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Knee pain

Hip pain, Knee pain, Spine

How to Protect and Strengthen Cartilage

July 19, 2016 • By

strengthen cartilageWhat if I told you that to keep your joint cartilage strong you need to put load on your joints – Not bike and swim?

Your articular cartilage forms the smooth covering inside your joints and often when someone has degenerated cartilage they are told to decrease loading and get into non-weight-bearing exercise – such as swimming and cycling.

strengthen cartilageIn a way this makes sense in that if you want to preserve and strengthen your cartilage, you wouldn’t run and jump and lift weights, would you? But our body doesn’t work like that, it responds positively to the force we put through it and really lives by the use it or lose it motto.

Recent research shows that:

Through putting load (body weight) on our cartilage we actually promote Transforming growth factor beta (TGFbeta) gene expression which helps to maintain our articular cartilage strength – That is pretty awesome.(1)

So without going into boring detail – By doing exercise which loads and compresses your cartilage, you actually help to strengthen cartilage and maintain homeostasis.

So get out there and walk, run or lift to keep your joints healthy – whether it is your knees, hips, back or any other weight-bearing joint.


Health, Knee pain

Torn Meniscus: Self-Treatment Exercises

October 13, 2015 • By

Often, surgery is not the best option – So what should home-rehab exercises look like for a torn meniscus?

In this second post in the series we look at your home rehab programme, covering exercises to reduce muscle spasm, improve balance and strength a well as an effective self-mobilization technique that will help you make big gains.

As we covered in the first post, a torn meniscus is a very common injury and there’s some important points when it comes to anatomy and surgery vs. conservative rehab, so make sure you have a read of that also.

So here is your self-treatment:

Rehab for a torn meniscus needs to cover four things:

  1. Muscle spasm
  2. Balance and muscle activation
  3. Graduated strengthening
  4. Joint mobility and meniscus healing

This is the order we need to start them in as well as the first step of your rehab is to settle the secondary symptoms, which is mainly muscle spasm and muscle switching off. This initially reduces pain, improves the range of motion and starts you being able to use it more – which speeds up recovery by helping you optimally load the knee.(1)

RICE injury treatment, heal strong and fastStep 1: Ease pain and improve range

First 72 hours:
As with most acute injuries, you need to first look after it, to allow initial healing – basically where the “scab” forms and to allow it to settle down.

 

Step 2: Switch the muscles back on, decrease spasm and improve balance

After the first 72 hours, it is important to prevent loss of muscle mass and get your muscles switching on again using some simple proprioceptive and stretching exercises:

 

  • Bosu ball, wobble board ankle and calf re-training rehab quickSingle-leg balance: The knee loses proprioception very quickly when injured (you can think of this as the “feeling” or the balance). So to get it back, you need to challenge your balance.
    • Level 1: Stand on one leg on the floor, when comfortable for 1 minute, progress…
    • Level 2: Fold up a towel and stand on this, when easy for 1 minute, fold it up thicker or
    • Level 3: Either roll a towel up tight or use a wobble board or bosu ball
  • calf stretch , soleus, gastroc - self treatment for shin splintsCalf stretch: Hang one heel off a step for 30 seconds at a time. Once per side.

 

 

  • Inner range quads torn meniscusInner range quads / Extensions: With knee injuries we lose activation of the distal thigh muscles, just above the kneecap very quickly. This is a nice and easy one (but still very important!). Sitting in a chair, or in bed with a towel under the knee, extend the knee by lifting the foot up to full extension or pain. Repeat this 20 times, every 2 hours.
    • Note: Do not force it, and take it nice and slow

 

Step 3: Start strengthening the knee

This is where it finally starts getting less boring! Start step three when it is comfortable to do the above exercises and remember not to push into pain.

  • correct squat form, strong and safeSquats. Yes these are great for getting your leg stronger again but it is important to start at the right level for you and progress from there through the following:
    • Level 1, Wall squats: Lean against a wall, with your feet shoulder width apart and out from the wall. Slide down the wall 1/2 range and no more. Hold this for 5-10 seconds and repeat 10 times. Tip: make this a bit easier on your knee by having a large round ball or Foam Roller between you and the wall.
    • Level 2, Double Leg Squats: Again, fee shoulder width apart. squat up and down within the comfortable range. repeat 10 times for 3 sets.
    • Level 3, Single Leg Squats: Now, standing on one leg, perform squats, within a comfortable range, 10 reps, 3 sets. Note: with this one you won’t be able to squat very low, and that is perfectly fine!
    • Technique: To take pressure off your knees, don’t let your knee/s go forward past your toes and it helps to stick your bum out further!
  • Cardio: Keep your fitness up and boost healing by utilizing:
    • Biking on a Exercycle ideally is great once you have over 90 degrees range in your knee
    • Swimming is a good one for un-weighted exercise, just stay away from breaststroke
    • Walking, as able. When you are able to walk pain-free for 1/2 hour, you can try a short jog and build from there.

Step 4: Gain full knee range

MTSS shin splints self treatmentThere are three things that will limit range mainly at this point: Joint stiffness, muscle tightness and the knee still healing.

The knee should continue healing, as long as it isn’t overloaded, so let your body get on with that.

Muscle tightness can be addressed by stretching out muscles such as your calf, hamstring and quads and also by foam rolling.

Last but not least, joint stiffness can be helped by self-mobilization to improve it’s bending and get the joint oiled-up. See the below video for a short and easy demo:


Health, Knee pain

Meniscus Tear: Heal Strong and Fast

October 5, 2015 • By

Meniscus tears are one of the most common injuries in sports and lead to a lot of time out from sports, swelling and pain. Here is what you can do to help your knee heal strong and fast and even avoid surgery.

Meniscus tears are, without a doubt the most common injury in the knee and the 5th most common injuries that present to sports medicine clinics.(1,2) With this in mind, we think it is important that you know:

  • What the meniscus is and how they get injured
  • What is better surgery or physio?
  • What are the best exercises you can do at home to heal strong and fast.

So let’s cover these three…


What is the meniscus:

meniscus tearThere are two meniscus in each knee, which are horseshoe-shaped and thicker on the outside to give a nice cup for your thigh bone to sit in. These give stability for your knee by adding a cup for the thigh bone to sit in and guiding the joint as it moves. The
meniscus also offer some padding between the two bones.

Meniscus blood supplyIt important to mention blood supply of the meniscus because this directly affects healing times. Only the outer 3rd of the meniscus has blood supplied to it, meaning in general healing can be slow for meniscus, particularly in the inner 3rd where there may be no healing response. In general, allow 12 weeks healing for meniscus tears.

 

How do they get injured:

Meniscus tears often happen with combined twisting and flexion, such as when you land and pivot on your leg after catching a ball or step out of the car and twist at the same time.
Think of it like this; Your meniscus sits between your shin and thigh bones. If your foot is planted on the ground and you are turning your body and pivoting way, this puts a huge amount of torsion through the meniscus. This combined with you body weight can often lead to a meniscus tear in many fast-moving ball sports – Makes sense right?

Common symptoms to look out for:

  • Pain on either the inside (more common) or outside of the knee-joint
  • Swelling, often a lot above the kneecap
  • Popping, clicking and catching
  • Locking of the knee joint, indicates a significant meniscus tear

What is the best treatment approach?

There are two main approaches for meniscus tear

  1. Surgical repair via arthroscopic surgery
  2. and conservative treatment which generally involves physiotherapy and strengthening exercises

There was a groundbreaking study done in 2002 which really made a lot of health professionals and surgeons take note. They took a group of patients with degeneration in their knees (arthritis) and split them up so that some of them had arthroscopic surgery, but some of them just got incisions in their skin so that it looked like they had surgery. The outcomes between the groups were no different.(3)

Since then a lot of further studies have been done, looking at meniscus injuries and whether surgery is better than conservative rehab and this is what they found:

  1. There is no significant difference in functional outcome between Physio and surgery (4)
  2. For degenerative meniscus tears, there is no difference between surgery and placebo (5)
  3. Arthroscopic surgery and strengthening is no better than strengthening alone in degenerative meniscus tears (6)

Conclusion: We really need to split meniscus tears into 2 groups; there are degenerative tears which are due to wear and tear and then there is acute meniscus tears which occur from one accident/incident. We can safely say that for degenerative mensicus tears surgery is not the answer and should be looked at only if conservative rehab fails – even the American Academy of Orthopaedic Surgeons state: “We are unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus.”(7)

When it comes to acute meniscus tears though, it gets a bit more complicated. Surgery definitely can help here, but as a general rule, only if there is:

  • Instability – Knee giving way and you can’t trust it
  • Locking up
  • Or if conservative rehab does not have good results after 6-12 weeks.

So if you have a meniscus tear, whether degenerative of acute and have no instability or locking up, then the best thing for you is to get onto a good rehab and strengthening programme and give it a good shot before jumping to the scalpel.

Follow this link for the second post in the series which details a simple home-exercise programme for you to follow.

 

 


Health, Knee pain

Knee pain: This is what works

September 18, 2015 • By

anterior knee pain patellofemoral painThere is an indisputable amount of evidence now that when it comes to anterior knee pain exercises… we can’t just treat the knee.

Here is a short and sharp explanation of why and what we should be doing:

 

Often people are told to strengthen up their quads and get their legs strong to help knee pain but really is this the best way to do it?

The answer is no. There is a lot of evidence when it comes to anterior knee pain (also known as patellofemoral pain) that rehabbing proximally is much more effective the strengthening the knee and quads alone. Proximally means working on the muscles further up the chain, closer to your spine, such as your:

  • Core/abdominals
  • Hip abductors
  • Hip external rotators

In fact, a thorough systematic review was published recently which showed that compared to quads strengthening:

  • There is strong evidence that proximal rehab, combined with quads strengthening had better pain reduction
  • Proximal rehab alone and combined with quads strengthening results in better functional gains
  • Proximal rehab, was better in the short and long-term.

This basically shows us that when it comes to knee pain, it isn’t often the knees fault. We need to look up the chain at what controls the knee – The hip. Including rehab exercises that improve him strength and neuromuscular control has much better effects in outcome in both the short and long-term and cannot be ignored.

 

So what exercises should you be doing?

Type of exercise: This should be a combination of closed chain (feet/foot in contact with the ground) and open chain exercises in a comprehensive rehab program.

Frequency of exercise: Exercises that aim at neuromuscular training and stretching/foam rolling can be performed daily, whereas strength training should be aimed for 3 x weekly.

What knee pain exercises work well?

Follow this link for a great post for the rehab exercises to get you started!

 

Conclusion: Proximal rehab should be included in all rehab programs for anterior knee pain and if in doubt, go and see your local physio for best results.


Health, Knee pain, running

IT Band Syndrome: New research, New Rehab Rules

November 23, 2014 • By

Patellofemoral pain - home rehab exercises and adviceAre you sick of trying to fix your IT Band Syndrome by stretching, strengthening or foam rolling your Iliotibial Band?

Good news, you don’t need to waste your time with that any more. Here you will find a clear summary of what really causes IT Band Syndrome and what you can do to really help it. All based, as always, on current research and good old-fashioned experience from a runner and physiotherapist.

IT Band Syndrome is a common overuse injury in runners and cyclists and is commonly thought of as a friction syndrome. Recent evidence shows that it is not due to friction and that there are some easy treatments and exercises that can effectively treat it.

 

First of all, the one myth that needs to be sorted out is this: IT Band Syndrome is caused by friction, from he IT Band rubbing over the lateral knee

IT Band Syndrome IS NOT CAUSED BY FRICTION and the IT Band CAN NOT SLIDE OVER THE LATERAL KNEE

In actual fact, IT Band Syndrome is caused by compression of the IT Band. Lets have a quick look at the anatomy so that you can see why this is:

IT Band SyndromeThe IT Band is a thick tract of connective tissue which connects up your hip muscles to the knee and helps stabilize the knee in the process. It originates from the Gluteus Maximus and Tensor Fascia Latae muscle (see in the image to the right) and ends up attaching into the tibia (right up the top of your shin bone).

Before attaching into your tibia, the IT Band crosses over the lateral femoral epicondyle (where IT Band Syndrome pain is felt). For years it was thought that the IT band slid back and forth over this epicondyle as your moved your knee (and this is still far too popular theory: 1,2,3). Fortunately it has been proven through studying cadavers and use of MRI that the IT Band is actually anchored to the femur by fibrous strands and so cannot actually slide – so no friction. The MRI’s also showed that at this point, underneath the IT Band is a layer of fat, full of little nerves and blood vessels, making it very sensitive, especially when compressed.

So from this, based on anatomical findings at least (which are hard to argue with) IT Band Syndrome is associated with compression of the sensitive layer of fat beneath the IT Band rather that friction.(4) This knowledge of the IT Band and it’s attachments isn’t all that new but has unfortunately been overlooked and ignored for too long. A big driver behind the myth of ITB friction syndrome is the perception that movement of the ITB across the epicondyle can be felt, but this is an illusion because of changing tension in its anterior and posterior fibres.(5)

ITB syndrome is a repetitive strain injury caused by the IT Band compressing the layer of fat beneath it. The factors leading to this happening are thought to be:

  • Increased hip adduction (the leg moving inwards, towards the opposite leg)
  • Increased knee internal rotation (7)
  • Impaired function of the hip muscles
  • Poor running technique

The good thing is, if these biochemical issues are found and addressed, a resolution can be found.(6)

So, here is how you should go about treating your IT Band Syndrome the right way.

1. Get a biomechanical assessment done by a sports physio or similarly qualified health professional. This should look at the strength, control and endurance of your hips, whether your have hip drop etc and ideally should look at how you are running, cycling etc.

Tip: As well as this, you can do a quick test at home – See this post to find out how easy it is.

2. Start your rehab exercises

3. Make sure that your running technique is spot on – Your physio can help with this, or check out this post for some easy tips.

4. Shoes: Make sure that you shoes aren’t too old and worn and ensure that you do not drastically change shoe style e.g. go from a cushioned, controlling runner to a minimal Nike or Vibram all of a sudden.

 

Lastly, if you have any questions, feel free to ask them and please share if this has helped you.