuracy of a screening tool, as the purpose of the screen is to identify those at risk. Similarly it is important to make sure that the intervention is targeting the correct population and is effective in making the modifications desired. Though research supports the sensitivity of screening tools as being effective in predicting ACL injury risk, these screening tests require extensive set-up, expensive motion analysis video equipment, and a skilled tester. Typically the athlete will run through a battery of jump and landing tests to determine the knee abduction moment. Even if a coach is educated on what to look for with a screening test and is able to use a simple camera, the time and cost required to conduct the testing exceeds the benefit.
The incidence of ACL injuries in youth is high enough that a screening tool is just not warranted. The high incidence rate equates to the fact that most athletes will benefit from an ACL injury prevention program, which are very inexpensive and highly effective as supported by research. On average, such programs decrease the incidence of ACL injury from three per cent to one pecent in a single season, saving on average $100 pre player per season in expenses related to such injuries. Universal ACL injury prevention programs for young athletes, male and female, are a cost effective strategy for reducing the physical, psychological and financial burden of ACL pathology.
Eric Swart MD, et al. Prevention and Screening Programs for Anterior Cruciate Ligament Injuries in Young Athletes. In the Journal of Bone and Joint Surgery. May 7, 2014. Volume 96A. Number 9. Pp 705 -711.
For more information on ACL injuries, visit our clinic resource page by clicking here.
Special thanks to star physical therapist Antara Quiñones for providing this write up on a recent article from the Journal of American Academy of Orthopedic Surgery.
Cadaver Cartilage Grafts Prove Promising for Large Cartilage Tears of the Knee
A recent review of the most up-to-date research found that large cartilage tears at the knee joint are best repaired with donations from cadavers. The review found that a technique called “Osteochondral Allograft Transplantation,” or OCA, is versatile in terms of what kinds of repairs it can help and has the best long-term effects when compared to alternative surgical options.
Chondral is a fancy word for cartilage. Cartilage is a protective layer of rubbery tissue that covers the ends of bones to prevent rubbing. There are two important layers of cartilage in the knee- one layer of articular cartilage that covers the end of each leg bone and your knee meniscus, which resemble rubbery washers that sit on top of the articular cartilage. Both of these can be damaged from trauma (like a side blow to the knee or excessive twisting forces) or they can degrade over time from normal wear and tear. Sometimes, due to abnormal forces across the knee joint or excessive use with improper form these pieces of tissue rub and tear earlier in life. This often happens to athletes who perform the same repetitive movements again and again or in athletes with high impact activities. In addition, if there are any muscle imbalances the knee joint moves at the less than optimal angle speeding up the wear and tear on the cartilage. This breakdown in the cartilage causes swelling at the knee, pain, and interferes with a person’s ability to perform their sport or typical functional tasks of life.
Cartilage does not have a good blood supply which means that it does not heal well. What’s more, it has no nerve endings so you do not really realize there is a problem until damage is done. Chondral degradation is graded on a scale from one to five, with five being the worst. Repair options hinge on the size and location of the tear as well as the goals of the patient.
Smaller lesions (<2 cm^2) are often repaired by clipping out the frayed pieces of cartilage (debridement), taking a piece of cartilage from another part of the knee and placing over the tear (osteochondral autograft transplantation), or by poking tiny holes in the bone below the cartilage so the blood clots formed will provide some healing and regrowth of fibrocartilage (microfracture). These techniques, however, are less effective for larger tears (>2cm^2 to <10 cm^2) or deep tears. Bigger tears are treated by either OCA or by an autologous chondrocyte implantation (ACI). An ACI procedure involves harvesting the cartilage cells and growing them outside the body and then planting them in the effected area. It is worth noting, however, that an OCA is the only back up procedure for a failed ACI. Authors of this review found that an OCA is less invasive (only one procedure), is more versatile, and has better long-term outcomes than an ACI.
The OCA procedure has become refined with time. The cartilage donation must be collected within 24 hours of the person passing away and is taken from people with healthy knees. The tissue is screened for a host of diseases. This process takes anywhere from 14 to 28 days, during which the cartilage is kept at body temperature, its ideal environment. The cartilage is then selected based on a size and location match, as there is a very minimal risk of tissue rejection since there is little to no immune response in cartilage. If the tear is deep and a bone graft is also required then the risk of rejection is only slightly higher.
An OCA procedure includes several different techniques depending on the type of tear. The most common technique is called a plug, where the chunk of torn cartilage, and perhaps bone, is removed and the new piece of cartilage is fitted perfectly in its place with as tight of a fit as possible. If the fit is not completely snug the surgeon can fasten it in using dissolvable materials or tiny hardware that will not disturb the knee function.
Rehabilitation after the surgery is broken into three phases. The first phase is a period of rest to allow the tissue to heal, with the amount of use of the leg depending on the type of repair. Typically phase one lasts 6 weeks. Phase two is from week six to twelve and involves return to daily activities, strengthening, and full motion of the knee. Phase three is from three months on and involves full return to sport with the guidance of a physical therapist. From six months up to one year after surgery repetitive high impact activities should be avoided.
Long-term outcomes for OCA procedures are promising with the greatest percentage of success in a younger, active population with traumatic onset of cartilage damage less than one year prior to surgery. That being said, however, the numbers are also promising for the non-traumatic middle-aged population with tears greater than 2cm. The authors suggest that an OCA become the standard practice for larger tears of these populations.
Seth L. Sherman, MD, et al. Fresh Osteochondral Allograft Transplantation for the Knee: Current Concepts. In Journal of American Academy of Orthopedic Surgery. February, 2014. Vol 22. No. 2. Pp. 121-133.
For more information on this topic, click here for an informative article that is on our website.
Special thanks to star physical therapist Antara Quiñones for providing this write up on a recent article from the American Journal of Sports Medicine.
Physicians are changing how they manage meniscal tears, according to a recent study that reviewed treatment methods over a 7 year period. Often when new evidence shows a better way to treat a problem it takes years for surgeons to alter their practice methods. This study concluded that surgeons have changed their treatment to reflect the most up to date practice. The authors attribute the change in treatment to new evidence and changes in physician education regarding effective treatment. This is good news for the prevention of knee arthritis.
The meniscus is a c-shaped piece of cartilage that is found on both sides of the knee joint sandwiched between the ends of your bones. It serves as a barrier between the leg bones, helps to redistribute twisting forces and decreases the wear and tear on the underlying cartilage covering the end of the bones.
The meniscus may be torn either by degeneration or by acute trauma. Sometimes from a blow to the knee both the meniscus and the anterior cruciate ligament (ACL) tear. A tear typically causes knee locking and catching, swelling, and pain. In the past, the standard treatment for a torn meniscus was removal, or meniscectomy. However, because recent studies have shown 60% of menisectomies result in osteoarthritis (or the wearing away of the cartilage covering the end of the bones), physician education has changed to emphasize preserving the meniscus. The attempt to preserve the meniscus is called a meniscus repair and involves suturing the structure back together as best possible.
Review of over 2 billion patient records from 2005-2011 showed an increase of 11.4% in the number of meniscal repairs, with young males and patients under 25 years old having the greatest increase in meniscal repair surgeries. Additionally, there was a 48.3% increase in ACL reconstruction in conjunction with meniscus repairs. This data suggests that physicians are changing their method of treatment of meniscus tears to reflect their training and are repairing meniscus when able instead of simply removing the tissue.
Geoffrey D. Abrams, MD, et al. Trends in Meniscus Repair and Meniscectomy in the United States, 2005-2011. In American Journal of Sports Medicine. July 17, 2013. Vol. 41, No. 10. Pp.2333-2339.
For more information, visit our patient education topic module by clicking here.
Healthcare providers usually call persistent pain at the front of your knee or under your kneecap patellofemoral pain syndrome. This pain is typically unrelated to a specific injury but instead occurs over time with an increase in physical activity. The pain may be a nagging ache or an occasional sharp pain that may cause you to limp or to limit your activities. This pain is also typically most pronounced when performing such activities as going up and down stairs, squatting, and running, or after sitting for a prolonged period of time.
The first step toward preventing this type of knee pain is being able to accurately identify potential risk factors that may lead to the problem. *A study published in the February 2012 issue of the Journal of Orthopedic and Sports Physical Therapy provides new insight on specific factors that may place you at risk for anterior knee pain.
In this study, the researchers evaluated published articles using a process called a systematic review. Their initial search of the literature found 3845 possible articles of interest. The research team found that weakness of the quadriceps muscle, which is on the front of your thigh and helps you to straighten your knee, was predictive of developing knee pain. They also confirmed that females are at higher risk for anterior knee pain.
Being able to predict which athletes are at risk for knee pain is helpful in developing prevention exercise programs that lessen the chance of injury and pain. This study suggests that having a weak quadriceps muscle is a risk factor for patellofemoral knee pain, and that if you are a woman, you are more likely to have this type of pain. Therefore, especially for women, regularly performing an exercise program that focuses on strengthening your quadriceps muscle may be an effective way to keep your knees pain-free.
Because exercises to strengthen your quadriceps muscles are easy to do and don’t require a lot of equipment, they can be done at convenient times and with little or no cost. As with any exercise program, you may also need to consider the physical activities you already perform and your response to this exercise approach. In addition, some people may need to address other areas of weakness or tightness throughout the lower extremities (such as the gluteal muscles) to ensure their best outcome. The physical therapists at Alpine Physical Therapy scan help customize an exercise program for you. For more information on the treatment of anterior knee pain, contact us at 251-2323.
For more information on this topic, view our patient guide on patellofemoral pain by clicking here.
* This JOSPT Perspectives for Patients is based on an article by Lankhorst NE et al, titled “Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review” (J Orthop Sports Phys Ther 2012;42(2):81-94. doi:10.2519/jospt.2012.3803)
Many thanks to Linsey Olson, one of our stars at Alpine Physical Therapy, for submitting this success story about one of her patients, Debbie.
I recently treated a dear patient of mine, Debbie, for her second total knee replacement. Prior to this, I’d seen her multiple times for rehabilitation from her past knee surgeries.
She progressed well in her physical therapy at Alpine. But soon we came to a crossroads in her rehabilitation. I could discharge her from physical therapy and have here continue with her home program on an independent basis. Or she could start to advance her exercises at the Peak Health and Wellness Center. This second option created its own concerns.
She admitted to having had a membership for a long while but had not used it since signing up due to her intimidation of the gym atmosphere (She didn’t even have a swipe card activated for this reason).
Knowing that the Peak is the least intimidating fitness center I have encountered, I quickly introduced her to the desk staff, retrieved a swipe card, introduced her to our many classes and equipment, and showed her the opportunities that await her as a member.
Currently, she is involved in the Wellness Program at Alpine with consistent check-ins as to her weight loss journey, cardiovascular fitness, and overall positive lifestyle changes. I am proud to say I have ‘caught’ Debbie working out at the Peak as often as I am here (yikes)! She has returned to playing racquet sports that she hadn’t dreamed of ever returning to.
As a physical therapist, this is one of my greatest accomplishments: PERMANENTLY changing someone’s life. Debbie now has both the tools AND motivation to improve her physical, mental, and emotional fitness.
Way to go Debbie!
In the words of the tag line of the Peak Health and Wellness Center, “Fitness is a journey, not a destination.”
All too often, I hear patients tell me that the pain in their knee must be from arthritis. Then they explain what makes their pain worse, which often defines that their pain is not from arthritis but more likely from other causes. For example, I got a letter from my cousin, who was told her knee pain was from arthritis. After she explained her symptoms, it was clear she was dealing with the pain from a knee cap issue . . . and not solely from knee arthritis.
Here’s what my cousin emailed to me:
I was wondering if you can recommend something for my knee. I have been diagnosed with early stages of arthritis. It has been bugging me for over two years, and now it hurts to go down stairs. I have been doing a lot of hiking and have lost thirty pounds hoping that would help! Are there any exercises, supplements, or a brace that will help heal or prevent more issues?
Here’s my reply:
From what you’re telling me about your symptoms, I get the feeling the issue isn’t arthritis but more likely a knee cap tracking issue (called Patellofemoral Tracking Dysfunction). This can be easily corrected with a special sleeve that you wear on your knee called a “patellofemoral brace.”
If I’m right, and you were able to get the right help (to include a knee brace like I mentioned), you’d likely be able to resume your activities without pain. From a clinical standpoint, the exercises are a bit complex to describe in an email. Let me point you in the direction of two documents. One is on knee cap problems. The other is on knee arthritis.
Read through them, and let me know which seems to fit your situation the best. The approaches are quite different for the two conditions.
1. Knee cap problems
2. Knee osteoarthritis
Once I know your answer as to which one fits the best, I will be better able to guide you.
Her reply after reading these two articles made it clear that her pain was coming from problems with her knee cap. Along with having her increase fish oil intake to 2,000 mg per day, I advised her to purchase a Kuhl Shields knee brace.
To order one online, Google Kuhl Knee Brace.” You’ll then need to measure the circumference of your knee by putting a dot on the middle of your knee cap. Wrap a soft tape measure all the way around your knee. If it’s 12 to 14 inches around, order a small. If it’s a 14 to 16 inches, you’ll need to order a medium. For 16 to 18 inches, you need a large. And for 18 to 20 inches, order an XL. You don’t need to specify left or right. They are interchangeable from left to right. Wear the brace during heavier activities, such as hiking, mowing the lawn, or doing any other form of climbing. It is also advisable that you work with physical therapist to gain instruction on specific exercises that can speed recovery from knee pain.
Brent Dodge is the founding owner of Alpine Physical Therapy and is a board certified orthopedic specialist. He holds additional certifications in Functional Dry Needling, Manual Physical Therapy, and Strength and Conditioning.
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