Knee Pain

Knee Joint Cartilage Tears

 What is a Knee joint Cartilage Tear?

The two types of knee joint cartilage tears  include traumatic and degenerative tears.

Traumatic tears occur through twisting injuries of the knee and degenerative tears occur over time through wear and tear on the joint.

 Do Cartilage Tears heal?

It depends on the location and severity of the tear. The meniscus (cartilage) generally has poor blood supply. The outside one third portion of the meniscus had some blood supply, which may give tears in this location a chance to heal. However, the inside two thirds has no blood flow, therefore tears in this region have no chance to heal. These tend to require arthroscopic surgery.

How do you treat knee joint cartilage tears?

 Small meniscal tears, or tears in the area receiving good blood supply can respond well to physiotherapy.

Physiotherapy treatment for meniscal tears aims to decrease the pain and inflammation in the joint, restore normal movement around the joint and muscle length. Physiotherapy will improve the strength of the hamstrings and quadriceps and hip muscles. Physiotherapy will also correct any longstanding biomechanical issues surrounding the knee joint.

Overall, the knee joint will improve in function and will have a reduced chance of re-injury.

How long does a knee joint cartilage tear take to heal?

MeniscKnee painal tears generally take 6-8 weeks to heal, although some meniscal tears require surgery. Your physiotherapist is the best person to guide you on the most appropriate course of action to recover. Typically, avoiding high impact activities that stress the joint whilst seeing your physiotherapist is key to a optimal outcome.

If you suffer from knee pain or knee injurt, it is advisable to start treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your knee pain and muscle spasm.

If you have suffered knee pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as the causes and treatment of knee stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our knee physiotherapists.

 

 

Ligament injury of the knee: When to see someone.

Imaknee injurygine this scenario: You are playing sport on the weekend when you step hard to change direction and your knee buckles underneath you, leaving a sharp searing pain in your knee.  You hobble off to the sideline and ice the knee straight away.  The next day you go and visit ED who send you for an XRAY which shows no broken bones.  Great you think, though its pretty swollen so yo plan to give it a week or two to settle before getting back to sport.  But the knee doesn’t feel right, maybe the pain doesn’t go away, maybe it feels unstable, something is definitely wrong. But what?

The above scenario is common to most physiotherapists, and highlights the need to seek a definite diagnosis as early as possible in a knee injury.  Most of the time a knee injury will be minor and not result in any significant ongoing problem but sometimes that is not the case.

Injuries to the knee

The knee is a large stable joint that is actually made up of two joints: the tibiofemoral and the patellafemoral components (three if we include the proximal tibiofibular joint.)  The stability of the joint is largely created by strong ligaments, large congruent articular surfaces and powerful muscles.  The stable structure of the knee allows it to perform its role whilst subject to large amounts of load during physical activity.  Accordingly, traumatic injury to the structures within the knee can lead to loss of stability and function.

the knee anatomy

Ligaments – There are 4 main structural ligaments of the knee that are usually considered during knee injury (remember though there are many more ligaments in and around the knee that have important functions and can get injured too)

  • Anterior cruciate ligament
  • Posterior cruciate ligament
  • Medial (or tibial) collateral ligament
  • Lateral (or Fibula) collateral ligament

These ligaments provide resistance to force in almost all directions and are injured when the force exceeds their capacity to respond.  For example, the medial collateral ligament is often injured by a force applied to the outside of the knee, forcing the knee open on the inside (a valgus force.)  Ligament injuries that are missed or poorly managed can result in:

  • Increased instability of the knee.
  • Ongoing pain.
  • Reduced function.
  • Risk of further injury including meniscal and cartilage injury.
  • Accelerated degeneration of the joint leading to osteoarthritis.

Meniscus and cartilage – The cartilage of the knee has a role in reducing friction and to act as a shock absorber within the knee.  It is particularly vulnerable to traumatic injuries, often in conjunction with ligamentous injuries.  Healing is variable and can be poor due to a number of factors including poor vascularisation (blood flow.)  Appropriate conservative management early can improve the chances of a good outcome.knee injury mechanicsSource: Anatomy & Physiology, Connexions Web site.  http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

When to see someone 

Always!  It is always in your best interest to make an appointment for assessment by a practitioner who is experienced in diagnosing and treating musculoskeletal injuries as soon as practical after a knee injury.  Commonly used diagnostic tests including XRAY and ultrasound are often not adequate for diagnosing common knee injuries.  Clinical suspicion of a major knee injury can be followed by MRI imaging and referral to a specialist as necessary.  When an injury calls for conservative management, early diagnosis and correct treatment allows for improved management and outcomes.

Clinical example: Medial collateral ligament injury

MCL injury can be split into three grades:

  • Grade I – Involves a tear in a small proportion of ligament fibres
  • Grade II – Involves partial disruption to the ligament
  • Grade III –  Complete disruption to the ligament often resulting in instability of the knee and possible injury to other structures.

Whilst all are usually managed conservatively (with the exception of some grade III injuries) grade II-III injuries that are managed poorly can result in ongoing instability and pain in the knee.  Most Grade II and III injuries will be treated for a period of time in a range of motion brace that limits valgus stress to the knee, as well as physiotherapy intervention including swelling management, range of motion exercises, strengthening of the muscles of the core and lower limb, proprioception and walking and/or running retraining.  Recovery is dependent upon unloading and protecting the ligament while it heals, so early accurate diagnosis is crucial.  In the event that the knee remains unstable following immobilisation, surgery may be required.

So always see your physiotherapist or sports specialist after a knee injury.  They can help guide you on the path to recovery as soon as possible.

Running With Injury – Is It Time For A Rest?

Running With Injury – Is It Time For A Rest?

If you’re a runner, chances are you’ve asked yourself this question. Up to 80% of runners will sustain a running-related injury at some point. If we include running with a cold or flu, then the number jumps to 100%. The question is, do you rest, modify your training or continue on as if nothing’s wrong!

running-rest-day-myths

running-rest-day-myths

Whilst we’re all different and each of our circumstances unique, here’s what I suggest you think about as you contemplate whether to strap the shoes on or stay in bed:

  1. Is it acute? If you suffered an injury significant enough to cut a training session short, you should take 48-72 hours off, give it a chance to settle and throw some ice on it. If it’s still troubling you after this rest period, get it seen to.
  2. Is the injury bad enough to affect your running style? If you can’t run with your normal gait, continuing to train will lead to a worsening of the injury or a secondary injury somewhere else. We see this all the time. Take some time off, cross-train, and/or see a professional.
  3. Is this a recurrence of an old injury? Keep an eye on these ones. It may just be that your brain (and your genes) have some ‘memory’ of the old injury, but always better to get on to managing these injuries quickly. If you do, you can usually stop them from progressing.
  4. Is the injury getting worse? In most cases, if you record a worsening of an injury over the previous week of training, it’s not going in the direction you want! Take some time off and consider getting someone in the know to have a look at it.
  5. Is your ‘cold’ more than just a ‘cold’? If your symptoms are typical for an upper respiratory tract infection (sore throat, sniffles and other things above the neck) then you’re probably ok. Research suggests that training in this situation wont make you worse or slow your recovery. However, if you have symptoms of a fever or cough (i.e. anything below the neck) then you need to rest, or there’s a good chance you’ll regret it!

I hope these tips help, but regardless of your answers, as you start to feel better and make your way back into training, back off a little and build your training up slowly. Taking some time off and then jumping straight back in is one (if not the most-likely) reason for problems to occur.

Most injuries are simple to manage with a common-sense approach. Be wary of reading too much on the net, as there’s an awful lot out there and a lot of it is…not prudent advice! If you’re unsure whether you need to see someone, set up a Skype appointment with one of the expert Sydney Physio Solutions Physiotherapists. They’ll ask you a series of questions and help you wade through the plethora of information available to advise you how best to tackle it.

No pain, no gain

No Pain No Gain??

One of the most common things we get asked is how much pain is acceptable?

We watch images of pro athletes pushing it to the limit and we hear stories of people smashing themselves day in day out…but the question always remains…how do we know when to push and when to hold back?

The question is an interesting one and the answer (of course) is not a simple one.  There are many contributing factors….I’ll try to explain the most common ones.

  1. How used to this kind training are you?

If you have gone from a relative couch potato to captain motivation overnight you are HIGHLY likely to get injured.

Sudden changes in exposure of our bodies to unfamiliar movements means that we are often poorly prepared to cope.

SOLUTION:

Engage in a progressive demands system

Start light and easy and progress your exercise demands slowly

If you are completely new to exercise it may even be worthwhile in the long run to be assessed by a physio/exercise physiologist for identification of biomechanical ‘risk factors’ (e.g. tight calfs, flat feet, poor lumbopelvic stability) and integrate some preventative training into your actual training.

  1. The pain disappears when you are actually running, only to stiffen up again after you’ve rested

WHAT THIS MEANS:

Unfortunately pains that settle with more activity can often mean the tendons are struggling with the change in load.

SOLUTION:

You may have to reduce your training load if this is happening, identify what tendon is causing the trouble and treat it locally with ice and targeted exercises.

In extreme cases you can use GTN patches to reduce the tendon pain but you will have to talk to your physio/GP/sports physician to make sure that this approach is right for you.

 

  1. The pain comes on with training and then just gets worse and worse until I physically have to stop.

SOLUTION:

Stop

This is not ok pain.  If the pain is in your legs it can be a compartment syndrome (where the muscles swell and are compressed within the fascial outer casing of the muscle) or it could even be a stress reaction in the bone.  Either way you need to get this looked at by someone who knows their stuff.

 

  1. My muscles are sore for up to 3 days following activity, but then they feel fine.

WHAT THIS MEANS:

Well Done

You are experiencing delayed onset muscle soreness…this is the no pain no gain they talk about.

You have exercised just enough to cause damage to the muscles, but it will be repaired and new, improved sarcomeres (the building blocks of muscles) will be laid down.

It is however a good time to rest for a day or two while you are sore, or cross train by doing something different (go for a swim or hit a few tennis balls gently).

Overall some discomfort is a acceptable with training, but if it is impacting your ability to perform regularly you must get it checked out.

Stuart Doorbar-Baptist | Senior Clinician and Research

Knee Braces

Do knee braces cause muscle wasting?

It’s often stated that knee braces can cause muscle wasting, if used for too long. However there has been very little research into this. A study this year (2016) by Callaghan et al. (reference below) assessed 108 patients using braces for OA of the patella-femoral joint. They found that the maximum voluntary contraction of the quadricep (thigh) muscles did not reduce with brace use.

So it’s fine to use a knee brace?

All studies have limitations. This study only assessed a flexible knee support, so we can’t apply the findings across all knee braces – these will need to be assessed separately.

Any other limitations?

Yes- the study was only over 18 weeks. We do not know what would happen in people who wear braces longer than this.

In summary?

Using a flexible brace appears not to have a detrimental effect on the quadricep muscles in the short term. Anyone wishing to wear a knee brace longer than this period should discuss this with their physiotherapist.

Reference: Callaghan M, Parkes M, and Felson D  2016 The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis

Journal of Orthopaedic and Sports Physical Therapy

Knee3

How to Avoid Overuse Running Injuries

With all the marketing hype around, you might be forgiven for thinking that footwear is the key to preventing running injuries. Especially now, with most runners at least aware of the “barefoot” craze, it’s becoming harder to know what is the right shoe. The “old” advice around finding the right shoe for a particular foot-type is slowly being tested, and the trend is towards a more lightweight, minimalistic running shoe.

This phenomenon is primarily due to Chris McDougall’s book, that I’m sure everyone has read or at least knows the context, and to a study published in the British Journal of Sports Medicine. There will likely many more studies popping up in the next couple of years to corroborate these findings, as this is a big shift in thinking around footwear and running.

The study, by Ryan et al., showed that matching the “correct” shoe to a foot type had no effect on injury rates in a group of 81 female runners. In fact, those that received the “correct” shoe were slightly more likely to get injured. I think it’s important not to take this conclusion too far, as this was a relatively small study and had some major limitations. It does, however, give some credence to the view that we need to reassess the way we professionals in sports medicine approach running footwear.

While a bit un-scientific, selecting a shoe based on comfort is probably our best bet at present. For example, a study on 206 military personnel, who were allowed to select a foot insert based on their feelings of comfort, showed a significant reduction in injury rates, even though the inserts often had no association with their “foot type” or what would normally have been considered the appropriate insert for their foot. If you have a specific injury, or history of injury, affecting your foot then a consultation with a good physiotherapist or sports podiatrist is probably appropriate.

Anyway, regardless of all this hype and innuendo, a far more important issue than footwear is how you manipulate your training variables. Some studies have suggested that up to 80% of overuse running injuries are attributable to training errors. How you build your training up—including mileage, terrain, speed, and frequency—is the most important single consideration in avoiding a running injury. Regardless of what shoes you wear, how you run, how tight your hamstrings are or how poor your core control, the body needs to adapt to new loads. If you haven’t run much before, or you’re ramping up in preparation for an event, how you choose to do this will be the major factor in determining success or injury.

The 3 keys to avoiding running injuries:

1) Plan your event preparation, including the training variables of mileage, terrain, speed, frequency and, of course, the rate of increase in these variables. Discuss your plan with a sports medicine professional as well as a coach.

2) If you’re unsure on the footwear issue, discuss it with a professional. At present, research evidence suggests that you select a shoe that is comfortable for you, rather than one that has been “prescribed”. The way I address this is to give you a few options and suggest you go for a run around the store and select the one that feels the most comfortable.

3) Have a good biomechanical assessment – it’s a small investment in the overall scheme of things and will allow you to deal with pre-existing issues and risks, and help to prevent further problems.

…and it really is preventing an injury that is the key. Once an overuse running injury has occurred, it’s much harder to fix the problem and get you back on track.

What should be covered at the 3-month check up? This is probably the most critical point in preparing for an event. Identifying problems at this stage gives us the time and opportunity to fix the issue before it takes you out of training or results in a serious injury.

The key elements are:

• Discuss previous history of injury and any current niggles
• Assess weaknesses and areas of potential overuse injury
• Discuss your training plan and current fitness level
• Discuss your footwear
• Assess running mechanics using video analysis
• Establish a plan to avoid any potential injuries

 

If you suffer from running injury why not contact the team at Sydney Physiotherapy Solutions to make an appointment at either of our Sydney CBD physiotherapy clinics or at our recently opened Chatswood Physiotherapy clinic.

5 Fun Facts about the Knee

knee-diagram

1. There are four major bones in the knee, the femur, the tibia, the fibula and the patella. That means that there are three joints as part of the knee complex, the knee joint between tibia and femur, the patella-femoral joint, kneecap and femur and the superior tibia-fibular joint

2. The knee has 14 ligaments. 7 intracapsular ligaments including the anterior cruciate (ACL) and posterior cruciate (PCL). 7 extracapsular ligaments including the medial collateral (MCL) and the lateral collateral (LCL)

3. The function of the knee is particularly important for weight bearing activities, such as walking, running and going up/down stairs. The load distributed over the kneecap can be up to 5 times the body weight, particularly on going down stairs.

4. Babies are born without kneecaps. They don’t appear until the child reaches 2 to 6 years of age. Technically newborns do have kneecaps, however, they don’t show up on x-ray very well because they’re not ossified, or bony

5. The knobbles on our knees are all different. It has been suggested that they may be as unique as irises and fingerprints – and research has started into the possibility of implementing an MRI scanner that works at knee-level for airport security systems.

If you are having problems with your knees please feel free to contact one of the Sydney Physiotherapy Solutions team at our Sydney CBD or Chatswood Physiotherapy clinic

Protect Your Knees when Skiing

With winter approaching, Physio’s are getting ready for the influx of knee injuries from the slopes. Although knee pain from the kneecap is very common, the far more serious problem we often see is an ACL rupture. This is the ligament right inside the knee and it can get damaged from twisting injuries. Although obviously not all skiing injuries can be avoided here are a few simple tips to best look after your knees whilst skiing:

  1. Train your legs for at least 6 weeks leading up to your skiing holiday. Focus on gluteals, hammys and quads especially in single leg loading exercises.
  2. If you have the luxury of spending a long time on the slopes think about building up gradually to a full days skiing (especially if your body is just used to sitting all day) – also think about rest days to reduce injury from muscle fatigue
  3. Skiing technique – this is something you are probably going to need a ski instructor to help you with. Good form will inevitably lead to reduced injury.
  4. Binding setting – check with your ski technician these are set correctly for you and are functioning correctly. If you fall and your binding doesn’t release it will increase your chances of twisting at the knee joint!
  5. Of course most importantly if you are worried about a knee injury make sure you stick to your comfort zone! Happy skiing.
    Skiing

    Skiing

Pilates for Runners!

I spend at least 50% of my day treating injuries caused by running! Most of these injuries could have been avoided if my clients had adequate control of their pelvis and lower limbs so they could run with good technique.

I know some patients find Physio exercises to be super boring and hard to keep up with once your pain settles down, which is why I suggest my patients join Pilates… or more specifically ‘Pilates for Runners!’

Pilates for Runners classes involves functional strengthening of the butt, abs and thighs in running specific positions. This means we do plenty of single legwork to practice stabilising the pelvis for running.

I find my patients really enjoy the classes and even once they are pain free and have improved their running form they stay on for maintenance as they  find it reduces their incidence of injuries.

If you don’t have a specialised ‘Pilates for Runners’ class in your area – a general Pilates class is a great start! I would struggle to think of a client who wouldn’t benefit from having a bit more Pilates in their life!

Running Injury Free

running Tberg

Every year when the running season starts to pick and more and more recreational runners start to enter into events like the Blackmores Half or Full Marathon and even some of the international events like the New York or Boston Marathon we see an increase in the same running injuries.

Common injuries that are usually a result of a certain factors that can be changed.   One factor is the periodization of the training program.   This means the progression of volume and load that you’re subjecting your body to.  Another factor is muscle strength and stability, for example, poor hip strength leading to poor knee mechanics.   And lastly running technique has a huge impact on injuries, whether it is high ground reaction forces as you land hard and pound the pavement or things like over striding.

All of these factors can be altered whether it’s through strength training at the gym, running drills and/or sitting down and planning a run program that will see proper running progressions.

First of all its important to find someone who can help you identify what the issues may be but then you must know how to implement it.

Here are a few key points to consider

  1. Training program- Instead of just going out and running distances you feel like you’re comfortable with, sit down and actually plan your distances.  The program should included different intensity runs to train all your energy systems.   Sprint training for short durations to increase your anaerobic system.   Tempo runs to target your lactate threshold and really learn how to push your race pace.   Long slow distances to increase your aerobic capacity and get some more KMs under your belt.  I generally look to increase your weekly volume by a steady 10% each week for safe progressions and would suggest that every 4 weeks is a recovery week in which you reduce volume from the previous week to allow your body to recover and prep for the next 3 weeks of increasing workload.
  2. Leg Strength- Make sure that you’re training your hip stabilizer muscles such as gluteus medius to ensure running efficiency.  You will most likely need someone to visually look at your running and single leg control to figure out if you’re lacking stability but you could start with doing some single leg squats in front of a mirror.   Compare sides to see if you can find a noticeable asymmetry between them.  Watch your knees and see if they collapse inward.
  3. Have someone film your running from behind and side on.  Look for the foot  to land under your hips and torso not out in front.