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knee pain

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

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, running

Running Myths Busted

December 8, 2014 • By

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From heel landing, stretching to make you faster and shoes for different arch heights, we aim to clear up these murky waters with 5 of the biggest running myths busted.

running myths busted

It is estimated that over 35 million people run in the USA alone for exercise or for sport(1). Runners are living in a confusing, challenging and ever-changing world. There are so many conflicting opinions out there about what shoe you should wear, how your foot should be landing, whether you should lean forward or not, stretching is bad for you… I could go on but, but I’m sure you get my point!

This conflicting information needs to be cleared up. For you, the runner – whether it be for fitness or competition – and for us health professionals, because we as often as anyone else are always on the look out for the exciting new bit of research, the next quick fix or magic bullet for running injuries. With the incidence of running injuries ranging from 26% upwards, we need to be doing the right things and know what will and will not help us.(2)

 

So what are the biggest 5 running myths busted?

1. Buying running shoes based on arch height help prevent injury

pronated foot - 5 running myths bustedWhether you have high arches, low arches or neutral feet – Having shoes prescribed for this does not reduce your injury risk. Between us we all have such a great variety of foot shapes,  which obviously can’t be nicely placed into 3 boxes(6).

You can read more here.

 

2. Stretching helps prevent injury

Even though this is the factor most often thought of as the cause behind running injuries, it is simply not true(3). There is a very common belief around the world that stretching before, during or after exercise decreases the chance of injury and improves recovery, but in actual fact it has been shown that stretching is not protective of running injuries (4). Static stretching could even affect your performance.(12)

It does need to be mentioned though that often stretching is mistaken for warming up. Warming up is defined as a period of prepatory exercise to enhance subsequent training or exercise(5). Warming up does help and has been shown to significantly reduce the risk of injury.

 

Mo-Farah-core strengthening3. Runners don’t need to strength train

Good, run-specific strength and conditioning can really help your running.

Your joints will be better protected, you will have less injuries and you will run faster! Ideal (7, 8, 9, 10).

Just remember, it isn’t all about the strength, you need to have neuromuscular control. This means making sure that you training is functional and running specific.

 

4. Minimalist/ Barefoot shoes make you run better

It isn’t about the shoe, it is about HOW you run. Yes, landing on your mid-foot when running reduces the load though your lower limb and reduces risk of injury, but this is altered through your technique (such as increasing your cadence or driving through with your knee) and not through shoes.(11)

First, look at you running technique, then your shoes.

 

Mo Farah5. One running pattern is right for everyone

As Bryab Heiderscheit writes “There is too much heterogeneity among runners to believe that one running pattern is universally ideal”(13). For example, changing running style to promote forefoot or mid foot strike may unload the knee and shin pain but it would be wrong for someone with  for example a stress reaction or inter-metatarsal bursitis.

Rather, this paper suggests that we may be better off showing people how not to run, giving a couple of things that do lead to poor economy and increased injury risk. These would be things such as not over-striding (foot landing well ahead of the center of mass) and not bouncing up and down too much.

You simply cannot put everyone into the same box – but there are some aspects that do benefit the majority, and these should be promoted.

 

So there are your 5 running myths BUSTED – what do you think? Surprised?

 

 

It is important that we embrace an approach that is not one size fits all, and that is holistic in nature, that takes into account nutrition, goals, ability etc. The other big thing that needs to be looked into further is training error, which has been estimated to account for over 70% of running injuries. This is a huge amount of injuries that are due to training error (running too far, too fast, too long, too soon) – Maybe more needs to be done to place some guidelines around training progression and the best way to go about this. Especially for beginners as they have a 2-3 x higher risk of injury.

 

I would love to hear your thoughts and feedback on these running myths, see the comments section below or find me on twitter.

 

Yours in good health,

Shaun

 


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.


Health, Knee pain

How to Prevent ITB syndrome: IT band exercises

July 28, 2014 • By

ITB syndrome can be painful and difficult to treat, BUT with the right pre-hab and IT band exercises, YOU don’t have to worry about any of that!

Prevention = Cure!

 

ITB syndrome is all too common, with up to 12% of long distance runners affected and a huge 22% of US marine recruits suffering from this, it is a very, very important problem to not only treat right but prevent. This leads to less time out from sport, training and work  – and more time doing what you love!(1,2)

So to prevent this, we need to sort out the risk factors – lessening the chances of you having to take time out.

The main risk factors are:

  • Downhill running(4)
  • Weak or inhibited lateral gluteal muscles (you hip stabilisers e.g.Gluteus medius)
  • Running around a track a lot in one direction
  • And greater than normal weekly mileage(3)

Now from that you can likely see that three of those points are easy to sort out. You can decrease downhill running and vary up your training more. you can run in both directions around a track, if you run n one. And you can make sure you don’t increase your training miles by more than 10% per week – No problem.

But having weak lateral hips – That’s something we really need to work at.

When your hip stabilisers don’t fire up or are weak, this leads to poor control of your pelvis ad hip abduction. Because of this, other muscles have to compensate for this deficit, leading to tight muscles and poor hip extension. This is a big problem, particularly in runners and studies have shown that runners with ITB syndrome do have weaker abductors in the affected leg.(5)

ITB syndromeOne of the muscles that takes over is your tensor fascia latae (TFL) – meaning it is working harder, often leading to spasm and tension. The clincher is that your TFL attaches into your ITB – That means if TFL tightens up, this tensions the band, making it tighter and tighter – causing compression at the knee and pain for you.

 

 

So here is the IT band exercises that we need to do:

  • Strengthen your lateral hip muscles
  • Improve glut activation
  • Loosen off and stretch compensatory muscles – e.g. TFL

 

The following exercises will do this and put you well on your way to being injury free!

1. Side plank

side plank for core strengthening

 

Level 1: Rise up into the position shown and hold for 30 seconds. Each time hold it for a little longer so that eventually you can hold it for two minutes.

Level 2: When you can easily hold it for two minutes, try doing side plank leg raises. This is where you rise into the side plank and then lift your top leg straight up and down. Begin this with 3 sets of 5 repetitions and build up, until you can do your goal of 30 in a row! (easily)

Note: If level one is too hard – bend your knees, so that you are lifting off your elbow and knee.

The side plank is great to getting your lateral gluts firing together with your obliques – just make sure you do not stick your bum out – bring it forward so that your body is straight.

2. Donkey kicks

Donkey kicks improve glut activation

Start on your hands and knee as shown and kick your leg out behind your slightly up towards the roof.

Perform 3 sets of 8 reps.

Note: to make this harder your can be on your toes instead of your knees on place your elbows on a gym ball.

 

 

3. TFL myofascial release

tensor fascia latae and itb myofascial releaseasis anterior super iliac spineThe TFL is, as you can see the image below a little muscle at the side of your hip. to find it, place your fingers on your ASIS which are the bones on either side of your pelvis at the front. From the side of these, drop down a couple of inches and you should be right on it!

I want you to lie on your side and place a ball under your TFL – you can use any ball you like, massage ball, lacrosse ball, tennis or golf ball. Then slowly roll the ball around that area, working out all the knots and tight spots – this can take 2-5 minutes but is well worth your time!

And remember, a bit of trigger point pain is expected here.

 

Interesting note for runners: Having a higher cadence (quicker strides) has been shown to lower the risk of ITB syndrome. This is because when you increase your cadence (which should ideally be 180 steps per minute) your land with your knee bent more and your foot below your knee – decreasing the force through the knee and making for more economical running.(5) This also links in with downhill running being a risk factor – when running downhill we land with our legs much straighter a position, placing a lot more force on our knees and hips.

 

And remember. You are much better off putting in a little bit of time now that spending a lot of time AND money when when you do get injured.

Invest in  yourself