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.
That’s right. Today is Fall Prevention Awareness Day 2016, the 9th national celebration and the 8th Montana state celebration! Please help our aging adults stay safe by offering education, reminders, home assessments, fall risk screenings, and lots of safe physical activity classes designed for the age group.
Here are some important resources for those needing additional information.
Here’s a link to the CDC website, highlighting the STEADI(Stopping Elderly Accidents, Deaths, and Injuries): www.cdc.gov/steadi.
And here’s a segment from the National Council on Aging on Falls Prevention Awareness Day: https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-awareness-day/
Finally, here’s an announcement from our very own University of Montana: http://news.umt.edu/2016/09/092016fall.php
If you missed our most recent blog on Alpine’s involvement on keeping our aging adults safely on their feet, click here!
Let’s keep our beloved aging adults steady on their feet!
For more information on Alpine’s Vestibular and Balance Clinic, click here for our webpage on this topic.
5/12/2013 0 Comments
At least forty of you have walked a marathon. On Saturday mornings 40-60 full and half marathon walkers in training meet at Community Hospital as part of the training program provided by Run Wild Missoula. On April 27th Alpine Physical Therapist Angela Listug-Vap had the pleasure of meeting with them prior to their long walk to discuss Injury Prevention and Core Stability. Here is a taste of what was discussed.
In order to complete a task like walking our body has to accomplish several things. We can call these biomechanical requirements. If we are lacking some of these requirements, our amazing bodies can still get the job done and complete the task but with compensations. These compensations may lead to pain and injury.
One example of a biomechanical requirement for walking is thoracic rotation. The body needs to be able to rotate in the middle of the trunk in both directions to help drive the next step and the swing your arms. If you stand or sit and rotate your trunk you can self assess by asking: “Am I tighter in one direction?”. To practice and gain trunk rotation you can do some simple stretches, and you can play with not allowing trunk rotation while you swing your arms . . . and then allow yourself to rotate all the way and swing the arm all the way across your body slowly alternating directions. You can view more examples of what we discussed by clicking here to access the handout.
Alpine Physical Therapy offers free 10-minute injury consults to all RWM members and Marathon participants. So give us a call at 541-2606 if you have a question and would like a chance to bounce it off one of our knowledgable physical therapists.
On average the human head weighs around 8 pounds. This accounts for roughly 8% of your overall body weight, yet all of this weight is held up by your seven cervical vertebrae and the muscles in your neck. Thankfully your body’s natural biomechanics places the majority of this weight directly on top of your spine allowing the muscles in your neck to provide more passive support. This delicate balance between your muscular system and your spinal cord and spinal nerves is easy disturbed.
A common disturbance occurs when unhealthy postural habits result in a condition called forward head posture. This happens when your chin juts forward, placing your head too far forward and out of balance with your spine.
The causes of this occur commonly with everyday tasks such as:
• Repeatedly looking down while typing or reading.
• Sitting improperly with rounded shoulders and a hunched back..
• Driving with your head more than 2 to 3 inches away from the headrest.
• Carrying a backpack or heavy purse slung over one shoulder.
Forward head posture can result in discomfort that if not addressed can result in chronic back pain, neck pain, and headaches.
Here are some more facts about the long term effects of forward head posture brought to you by The PT Project.
1. The effects of chronic forward head and neck postures are long-term . . . and may result in muscle strain, disc herniation, nerve impingement, and the early onset of arthritis in the joints of the neck.
2. Forward head posture is strongly linked to decreased respiratory muscle strength and breathing ability, which results in up to a 30% loss in vital capacity in the lungs as well as a significant increase in cardiac and vascular pressure.
3. For every inch of forward head posture, it is found to increase the weight of the head on the spine by an additional 10 pounds. On average, this is over a 100% increase of weight bearing stress on the spine and it’s associated neuro-muscular structures.
4. A loss of the cervical spinal curve, due to forward head posture, can stretch the spinal cord up to 7 centimeters resulting in adverse neural tension. Subsequently, this causes additional tension of the meninges and elicits additional pressure on the brain-stem nuclei leading to increased compression and disruption of basic metabolic control functions and diseases.
5. Forward head posture results in an increase in discomfort and pain, due to disrupted proprioceptive and sensory input from the first four cervical vertebrae.
6. Forward head posture results in an anterior translation of the body’s center of gravity, which in turn results in a significant loss of balance and coordination, along with and increased probability of sustaining a fall.
Take a moment right now and get a sense if your head is balanced atop your spine. If your head is forward, think about tucking your chin, as if you were gliding your chin on a marble table. Don’t lift your chin of the “table.” And avoid the temptation to push your chin down onto the table. Simply glide your chin back. This lengthens the back of your neck, taking pressure off of nerves and muscles. Check your posture often during the day to make sure you’re not falling victim to the hazards of the hazards of forward head posture.
For more information on how physical therapists can help you improve your posture and the way you feel, visit our clinic website by clicking here. Or call our clinics at 251-2323 or 541-2606.
It’s that special time of year again when the Missoula Marathon is upon us this Sunday, and I’m sure the first thing that is on nearly every runner’s mind is what you will do after the race. After weeks of training and discipline, it’s only natural to want to let loose, go crazy, or just go home and take a nap. Here are a couple things that you will want to keep in mind after you cross that finish line to ensure you do not spend the next week in pain.
• Cool down : This is an important part of any workout. After your run, make sure you cool down with a walk or light jog for about a mile. This could be as little as walking around the expo area, but make sure you keep moving. When you stop moving your muscle will begin to stiffen and will cause you to hate your body for the next couple days.
• Rehydrate and refuel!: If there is one thing you MUST do post-marathon it is rehydrate. Focus on sports drinks. These drinks are more ideal then water post-Marathon because they will replenish the electrolytes you lost during the race. Make sure you drink at least 16 oz after the race even if you feel hydrated. Dehydration is common in post-marathon runners, so watch out for the signs such as headaches and dizziness. Make sure you also replace your body’s glucose levels by eating some bread or fruit. These simple carbs will help refuel your tired muscles.
• Stretching: Don’t neglect to stretch. It’s another important part of a cool down. Keeping your muscle long and loose will help you avoid severe soreness over the next couple days. Focus on stretching all your major muscle groups. If you need stretching ideas please come visit Alpine Physical Therapy’s stretching stations at the marathon this Sunday and at the expo on Saturday.
• Massage: Alpine Physical Therapy’s team of physical therapist will be at the marathon this Sunday offering massages for your sore muscles. Stop by for a quick massage and chat with a therapist. Massages are going for $20 for 15min! See you there and Good Luck!
Congratulations to all of Missoula Marathon’s runners out there. Make sure you treat your body to some stretching, carbs, sports drinks, and massage. Soreness is unavoidable post-marathon, but a strategic cool down can reduce it.
Long summer days open up many opportunities for 9-5 workers to get out and enjoy the outdoors. This is easier said then done. For many people finding the energy to actually enjoy your evening activities is hard. After working all day and then getting the kids to activities and running errands, it’s easy to see why many people feel too burnt out to get outside to enjoy the weather or exercise.
Lucky enough, the solution might be easier then you think. No, you don’t have to load up on 5-hour energy drinks or coffee that will probably end up keeping you awake all night. Rather, you may just need to adjust your diet. The foundation of this nutritional secret is in your blood sugar. Glucose levels in your body are directly related to your brain and how it preserves exhaustion. This is what happens when people experience sugar highs and then crashes. So how do you fix this?
1. Eat breakfast! Why? It’s the most important meal of the day! Research shows that people who eat complex carbohydrates such as whole grain breads and high fiber cereals and protein for breakfast rated their energy for the day higher then those who ate high sugar yogurts, smoothies, or other simple carbohydrates. These folks also had a lower BMI (Body Mass Index).
2. Eat every three to four hours. You’ll help to keep your blood sugars level by eating every three to four hours. You don’t have to eat a full meal. Instead, by eating a high fiber or high protein snack such as a protein shake or ½ a cup of Greek yogurt with granola, you’ll avoid the mid-morning and mid-afternoon crash. Eating every few hours also helps your body keep your metabolism elevated, which allows your body to constantly burn energy throughout the day.
3. Make lunch or breakfast your largest meal of the day. This is the opposites of most households which generally eat their biggest meal at dinner. But think about it. You eat food to give you energy for the activities you have to do. So why would you eat so much between 6 and 8pm? For most of us, after dinner activities consist of things like getting homework done, working at the computer, and getting ready for the next day. By eating your largest meals earlier in the day, you allow your body a chance to burn off all this energy. Eating a larger lunch also gives you the energy you need to hit the gym after work or enjoy the beautiful summer weather with a walk or a hike. Think of it like this: eat breakfast like a king, lunch like a prince, and dinner like a pauper.
As the summer solstice approaches, we move into a new season: the season of overtraining. The days get longer allowing for more outdoor training time, and the weather is nice which tempts us to cram in training sessions while we can. Add in the pressure that some of summer’s top events like the Missoula Marathon and the Missoula XC are just weeks away, and you have all of the right ingredients for overtraining and potential injury.
Any training will cause fatigue, but true overtraining requires going above and beyond tiredness caused by a few tough workouts. Overtraining is defined as chronic fatigue. This means listlessness and underperformance even after two weeks of rest are given and where no other medical condition such as anemia or mononucleosis can be identified as the cause. Other symptoms of overtraining include irritability, depression, and frustration with decreased performance. Unfortunately, this frustration will lead many to believe they need to train harder, worsening the problem. Other indicators of overtraining are loss of appetite, insomnia, loss of lean body mass, sluggishness, and frequent illness.
Highly motivated athletes may have a hard time avoiding overtraining especially because the optimal level of training stress will often take them right to the brink before crossing into overtraining. Elite-level coach and author of The Cyclist’s Training Bible, Joe Friel, calls this training load overreaching. This is an appropriate amount of fatigue that the body can then recover from with adequate rest. After many bouts of overreaching without rest, overtraining may be achieved. Friel places a huge emphasis on rest. He says that training doesn’t make you faster. Just training will make you tired; recovering from training is what gets results.
If you have been tempted into fatigue by the nice weather or a surplus of motivation, you can turn that around before you become overtrained. Don’t be afraid to rest until you feel energetic and ready to go again. Rest needs to include plenty of sleep, proper nutrition, and little to no exercise. Even active recovery or easy sessions may be too taxing on a body close to being overtrained. If caught at the right time, overtraining can be stopped, and your body will be rested and fast for the big races in July. Remember, in the words of Friel: “Train hard, rest harder.”
For more on overtraining visit Joe Friel’s blog by clicking here.
As the Missoula Marathon and other summer races approach, more and more athletes will be battling injuries hoping to make it to the big event. Many will place ice on those injuries, a convenient and inexpensive way to cool painful tissue and reduce inflammation.
However, ice is not always the right answer. There is a time when it will hurt, not heal. That time is right before exercise, a time when a desperate runner may be most tempted to use it.
Studies have shown that applying ice directly before exercise significantly reduces the strength and power output of the underlying muscle for up to 15 minutes after the icing had ended. Also, ice can hinder fine motor control and impair position sense of your limb. Ice is proficient at numbing pain, so training immediately after application can encourage overuse and further injury as sensation of pain is markedly reduced. There will be no warning signal of pain to indicate when exercise should cease.
After exercise, ice maintains its benefits to provide soothing relief. Just remember that ice doesn’t work around the clock. Muscles need to be warm before exercise so they can work properly and provide the right signals so you can train effectively and safely. A soak in a cold creek post-run is a different story . . . Yikes!
May marks the beginning of good weather in Montana and with good weather comes the need to clean and spruce up the house for the coming summer activities. Spring cleaning can be a challenge for many people living with arthritis. Here are some tips for minimizing your pain when cleaning:
Avoid Overexerting Yourself: Aim to clean just one room a day. This will prevent you from over using your joints and causing more inflammation.
Focus on High Traffic Areas: Sprucing up your house may not require a complete overhaul of the place. Start by cleaning areas of high traffic such as entryways and living areas. This might be enough to make the place look brand new without the need of days of vigorous cleaning.
Get the proper supplies: Cleaning is tough on the body’s joints and can be even tougher if you are not using the proper tools. Look for arthritis- friendly cleaning tools like long handled mops and duster can help avoid over reaching and climbing. Tips such as using magic erasers to clean tough stains of walls can up minimize the amount of muscle needed to remove the grime and all you need is the erasers and water! Also buying concentrated cleaners can help you avoid having to lug around heavy bottle while still giving you the cleaning power of the non-concentrated counterparts.
Letting Cleaners Sink In: Let your cleaners sit on tougher grime for a minute or two before scrubbing it. It will come off easier and save you the elbow grease and the extra stress on your joints.
Store Supplies Where They Are Needed: Storing your cleaning supplies where they are used most often will save you the strain of having to move them from room to room. For those living in multi-level homes having a set of supplies for each floor is a great way to avoid having to carry heavier objects such as vacuums up and down the stairs.
Inflammation is the body’s natural response to infection and injury. While initial inflammation is necessary for healthy healing, prolonged inflammation can actually decrease the body’s immunity and prevent tissues from repairing. Here are some tips to reduce chronic inflammation without the need for over the counter medication.
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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