Viewing entries tagged
knee pain

What the Cup?

Comment

What the Cup?

What is cupping?

Cupping has been used since 3000 BCE, it originated in ancient Egypt where it was used to remove toxins from the body [1]. Since then cupping has spread throughout the world and been used in many cultures as a treatment for a variety diseases. Today cupping is mostly seen in traditional eastern medicine, where it is used to correct blockages and help the flow of Qi throughout the body [2]. It involves suctioning special cups to the skin of a patient, in the form of wet cupping or dry cupping. Wet Cupping is invasive and involves suctioning small amounts of blood through minor incisions made in the skin, this means it is usually not performed by physiotherapists in western practices [3].

What is dry cupping?

Dry cupping is non-invasive, as it doesn’t involve exposure to blood. It is mostly used to treat musculoskeletal pain in the chest, stomach, back and buttocks [4]. Smaller cups can also be used to treat regions on the arms and legs.

Cups vary from 38-50mm in diameter and are generally made of plastic or glass [3].

The cup is suctioned and held in place by heating the air in the cup then placing the rim of the cup on the skin so it is air tight, or by suctioning air out of the cup using an air pump after placing it on the skin [3]. This negative pressure inside the cup suctions the skin and feels like your skin and soft tissue underneath is being pulled or stretched. Then it is generally left in place for 5-20 minutes or can be moved around to cover a larger area using lubricant so that it can slide without interrupting the vacuum seal made between the skin and the cup [5].

 

How does dry cupping work?

The vacuum inside the cup creates a tensile force that stretches the skin, subcutaneous tissue and fascia lying beneath [2]. This also causes the small blood vessels in that area to expand. The larger the cup and more suction created the stronger it stretches the soft body tissues underneath, and the longer it is left in place the more blood that is drawn to that area [2].  

This means dry cupping has the potential to be used for a number of benefits such as:

  1.  Relieving muscle and surrounding fascia tightness [3]

  2. Aiding muscle and soft tissue healing [6]

  3. Increase blood circulation and aid removal of toxins from muscles [4]

  4. Improve immune function by aiding flow of lymph [6]

  5. Provide pain relief through stimulating pain inhibiting nerves [7]

  6. Promoting deep relaxation [7]

 

Is it safe?

Yes, provided it is performed by a suitably trained therapist. Patients may feel warmer and may sweat during a cupping treatment, this is just a result of blood vessels expanding and drawing more blood and heat to the skin [3]. Patients may also experience redness, swelling and bruising of areas of skin that have been cupped after a treatment, this is normal and should go away within a few days or weeks [4]. You should not having cupping therapy if you are pregnant, menstruating, have metastatic cancer or have cupping therapy over an area with a bone fracture, deep vein thrombosis, palpable pulse or skin irritation [8]. 

Complications to cupping are very rare and usually due to a lack of therapist training and incorrect practice, which have lead to only a few reports of skin burns, contamination and pressure wounds [9].

 

What does research say about the effectiveness of dry cupping?

There have been several studies investigating the treatment effects of dry cupping on a variety of musculoskeletal conditions. The findings of these studies are:

  • 2 weeks of cupping treatment significantly reduced chronic neck pain [10]

  • 2 weeks of pulsating cupping effectively relieved pain, improved function and quality of life in patients with chronic neck pain [11]

  • Cupping and exercise together is effective in improving neck pain and neck function, and better at improving pain than using a heating pack [12]

  • Patients with sub acute and chronic lower back pain felt less pain and improved flexibility in their lower back after 1 treatment [13]

  • Pulsating dry cupping is effective at relieving symptoms of knee osteoarthritis [14]

There is however a need for future studies to focus on confirming comparing these effects to standard treatments as well as understanding long lasting effects of dry cupping.

 

If you have any questions regarding treating your aches and pains or cupping therapy, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Nickel, J.C., Management of urinary tract infections: historical perspective and current strategies: part 1—before antibiotics. The Journal of urology, 2005. 173(1): p. 21-26.

  2. Tham, L., H. Lee, and C. Lu, Cupping: from a biomechanical perspective. Journal of biomechanics, 2006. 39(12): p. 2183-2193.

  3. Rozenfeld, E. and L. Kalichman, New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of bodywork and movement therapies, 2016. 20(1): p. 173-178.

  4. Yoo, S.S. and F. Tausk, Cupping: east meets west. International journal of dermatology, 2004. 43(9): p. 664-665.

  5. Turk, J. and E. Allen, Bleeding and cupping. Annals of the Royal College of Surgeons of England, 1983. 65(2): p. 128.

  6. Ahmadi, A., D.C. Schwebel, and M. Rezaei, The efficacy of wet-cupping in the treatment of tension and migraine headache. The American journal of Chinese medicine, 2008. 36(01): p. 37-44.

  7. Musial, F., D. Spohn, and R. Rolke, Naturopathic reflex therapies for the treatment of chronic back and neck pain-part 1: neurobiological foundations. Complementary Medicine Research, 2013. 20(3): p. 219-224.

  8. Chirali, I.Z., Traditional Chinese medicine: cupping therapy. 1999: Elsevier Health Sciences.

  9. Cao, H., X. Li, and J. Liu, An updated review of the efficacy of cupping therapy. PloS one, 2012. 7(2): p. e31793.

  10. Lauche, R., et al., The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain-a randomised controlled pilot study. BMC complementary and alternative medicine, 2011. 11(1): p. 63.

  11. Cramer, H., et al., Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Complementary Medicine Research, 2011. 18(6): p. 327-334.

  12. Kim, T.-H., et al., Cupping for treating neck pain in video display terminal (VDT) users: a randomized controlled pilot trial. Journal of occupational health, 2012. 54(6): p. 416-426.

  13. Markowski, A., et al., A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. The Journal of Alternative and Complementary Medicine, 2014. 20(2): p. 113-117.

  14. Teut, M., et al., Pulsatile dry cupping in patients with osteoarthritis of the knee–a randomized controlled exploratory trial. BMC complementary and alternative medicine, 2012. 12(1): p. 184.

Comment

Don’t run from the P.O.L.I.C.E.

Comment

Don’t run from the P.O.L.I.C.E.

So, you rolled your ankle, you're thinking it will be fine, I’ll just walk it off. Little did you know as you continued to play the last 10 minutes of the game, the phases of healing have already begun. As you continue to run, your ankle throbs and feels unstable beneath your body. You feel sick as the pain won’t go away but continues to get worse. Thoughts race through your mind, what have I done? Should I see someone? Finally, you make the decision to come off the court, but what do you do now?

In the past, the process to assist with recovery was known as R.I.C.E.R. (Rest, Ice, Compression, Elevation and Referral). This has been proven to be effective, however, methods of management have changed to the P.O.L.I.C.E. protocol [1] :

P – Protection: this reminds individuals that a little bit of pain is okay but if the injury causes severe pain then the ankle should be protected using bandages, taping or crutches to off-load the ankle.

O – Optimal: the right amount of pain/discomfort (not too much but tolerable).

L – Loading: placing weight on the ankle (optimal-loading is advised).

I – Ice*: applied for 8-10 minutes at a time [2,3] alternating between 10 minutes on then 10 minutes off. This should be done as often as possible in the first 48 hours.

C – Compression: apply a compression bandage around the ankle, ensuring it is firm enough without cutting off circulation to the foot (Pinch test: squeeze toe, it should turn white then red again).

E – Elevation: raise leg above heart height to prevent pool of blood around the ankle due to gravity.

* Warning: any burning sensations in the region REMOVE the ice. Do not place ice directly on skin (apply a 1-2 cm cloth in between ice and skin). Never place ankle on top of the ice but rather the ice on top of the ankle.

 

Why this protocol?

Recent studies have shown that protecting the joint should be only as required as resting or offloading the joint could be detrimental causing changes as to how the tissue recovers [1, 4, 5]. These studies therefore promote optimal loading, where an individual can start placing body weight onto the ankle, as tolerable. This encourages correct fiber type and alignment to develop, early mobilisation and can facilitate accelerated recovery times [1, 4]. Further benefits of optimal loading are positive as changes to mechanical properties regarding load alter sensory feedback. This informs the brain that this painful feedback, which it was experiencing earlier on, is no long dangerous thus de-sensitizing the injury and reducing pain levels [4]. Previously the R.I.C.E. [6] method did not consider optimal loading and referral but rather focused on resting and went straight into management. Though icing is effective, studies have shown this has a limited effect depending on the duration and severity of the injury and should only be utilised in the acute phases [3]. Benefits of using ice should still be utilised as icing reduces the analgesic (pain) response and facilitates optimal healing by reducing swelling that would otherwise delay an individual’s rehabilitation process [7, 8].

So, when in doubt, don’t run, follow the P.O.L.I.C.E. protocol. If pain persists or worsens or you are unable to weight bare, contact your local physiotherapist and book an appointment.

 

What would a Physiotherapist do to help?

  • Perform a thorough movement examination of the lower body to provide education and understanding of the condition.
  • Provide tailored strategies and modifications to correct improper biomechanics of the ankle, i.e., taping, ergonomic assessment.
  • Design a personalised exercise program tailored to resolving muscle imbalances that would otherwise cause ankle instability.
  • Assist with improving range of movement and pain management strategies.
  • Provide education on self-management techniques.
  • Improve balance and retrain an individual back to pre-injury status.

 

If you have any questions regarding your acute injury, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?. British Journal of Sports Medicine. 2011 Sep 7:bjsports-2011.
  2. Adie, Naylor, & Harris. (2010). Cryotherapy After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty,25(5), 709-715.
  3. Prins, J., Stubbe, J., Van Meeteren, N., Scheffers, F., & Van Dongen, M. (2011). Feasibility and preliminary effectiveness of ice therapy in patients with an acute tear in the gastrocnemius muscle: A pilot randomized controlled trial. Clinical Rehabilitation, 25(5), 433-41.
  4. Glasgow, P., Phillips, N., & Bleakley, C. (2015). Optimal loading: Key variables and mechanisms. British Journal of Sports Medicine, 49(5), 278-279.
  5. Bleakley, C., Dischiavi, S., Taylor, J., Doherty, C., & Delahunt, E. (2017). Rehabilitation reduces re-injury risk post ankle sprain, but there is no consensus on optimal exercise dose or content: A systematic review and meta-analysis. British Journal of Sports Medicine, 51(20), British Journal of Sports Medicine, Oct 15, 2017, Vol.51(20).
  6. Hing, Wayne, Lopes, Justin, Hume, Patria A., & Reid, Duncan A. (2011). Comparison of multimodal physiotherapy and "R.I.C.E." self-treatment for early management of ankle sprains. (RESEARCH REPORT)(Report). New Zealand Journal of Physiotherapy, 39(1), 13-19.
  7. MacAuley, D. (2010). Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ. British Medical Journal (Clinical Research Ed.), 340(10), 1122.
  8. Bleakley CM, O'Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010; 340:1964.

Comment

Patello-Femoral Pain Syndrome

Comment

Patello-Femoral Pain Syndrome

What is PFPS?

Patellofemoral pain syndrome (PFPS) is prevalent in approximately 25% of the athletic population and most commonly affects young adult females [1].  PFPS is characterised by anterior knee pain in and around the patella [2,3]. When bending at the knee joint, the patella should normally track in a lateral to medial direction before moving laterally again at full knee flexion. This motion is controlled by the quadriceps muscle group, particularly the vastus medialis oblique and vastus lateralis components. Poor coordination or weakness of these muscles can lead to inflammation of soft tissues (lateral retinaculum, infrapatellar synovium and fat pad) in addition to stress on cartilage and bone causing pain [3].

Presentation

  • Acute or gradual onset
  • Aggravated by increased on unaccustomed loads on the patellofemoral joint (e.g. higher training volume, increased running speed, hill/stair running and bounding)
  • Varied presentations including achy/sharp pain, poorly localised under or around the patella
  • Knee/s may feel like it is gives way or buckles [2,3]
  • Pain during squatting [4]
patellofemoral-pain-syndrome.jpg

Aetiology

  • Inadequate neuromuscular control or weakness of quadriceps muscles
  • Patella position (tilt/rotation)
  • Pronated foot type [1,2]
  • Increased knee valgus or femoral internal rotation
  • Reduced strength, coordination or range of motion of hip abductors causing increased stress on frontal and transverse forced around the knee [3]

Complications

May predispose to the development of patellofemoral osteoarthritis.

How can Physiotherapy help?

  • Provide education and advice about your condition and promote strategies to reduce your pain and symptoms
  • Provide an accurate and comprehensive assessment of your condition and address any underlying biomechanical factors contributing to your pain
  • Provide condition specific treatment including manual therapy, massage and stretches
  • Create an individualised exercise program to target muscular imbalances in the hip and/or knee and improve coordination of quadriceps muscles
  • Taping to correct abnormal positioning of the patella [2,5]

 

If you have any questions regarding your knee pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Nunes, G. S., Stapait, E. L., Kirsten, M. H., De Noronha, M., & Santos, G. M. (2013). Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical Therapy in Sport, 14(1), 54-59.
  2. Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill. 4th Edition, 87. 725-726.
  3. Panken, A., Heymans, M., Van Oort, L., & Verhagen, A. (2015). Clinical prognostic factors for atients with aterior knee pain in physical therapy: A systematic review. International journal of sports physical therapy, 10(7), 929.
  4. Collado, H., & Fredericson, M. (2010). Patellofemoral pain syndrome. Clinics in sports medicine, 29(3), 379-398.
  5. Collins, N. J., Bisset, L. M., Crossley, K. M., & Vicenzino, B. (2012). Efficacy of nonsurgical interventions for anterior knee pain. Sports medicine, 42(1), 31-49.

Comment

Medial tibial stress syndrome

Comment

Medial tibial stress syndrome

What is medial tibial stress syndrome?

Medial tibial stress syndrome (MTSS) is a common condition mostly affecting runners and recreational sports players. It is an overuse injury resulting from repetitive stress to the bone in the lower leg, the tibia. Stress reactions occur on the tibia and the surrounding muscles when the body is unable to heal properly, and with repetitive stress and inadequate healing, this creates an overuse condition. Tibialis posterior, a muscle in the back of the calf has been the main muscle responsible for this condition. However recent studies have identified that several muscles are involved, including flexor digitorum longus and the soleus, which are two muscles in the calf as well.

 

What are the symptoms?

The symptoms of MTSS include:

  • Vague diffuse pain in the lower leg near the shin bone
  • Pain that gets worse at the beginning of exercise but eventually subsides
  • Pain the following morning
  • As the condition worsens the pain may persist during activity

 

What are the risk factors?

The risk factors for MTSS is influenced by your individual biomechanics of movement, and the type of training you are performing. This means that the way your body moves and its positioning during walking and running can make you more susceptible to this condition. Some of these risk factors include:

  • Flat feet (excessive pronation)
  • Training errors
  • Sudden changes in physical activity e.g. sudden increase in intensity or duration
  • Shoe design
  • Surface type
  • Fatigue
  • Decreased flexibility
  • Muscle dysfunction

 

How do we treat it?

The foundation of treatment for medial tibial stress syndrome is based on identifying the risk factors involved, and treating the underlying pathology. This will ensure that we are treating the cause of the problem so it will not return in the future. Treatment begins with providing relief through rest and ice. In order to keep you active and still exercising you are able to completed pain free activities such as swimming or cycling.

Your physiotherapist will then begin a careful assessment of how your foot, knee and hip alignment are affecting your running and walking. Taping may be used to control your foot pronation (flat foot), and other techniques including strengthening and stretching of muscle imbalances, mobility exercises, motor control and stability exercises. Your physiotherapist will tailor these treatment options to your specific biomechanics which will reduce the stress placed on the tibia.

 

If you have any questions regarding shin pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Galbraith, M. Lavallee, M. 2009. Medial tibial Stress syndrome: conservative treatment options. Current Rev in Musculo Med. 2(3) 127-133.
  2. Batt, M. 2011. Medial Tibial Stress Syndrome. British Journal of Sports Medicine. 45(2)1-8.
  3. Franklyn, M. Oakes, B. 2015. Aetiology and mechanisms of injury in medial tibial stress syndrome: current and future development. World J of Ortho. 6(8) 577-589.

Comment

Gua Sha

Comment

Gua Sha

What is gua sha?

Gua sha is commonly known to be a traditional eastern medicine technique where a blunt tool, such as a ceramic soup spoon, is used to scrape the skin to improve blood circulation and oxygen supply to the soft tissue. A modern take on this technique is often referred to as instrument-assisted soft tissue mobilisation (IASTM).

 

What happens during tissue injury?

Inflammation usually occurs following an injury to generate new cells. The formation of scar tissue reduces elasticity of the injured tissue and results in adhesion. The scar tissue may also limit oxygen and nutrient supply and thus affect tissue regeneration. If left untreated, chronic inflammation may lead to tissue degeneration and contribute to chronic pain. These areas may also be more susceptible to re-injury.

 

How does gua sha work for injured tissue?

Adequate pressure and shear force applied during soft tissue mobilisation create micro-trauma in the affected area. This can facilitate the inflammatory response during the healing phase of the tissue. By using an instrument to assist, the clinician is able to deliver a greater force and stimulate adhesive points deeper within the tissue. Removing scar tissue and releasing adhesions help collagen synthesis and realignment. These in turn improve soft tissue function, range of motion, decrease pain and speed up healing.

 

Do I need gua sha?

Gua sha can be beneficial for conditions including but not limited to:

  • Tennis elbow
  • Patella tendon injury
  • Hamstring tendinopathy
  • Achilles tendinopathy
  • Partial muscle tears
  • Plantar fasciitis
  • Chronic neck pain
  • Chronic low back pain

 

What should I expect when receiving gua sha?

The clinician will typically start by rubbing lubricant such as cream to the skin before applying the instrument at a tolerable pressure onto the affected area. The clinician will perform smooth firm strokes over the affected area while feeling for restrictions or soft tissue irregularities. This process may take about 5-15 minutes depending on the affected area and condition.

In physiotherapy, gua sha may be used in conjunction with stretching and strengthening exercises depending on the type of injury and the stage of recovery. These exercises help restoration of function and prevent re-injury.

 

Are there any side effects with gua sha ?

Gua sha should not be painful during treatment. The rubbing and scraping may cause small blood capillaries near the surface of the skin to burst and result in redness, light bruising or soreness. These symptoms should resolve in a few days and can be managed with ice if necessary.

 

If you have any questions regarding whether gua sha can help, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12-22.
  2. Lambert M, Hitchcock R, Lavallee K, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews. 2017;22(1-2):76-85.

Comment

What is Osteoarthritis (OA)?

Comment

What is Osteoarthritis (OA)?

What is osteoarthritis?

Osteoarthritis (OA) is a complex degenerative non-inflammatory joint disease that affects the whole joint including subchondral bone, articular cartilage, ligaments and muscles that surround a synovial joint1 [1]. It is characterised by progressive cartilage loss, subchondral bone remodelling and formation of osteophytes narrowing the joint space [2]. Low-grade local synovial inflammation occurs believed to be a result of release of inflammatory mediators from the degradation of articular cartilage [3]. OA is the most common type of arthritis that leads to a gradual decline in health, physical function and well-being if not managed correctly [1]. Hands, hips, lower back, knees and feet are the areas that are most affected by OA.

OA is commonly referred as a “wear and tear” form of arthritis as it is thought to occur as a part of an aging process, however it has been found that aging is not a predictor of OA [1]. The aetiology of OA is however due to the result of excessive mechanical stress applied in context of susceptibility modifiable and non-modifiable factors such as age, genetics, gender, ethnicity, local mechanical factors, obesity and joint injury [2]. OA is a highly preventable and manageable disease, with 70 per cent of cases within Australia preventable by avoiding excess weight gain and joint injuries [1].

 

How common is OA?

OA currently affects one in 12 Australians and is the leading cause of chronic pain and disability world-wide [1,4]. Although the incidence of OA has been found to increase with age, osteoarthritis can occur at any stage, with more than half of the people being of working age [1 ]. It is estimated that within the next four years, the prevalence of OA will have doubled due to the higher rates of obesity also placing people at a higher risk of death compared to a general population [2].

 

Common Causes and Contributing Factors of OA

The causes of OA are not well understood however it has been shown that several biomechanical, genetic, behavioural and environmental factors contribute [1].

Person-level factors [5]

  • Genetics
  • Excess weight and obesity
  • Gender: Higher prevalence in women, incidence rates increases around menopause.
  • Age: Main risk factor however not an inevitable factor of OA

Joint- level factors

  • Abnormal joint irregularity, joint malalignment, muscle weakness and ligament rupture are some local mechanical contributing factors that increase susceptibility and progression of OA [2]
  • Joint injury and certain repetitive joint loading occupational activities [2]

 

 Common Symptoms of OA [6]:

  • Limited/reduced range of motion
  • Stiffness
  • Clicking or cracking sound
  • Mild swelling around joint
  • Pain- worse at the end of day
  • Tenderness
  • Muscle weakness
  • Mild effusion
  • Joint and limb deformity

 

How can physiotherapy help?

Currently physiotherapy treatment and management of OA is focused on reducing mechanical loads and symptom management [1]. Physiotherapy management includes the use of a variety of low impact exercise programs which has been shown to be effective [7]. Exercise based treatment approaches such as walking programs to water and land based strengthening programs have been proven to be beneficial in managing symptoms of OA [7]

Other management strategies include [4]

  • Electrical based therapy
  • Prescription equipment/aids
  • Taping
  • Weight loss program
  • Manual therapies
  • Education on pain and self-management.

Studies has found that the benefits of exercise in OA in relation to pain and physical function has a similar effect to that gained by analgesic and non-steroidal anti-inflammatory medications with fewer side effects [2] Physiotherapy treatment and management will be tailored to target each individual taking into account specific risk factors and patient characteristics.

If you have any questions regarding managing OA better, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References:

  1. Arthritis A. Time to Move: Osteoarthrtis. http://www.arthritisaustralia.com.au/index.php/reports/time-to-move-arthritis-reports.html: Arthritis Australia;March 2014.
  2. Hunter DJ. Osteoarthritis. Best Practice & Research Clinical Rheumatology. 2011;25(6):801-814.
  3. Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis and Cartilage. 2013;21(1):16-21.
  4. Larmer PJ, Reay ND, Aubert ER, Kersten P. Systematic review of guidelines for the physical management of osteoarthritis. Archives of physical medicine and rehabilitation. 2014;95(2):375-389.
  5. Palazzo C, Nguyen C, Lefevre-Colau M-M, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Annals of Physical and Rehabilitation Medicine. 2016;59(3):134-138.
  6. Michael JW-P, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Deutsches Arzteblatt International. 2010;107(9):152.
  7. Rosedale R, Rastogi R, May S, et al. Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial. journal of orthopaedic & sports physical therapy. 2014;44(3):173-A176.

 

Comment

Conservative Management of Meniscal Tear

Comment

Conservative Management of Meniscal Tear

History

A 47-year-old male presents with an acute left knee injury from rotational standing up movement from a seated position at lunch. He felt immediate pain in the medial side of his knee and reports a locking sensation when attempting to straighten his knee. What can physiotherapy do to help.

 

Clinical Examination

The patient was unable to weight bear on his left leg as he could not straighten his left knee due to pain and catching sensation. During passive range of motion movements, his knee could be flexed to full range, however was painful at end of range and when moving leg back into extension. Passive patella movement did not reproduce his symptoms, though symptoms reproduced upon palpation of medial border of knee cap and medial knee joint. No swelling was evident at time of review, however this is expected in the acuteness of his injury.

His mechanism of injury and clinical presentation indicate an acute torn flap of his medical meniscus.

 

Management

Small meniscal tears can be managed conservatively if a person’s range of motion is not greatly affected, have minimal swelling and are able weight bear. The first phase of conservative management of an acute meniscal tear includes maintaining knee extension range of motion and providing stability to the knee to reduce any risk of further injury. Small amplitudes of passive accessory movements were undertaken in attempt to normalise joint range of motion. He was provided with education regarding the importance in maintaining knee extension and encouraged to undertake light knee extension stretching techniques to aid in this. Kinesiology tape was used to strap his knee to promote healing, support, reduce swelling and assist in pain reduction. The patient responded well with dry needling to his hamstrings and calf muscles which assisted in off-loading the knee joint from muscle tightness. Following the initial treatment, the patient had a reduction in pain symptoms and ability to weight bear as tolerated through left leg.

Over the next two to three weeks, the focus was to eliminate swelling and achieve full range of motion and focus on hamstring and quadriceps strength. Through the completing all home strengthening and stretching exercise program, this patient improved well and could obtain full range of knee extension with a reduction of pain and an increase of muscle strength. He was provided with full range squats and lunges as a progression to his hamstring and quadriceps strengthening exercises with added endurance training program for his hip external rotators. After another few weeks, he could return to his home-based fitness program and work schedule without any issues.

 

If you have any questions regarding your knees or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

Comment

ACL Tear

Comment

ACL Tear

History

A 15 years old female Miss K who is a netballer presents with a right ACL reconstruction surgery one week ago. Her surgeon has referred her to do physiotherapy. What does she need to do in rehab?

 

Clinical examination

The patient is walking with two crutches. Her knee is moderately swollen. Her wound is covered by wound dressings. Her knee extension range is -5 degrees (meaning it’s in a slightly bended position) and her flexion range is about 20 degrees, both motions are limited by pain and stiffness.

 

Management

It is expected that ACL reconstruction rehabilitation to be a lengthy process. It generally takes at least six months to twelve months to return to sports. Most surgeons would provide the patient and the physiotherapist a rehabilitation protocol, but it is common to have variations which depend on the graft choice and individual factors.

Initial stage of ACL-recon for Miss K focuses on swelling control and restoring her loss of knee extension range. This is critical as it allows her to walk with normal gait as soon as possible and avoid the development of compensation strategies. Her treatment includes manual therapy, compression therapy, and inner range closed chain quadriceps exercises. 

In six weeks times, Miss K has recovered full knee extension and ninety per cent flexion range of motion.

Depends on the sports type, most patients can return to sports after six to twelve months. In between this six to twelve months, there is a variety of exercises need to be covered to allow successful return to sports. That includes improvement on proprioception, strength, balance, flexibility, agility, functional strength, plyometric ability and sports-specific skills.

As Miss K is very compliance to her rehabilitation program and keen to return to sports. She performs her exercises well and on schedule. She is able to return to low level netball in nine months.

 

If you have any questions regarding your post operative rehabilitation or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

Comment

Knee Pain whilst Running

Comment

Knee Pain whilst Running

In this episode of our case review, we take a look at a challenging group to treat - runners.  The most important rule of treating them - never tell them NOT to run.

Comment