Knee and Leg Archives - Jeanne Marais Physiotherapy

Arthritis

Conditions — Thu, 04 Jan 2024 08:49:09 +0000

You have arthritis. What now?

The closed ended diagnosis of arthritis can feel like a death sentence:

Wear and tear.
Your joint surface is damaged.
The damage is responsible for your pain.
Using the joint will damage it more.
You need to stop doing the activities you enjoy.
You’ll be stuck on stomach and kidney-destroying medication which only take the edge off on some days until you fuse or replace the joint.
Cortisone injections might help if they don’t cause more damage.
Scraping the joint may buy you some time but the damage is done, and the joint replacement is inevitable.

Unless you’re looking for a reason to have an operation, please ignore the dooms-day inaccuracies above and continue reading… This is the perfect time to learn that surgeons are best geared to offer surgical solutions, but they aren’t that well versed in the alternatives to surgery because that’s simply not their job. The same goes for GPs, radiologists, your best friend and the internet. Its also not too late simply because your pain has been ongoing for years or because you picked up weight at some point in the past.

Be kind to yourself while considering the following:

A diagnosis based on your symptoms and history alone is at best an easy guess.
You’ll usually get different guesses from different people – whether they are qualified to have an opinion or not.
Scans don’t tell the full story outside of traumatic injuries for musculoskeletal problems. Since we can’t see function on a scan, it already assumes pain must have a structural cause and any findings (even harmless ones) are incorrectly assigned to the cause of your symptoms.
The good news is that we see bona fide arthritis in the totally asymptomatic population just as often as what we do in people in pain.

This doesn’t mean you don’t have arthritis, and it doesn’t mean that arthritis isn’t causing your pain, but it does mean that scans and x-rays are unreliable in determining the cause of your pain and if you believe the x-ray, you may be shacking yourself up with an irrelevant diagnosis while missing the solution to the symptoms plaguing you.

Clues to suggest that your “arthritis” may not be the cause of your pain:

Relief with pressure: Even if this only happens occasionally
Migrating pain: Shifts in where the joint hurts or which joint hurts
Whole limb complaints: If the pain sometimes spreads to more joints in the same limb
Unpredictable triggers: If a movement or position is problematic one day and not on another
Pain escalating with rest: A palpable increase in the intensity of pain while you’re giving the joint a break for a few minutes / hours.

So, you may / may not necessarily have arthritis but, “What now?”

If surgery is something you’d like to avoid, then seeing someone who appreciates the mechanical, physiological and chemical environments in addition to the structure is essential – even if the surgeon said your joint is too far gone – pinch of salt, please. The inconsistencies mentioned above are typically observed in mechanical conditions (even when the structure seems to be a disaster). While consistency is possible in mechanical conditions, it is imperative for the diagnosis of structural conditions such as arthritis. Noting and understanding any inconsistencies is key in uncovering the real cause of pain for people with “arthritis”.

Your health and wellbeing deserves quality care. Make sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Photo by Dr. Manuel González Reyes from Pixabay

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Bunions

Conditions — Thu, 04 Jan 2024 08:46:29 +0000

When your big toe pushes against the next toe, forcing the joint of the big toe to expand and protrude, the resultant bony bump is known as a Bunion. The skin over the Bunion is often red and painful. Wearing tight narrow shoes is commonly the cause of bunions, but they can also develop from a medical condition like arthritis, inherited structural defects, or other stresses on the foot.

When the muscle that supports the arch of your foot weakens, through modern life and the wearing of shoes, this can increase the likelihood of Bunions forming.

What are the symptoms of Bunions?

The primary symptom is the bulging bump outside the base of the big toe, but other symptoms are: swelling, redness and pain around the big toe joint; corns and calluses which develop where the first and second toes overlap; intermittent or persistent pain and restricted movement of the big toe.

What are the causes of Bunions?

Bunions result from complex biomechanical changes in the feet and shoes (particularly tight-fitting shoes with high heels and narrow toe boxes) that restrict the feet. Because wearing shoes isn’t exactly natural and they limit foot and toe activity, our feet and in particular, the toes, tend to chronically lack exercise. Just walking barefoot regularly can be beneficial to Bunion sufferers.

The slope of the foot bed of high heel shoes put the feet at a disadvantage and makes them more susceptible to strain. It causes the front of the foot to bear your weight which makes the forefoot widen. A narrow toe box exacerbates the problem by causing the toes to squeeze together and be at an angle, straining the big toe in particular.

Injuries to the foot and poor arch control leading to flat feet or overpronation can also cause Bunions.

What is my best course of action?

Consult your Physiotherapist directly who, after a comprehensive examination, will embark on a treatment program which typically targets:

Pain relief, minimising swelling and injury protection
Restoration of normal foot and ankle ROM and muscle length
Restoration of muscle strength and control through prescription of exercises to correct the foot biomechanics – this starts from day 1 and should be made a priority
Restoration of full function and prevention of recurrences – Your rehabilitation program will be tailored to achieve your own functional goals. Depending on your needs at this point, you may be fitted with off the shelf inner soles, or referred to a Podiatrist for custom made orthotics.

Bunions can be corrected to the point where you forget they were ever there! And more importantly, they are preventable in the first place – so contact us today to embark on a program that will lead to a pain free and bunion free future!

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Bursitis

Conditions — Thu, 04 Jan 2024 08:44:07 +0000

Bursitis is the swelling and inflammation of a small sac of synovial fluid. These sacs are found over bony prominences where a muscle (usually the muscle’s tendon) could be at risk of high friction or damage. The resultant pain from the increased swelling and pressure inside the bursa is very effective in keeping you from causing further friction, and this pain typically starts long before any damage to the tissues could start.

Under normal conditions, the bursa need not swell up to protect the tendon, but if the tension in the tendon increases beyond the acceptable norm, swelling in the bursa physically pushes the tendon away to avoid friction over the bone. Bursitis is therefore often caused by repetitive motion or excessive pressure by the muscle and may on rare occasion result from a traumatic event. The symptoms may vary from local joint pain and stiffness to a sharp, stabbing pain surrounding the area, and the pain peaks during and after provocative activities, while joint stiffness can be a common symptom in the mornings.

Addressing the underlying cause of the increased risk of friction is ultimately what is needed.

Surgeons may offer to remove the bursa but this leaves us wondering what would then act as the barrier and the early warning sign to protect the tendon from damage when repeatedly rubbing against the bone? So rather than shooting the messenger…
We recommend determining why the tendon or muscle is tensioned beyond what the bursa deems safe.
Home remedies in the interim could alleviate the symptoms and at times, allow for the condition to resolve, but if you do not see a marked improvement within 3 days and an ultimate resolution through use of a home remedy or any formal treatment, we recommend a change in your approach.

The goal with any treatment for bursitis should be to correct the bio-mechanical imbalances which caused the increased tension in the muscle and the initial irritation for the bursa, and unless proven otherwise, our experience says to look at altered joint mobility or altered nerve control for the muscle in question, as the primary suspect.

Your health and wellbeing is deserving of quality care so be sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

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Delayed Onset Muscle Soreness

Conditions — Thu, 04 Jan 2024 08:37:02 +0000

DOMS is the commonly used abbreviation of ‘Delayed Onset Muscle Soreness’ and is the pain and stiffness felt in muscles a while after unusual or strenuous exercise. Felt most strongly from 24 to 72 hours after exercise, it is thought to be caused by lengthening or ‘Eccentric’ exercise, which causes ‘micro-trauma’ or small-scale damage to muscle fibres. The muscle adapts rapidly after exercise, to prevent muscle damage and soreness, if the exercise is repeated.

DOMS is one variety of muscle damage caused by exercise but is typically nothing sinister; the other occurs during and immediately after exercise and this is ‘acute muscle soreness’.

What are the symptoms of DOMS?

Apart from short term loss of muscle strength, reduced range of motion and possible swelling of the muscles, the most significant symptom of DOMS is a dull muscular ache. Passive stretching increases the symptoms, which explains the feeling of stiffness.

What are the causes of DOMS?

The primary cause of DOMS is muscle strains or ‘Myofibril tears.’ Small scale damage results in an inflammatory response with intramuscular fluid and electrolyte shifts. Blood tests can confirm this micro-trauma though the detection of markers like ‘creatine kinase’ and ‘lactic dehydrogenase’.

Muscle strength, motions and functions are impaired in someone experiencing DOMS due to swelling, altered muscle firing patterns and pain.

How do I know if I have DOMS or an injury?

Innocent soreness (as in the case of DOMS) is a tender, tired or burning feeling, usually an achy, stiff or tight feeling, typically occurring bilaterally and has a delayed onset.

An injury on the other hand causes deep, sharp, stabbing pains, typically only on one side and starts less than a day after activity, if not during. These are the signs that there may be a more serious injury and one should not assume that it’s just DOMS. Additionally, an injury will typically last longer than just a few days. General soreness from DOMS should peak at 24 to 48 hours after activity and last only up to 3 days. If symptoms are not subsiding after that, something more serious is possible.

What is my best course of action?

DOMS responds well to light activity of a similar nature to that which cause it …E.G. if you’re stiff from running, taking a leisurely walk should help. If symptoms linger beyond 3 days, or if any improvement seems negligible, schedule an appointment directly with your Physiotherapist, as you may be suffering DOMS or an injury. Try to remember what could have caused your pain and what it feels like, as this can help in your diagnosis. Contact us to ascertain the specifics of your condition and create an individualised plan to get you back on track with advice on how to avoid DOMS going forward.

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Fibromyalgia

Conditions — Thu, 04 Jan 2024 08:17:01 +0000

Widespread pain to the muscles of the body, unusually high levels of fatigue, tender points in multiple areas and great sensitivity to seemingly normal things, are all indicative of someone suffering from the disorder known as Fibromyalgia.

What are the symptoms of Fibromyalgia?

Each individual can experience different symptoms, but the most common are:

Fatigue that is disproportionate to the level of the individual’s activity and sleep
Stiffness, tenderness and a high level of pain in the muscles and joints
Anxiety, depression and possible bowel function problems
Poor sleep patterns or waking after long bouts of sleep, but still feeling tired all day.
Poor memory and alertness. A ‘foggy’ feeling in the brain.

The symptoms of Fibromyalgia are cyclical and each symptom can create the onset of another. The typical cycle would be:

An injury or disease leads to limited physical activity – which leads to muscular tension or stiffness – leading to stress/depression/anxiety – which leads to poor sleep – leading to pain – which leads to disease etc …and so the cycle will resume and continue. Breaking this cycle is essential to the recovery of a Fibromyalgia patient.

What are the causes of Fibromyalgia?

Far more prevalent in women than in men, there is really no known cause of this disease. It is extremely difficult to diagnose and treat, as it is neither an inflammatory, degenerative, nor an auto-immune disease.

What is known is that Fibromyalgia appears to manifest itself after:

A stressful event like a motor accident or the death of a loved one
A traumatic injury
Repetitive poor sleeping patterns
The sudden onset of an unexpected or chronic illness like Lupus or Rheumatoid arthritis

What is my best course of action?

Alleviating any of the symptoms of Fibromyalgia, even temporarily, can enable the sufferer to break the chain of symptoms and experience some relief or potentially break the cycle altogether.

Because it is difficult to diagnose and other conditions like an underactive thyroid, Vitamin D deficiency, or Rheumatoid arthritis can mimic this disease, extensive testing by a doctor or Rheumatologist may be necessary to eventually establish that you have Fibromyalgia.

Through alleviation of the pain, even for a few days, your Physiotherapist can assist you in finding, starting and maintaining comfortable and regular exercises, in addition to providing guidance on sleeping more comfortably. The combination of a reduction in pain, improved sleep and regular exercise provides a massive leap towards snowballing back in the right direction. Contact us for advice, referral to the correct specialist if necessary and positive treatment of this complex, yet but not necessarily incurable, disease.

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Illiotibial band syndrome

Conditions — Thu, 04 Jan 2024 07:56:05 +0000

If you’ve ever felt sharp or burning pain on the outside of your knee or thigh, especially during running or cycling, you might have been told it’s an iliotibial band (ITB) problem. The ITB is a dense tendon that stabilizes both the hip and the knee. When it acts up, should you listen to your colleague and rest it? Should you listen to your training buddy and abuse it with a massage gun? But before assuming what causes the pain or how to fix it, we need to look more closely.

Why ITB-type Pain Isn’t Always Tendon Load Related

Tendon overload causes tendinopathy: Pain from a tendon’s inability to cope with load. This occurs with either excessive load on a healthy tendon or normal load on a compromised tendon.
Lower back referral is common: A pinched nerve easily causes isolated thigh/knee pain through misleading signals. It’s more likely than tendon pathology even in the absence of lower back pain.
Hip mobility and health: Limited hip motion or joint health can refer pain to the same area, even without hip pain.
Knee mobility and joint: Pain in the thigh is not explained by knee joint pathology, so assessing the knee is unlikely to be helpful. Pain at the knee may justify assessment for the rare possibility of two separate conditions.
Muscle weakness and muscle overuse may contribute to pain but are not legitimate diagnoses for persistent or recurrent symptoms, despite common use. Identifying the true drivers is essential for full understanding and management.
Pain processing errors result in false alarms in the absence of tissue danger or damage. Symptoms would typically be more widespread than thigh and knee alone but may still play a role.
Uncommon but important causes include infections, bone diseases, stress fractures and autoimmune conditions.
Differentiating between the commonly assumed overuse / weakness and the real-world possibilities noted above, require careful analysis of training habits, symptom patterns, and how joint movement affects symptoms in the moment.

Why Foam Rolling, Massage, And Rest Are Frustratingly Worthless

When the tendon is the source:

Tendon, not muscle: The ITB is not a muscle. It can’t contract or forced to relax. In fact, tendons respond poorly to compression and are likely to retaliate. Tendinopathies need correct loading to build capacity, and counterintuitive as it sounds, this rehab requires some pain. No alternative restores lasting function.
Rest deconditions: Given the above, rest moves us in the wrong direction. While significant pain may suggest rest, effective ways exist to begin reconditioning without leaving pain unchecked. Work with a knowledgeable professional to guide the process.

When the tendon isn’t the root cause:

If it’s a nerve, joint, disease or processing error responsible for the pain, addressing these directly yields better results than rest, “TLC,” or aggressive treatment.

Where to from here? A Full Assessment

Because the causes vary so widely, a full assessment is essential. A professional will consider:

Is the ITB actually the pain generator, or is it perhaps a nerve?
Is hip mobility limiting or affecting load distribution?
Is the nervous system triggering a false alarm?
Are there signs of a medical cause where referral to a doctor is needed?

Once the true cause is understood, we can act:

If it’s a tendon, we lessen pain and load it!
If it’s a nerve or joint, we remove obstructions and restore normal mobility.
If it’s processing errors, we retrain it.
If its outside of the scope of physiotherapy, we refer you to the correct profession

The right diagnosis means the right treatment and that’s what gets you back to your sport, stronger and safer.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

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Knee Pain

Conditions — Thu, 04 Jan 2024 07:54:34 +0000

Until we answer the question “What is causing my knee pain?”, treating the pain will be a hit and miss and considering the number of conditions which may cause knee pain, the law of averages says, it will likely be a ‘miss’! We can make many (potentially incorrect) assumptions:

I am getting old so it’s probably arthritis. (We’re all older than what we used to be but arthritis and advancing age alone doesn’t cause pain nearly as often as what people think)
I’ve been rough on my knees, so I’ve torn the meniscus. (Using our joints result in conditioning, not abuse, and believe it or not, meniscal image findings are often incidental, pain-free discoveries)
I fell badly / trained hard / injured the knee on Sunday (You’ll be surprised how resilient these structures can be and while a bona fide injury / tissue damage is possible resting a non-injury will be futile and frustrating)
I’ve suddenly and enthusiastically started a new activity, so I probably just have tendonitis (The updated term is tendinopathy but considering the immense patient dedication required to correct this mismatch in load, I would suggest removing ‘just’ from each patient’s sentence when this discussion comes up)
My pain was diagnosed on x-ray / ultrasound scan / MRI (in the absence of a recent, sudden onset of pain from a traumatic event, research says that while x-rays may on occasion be correct, we can’t reliably establish the cause from such imaging)
I need a knee replacement (with the mixed feedback from patients worldwide, we only support this drastic measure if all other causes for pain and dysfunction have reliably been ruled out)
I haven’t been as active as what I’m supposed to be, so my knees are probably weak. (But does weakness cause pain? Really??)

It’s important to know that you could simultaneously have more than 1 of the conditions mentioned above, or may not have any one of those. Pain and musculoskeletal dysfunction is a complex environment and in the interest of efficiency or wanting to show competence and confidence, health professionals, your family, friends and even Google may easily lead you on any incorrect path. Taking one or 2 elements into account and overlooking the others brews incorrect assumptions, poor responses to treatment and persisting symptoms!

So, consider the following:

How did your symptoms come about? (traumatic and instantaneous onset, or over time)
Does your pain intensity fluctuate from day to day or based on the time of the day?
Does the pain location change / move around / spread or become more localised?
Did the current pain migrate from elsewhere?
Do you have other medical conditions which may impact your knee?
Do you have symptoms on the other side, or pain anywhere else ranging anywhere from your lower back to the tips of your toes?
Has your pain changed from one side to the other, be that over weeks and months or potentially daily.

As professionals specialised in the health and functional capacity of the neuromusculoskeletal system we need to investigate all the above and far more before we can consider any possible diagnosis and even then, there are likely still 3 or 4 possibilities we need to rule out as we work to get to the bottom of it all.

If you’ve allowed anyone’s momentary judgement of your symptoms to determine your diagnosis and the required treatment, especially if such treatment fell short of providing an impactful and lasting answer, perhaps your real diagnosis is still out there! Treatment of most conditions (excluding e.g., autoimmune conditions and recovering trauma) should show obvious and progressive restoration of normal comfort and function, or the diagnostic mark has been missed.

Your health and physical wellbeing should be a priority deserving of quality care. Make sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

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Ligament sprains

Conditions — Thu, 04 Jan 2024 07:53:53 +0000

‘Ligament sprains’ and ‘Muscle strain’ are often confused and usually written about in tandem, however they are in fact quite different. Muscle and tendon (joining muscle to bone) strains occur when there is a poor level of fitness or poor dynamic control within the muscles, whereas Ligaments join bone to bone and injuries occur when there is excessive movement forced through a joint…quite different and so we deal with them in separate articles.

What is a ‘Ligament sprain’, as opposed to rupture?

To elaborate a little, ‘Ligament sprain’ occurs when its inelastic fibres are stretched through too great a range and tearing of the ligament takes place. The tear can be just a few fibres and classed as mild or grade I, but when classed as severe or grade III, a complete ‘rupture’ of the ligament has taken place, leading to joint instability.

How do ligament sprains happen?

The most common type of sprain is a sprained ankle, usually occurring amongst runners and sports people in general but it could happen to anyone. To give an example, in the USA alone, 25 000 ankle sprains occur daily. A runner going over a curb, catching the foot and twisting the ankle is a typical example. Knee and ankle sprains also happen in stopping and turning sports like hockey or soccer or in baseball where a player slides into the plate and twists the knee. The whipping arm action of the baseball pitcher and swing of the Golfer can also cause shoulder and elbow sprains and thumb, finger and wrist sprains happen in sports like skiing where one falls with an outstretched palm, or netball and cricket through catching injuries.

What are the symptoms of sprains?

Pain, inflammation and bruising are all common signs and symptoms of a sprain. At the time of injury, you may hear or feel a “pop” in your joint. With a mild ankle sprain, the pain may not be too intense and you may just have a limited ability to move the affected joint, but with a ruptured ankle ligament one may not be able to bear any weight on the foot.

What is my best course of action?

Mild sprains can sometimes be successfully managed at home with relative rest, compression and elevation but if the symptoms aren’t improving significantly each day over any 3 consecutive days, it’s likely that the management at that time is not sufficient. For your own peace of mind, to assure that the treatment is being correctly administered and to reduce the recovery time, it is advisable to consult a Physiotherapist directly to get started on the correct rehabilitation program, in addition to the management of your symptoms. It is essential to contact your Physiotherapist if you can’t walk more than a few steps, move the affected joint, or if you feel any numbness in the injured area. Severe sprains or ruptures may even require surgery, but you can save time and money if you contact us first, as Physiotherapists are the specialist for this type of injury, trained to have you back in action ASAP and refer immediately should that be required.

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Meniscus Injuries

Conditions — Thu, 04 Jan 2024 07:50:25 +0000

This term is derived from an injury done to the Knee Meniscus and is more commonly referred to as a ‘Meniscus tear.’ So, what is the knee Meniscus? It is a kidney shaped, fibrous cartilage wedge which separates your thigh bone, or ‘Femur’, from your shin bone or ‘Tibia.’ The knee absorbs great forces when we run and jump or even just walk, so the Meniscus is a type of ‘shock absorber’ which also assists in rotational stability due to the wedge-shape. The Meniscus helps to spread the compressive forces over the whole knee, which escalate as we go from walking to running to jumping.

What causes a ‘Meniscus tear?’

This injury is usually sports related, particularly in the case of younger people and happens when the knee Meniscus is compressed and sheared through the sharp twisting of a slightly bent knee. Another more chronic cause may be degeneration due to arthritis on the femoral aspect of the joint tearing into the meniscus over time.

What are the symptoms to watch out for?

The symptoms of a Meniscal knee injury may include:

Pain when twisting a slightly bent knee
The knee locking, popping or clicking
Pain along the line of the knee joint
Joint swelling
Pain when squatting

What is my best course of action?

If you are experiencing any of these symptoms and suspect a torn meniscus, remember that a Physiotherapist is best able to treat it and identify the presence of any other knee injuries commonly associated with Meniscal injuries and the compensations that follow, which need to be treated simultaneously. A small Meniscus tear responds quickly to physiotherapy treatment which also aims to: strengthen your thigh and leg; reduce bone stresses; reduce pain and inflammation and normalise joint motion, all while ensuring that your pelvis, lower back and knee on the other side aren’t taking strain. A normal recovery time for a Meniscal injury is 6 to 8 weeks and you may be required to stop certain activities and exercises, take weight off the knee with crutches, or in more severe cases even require an MRI scan and may be recommended for surgery. All people are different and once again your Physiotherapist will give you the best guidance for your particular situation. Even if your surgeon does feel that surgery may be needed, he or she will most likely recommend pre-operative physiotherapy to see if it can be avoided, so to save time and money contact us first and let’s see if we can have you back in action before any more drastic courses of action are suggested.

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Muscle Tears or Strains

Conditions — Thu, 04 Jan 2024 07:48:06 +0000

‘Muscle strains’ and ‘Ligament sprains’ and are often confused and usually written about in tandem, and although the rehabilitation principles are similar they are in fact quite different conditions. Ligaments join bone to bone and injuries occur when there is excessive movement forced through a joint, whereas muscle and tendon (joining muscle to bone) strains occur when there is a poor level of fitness or poor dynamic control within the muscles…quite different and so we deal with them in separate articles.

What is a ‘muscle strain or tear?’

Muscle strains are the most common source of muscle pain and are also known as muscle tears in the more severe cases. They vary greatly in severity from mild up to a complete muscle rupture. Muscle sprains that occur in the ankle, calf, thigh and biceps usually happen at high speed when the muscles are overloaded. When occurring in the back, shoulders and neck, it is more commonly as a result of muscle fatigue from postural strains.

What are the symptoms of muscle strain or tear?

Naturally, pain is experienced in the affected area and the pain can vary according to the severity of the tear. One can also experience:

Weakness of the muscle – an inability to perform normally
Bruising of the muscle
The muscle feels tight and strained
You cannot fully stretch the muscle

What is my best course of action?

If you experience these symptoms and the injury appears to be fairly mild your immediate course of action should be to apply a compression bandage on the affected area. It’s also a good idea to elevate the area if it’s swollen by, for example, raising your leg above your body. If you are still able to perform, then reduce training to a level where pain is no longer experienced.

Should your home treatment be ineffective and the injury continues to niggle, or if you are experiencing severe pain, or are unable to move normally, then it is advisable to immediately contact your Physiotherapist, who is trained to accurately diagnose the exact nature of the injury, advise on and carry out the best treatment for you. If the injury is sports related and waiting/resting is not an option you’d like to consider, you can save time (and often money too) by contacting your Physiotherapist directly to get back into action ASAP.

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