Ouch My Knee Hurts!!! [Part 2]

Knee pain in Zone 1 could indicate a couple of things but most often times leads to patella tendinitis.

What is patella tendinitis?

Patella tendinitis is inflammation of the patella tendon. The patella tendon extends from the patella (knee cap) and attaches to the tibial tuberosity.  This tendon connects the entire muscle group of the quadriceps to the body. The patella tendon is therefore placed under significant force during running and jumping activities. Imagine a shoe lace holding a 100lb bucket from a pulley system; this is just a fraction of the forces placed of the patella tendon. Although the patella tendon is incredibly strong and can handle these forces sometimes these incredible forces can take its toll and can cause injury.

What does patella tendinitis feel like?

• Pain with jumping, running and sometimes walking
• Pain when rubbing the patella tendon
• Pain feels like burning and sometimes throbbing.
• Pain persisted after sitting down (not aways)

What causes patella Tendinitis?

• Repetitive jumping activities such as volleyball and basketball
• Not warming up before activity
• Tight quadriceps and a lack of stretching of said muscles

What are some treatments?

Of course, Physical therapy is suggested. In the short term, avoid painful activities, ice and resting. Taping and patella straps are sometimes beneficial. Talk to a professional before purchasing braces.

Other Possible diagnoses

• Patellofemoral syndrome
• Chondromalacia patella
• Knee arthritis
• Osgood Schlatters disease (NOTE: If you are complaining of pain similar to patella tendinitis but you are younger than 17 it is possible that you are experiencing another condition. Individuals that participate in repetitive jumping activities, that have yet to go through puberty, could have this condition) This is a condition where the patella tendon starts to pull away from its boney attachment (Tibial tuberosity). 

Ouch! My Knee Hurts!!! [Part 1]

This Blog is going to be one of a series of blogs. The next few weeks we will be discussing the knee and the variety of diagnoses and treatments related to it.

Among athletes and non-athletes one of the most common complaints I hear is of knee pain. The knee probably seems to be a straight forward joint compared to other joints of the body.  Although the knee may seem less complicated than a shoulder or the back, the knee is extremely dynamic and can pose several different problems.  The key to figuring out how to fix the problem, is to ask the right questions. Answering these questions accurately is the imperative to being able to accurately diagnosis any knee issue.

Where is the pain located?

It is important to note where the pain is located when you experiencing knee pain.

1. Patella tendon – Possible patella tendinitis
2.  Either side of the patella tendon – Possible patella femoral syndrome
3. Quad tendon – Possible Quad tendinitis
4. Joint line– Possible  medial meniscus (a), lateral meniscus (b)
5. Posterior knee – Possible Hamstring strain, popliteal tendinitis
6. Whole anterior knee – Possible L4 peripheral symptoms, arthritis, internal tear (ACL, PCL)
7. Inside joint line – Possible MCL issue
8. Outside joint line – Possible LCL Issue

What causes pain?

•  Is the pain caused when standing?
•  Is the pain caused by sitting?
• Does it hurt to run?
• Does it hurt to turn?

What does the pain feel like? What Else are you feeling?

• Burning?
• Tingling?
• Throbbing?
• Sharp?
• Stabbing?
• Was there a pop or a snap?

In the next few weeks we will go over each possible diagnosis. We will review the possible causes, treatments and how to avoid these issues. 

Fitness FAQ’s from your resident CSCS

How do I lose my arm or stomach flab?

I think I get asked this question more than any other question in my professional career! My wife alone has asked me this question about fifty times and she is always dissatisfied with the answer. It’s a simple answer to a simple question that people usually don’t want to hear. This is my fat loss golden rule:  To lose fat anywhere, you must lose fat everywhere! It really is that simple. It’s physically impossible to lose fat locally without total body fat loss. You can do 1,000 crunches a day and you will not see any stomach fat loss unless your calorie intake is less than your calorie output. Meaning, that what you eat (calorie intake) has to be less than what you put out during your daily life and exercise (calorie output). A recent study has shown that it is not just about exercise but that diet contributes most to weight loss.

[Small tangent: Women have a tendency to pool fat in certain areas of their body in subcutaneous fat (below the skin). These areas are the upper arms, stomach, thighs and buttocks. Men have a tendency to pool fat viscerally (below the muscle, around organs in the abdomen) Subcutaneous fat is harder to lose than visceral fat… Sorry, ladies.]

How do I lose weight?

So let’s get one thing straight. You should not just aim to “lose weight.” Instead, you should aim to lose fat mass in relation to lean body mass (muscle). There are plenty of very, very unhealthy “skinny” people. Take for example, an anorexic female that has very low fat mass but also has critically low muscle mass and is malnourished. Although the anorexic female may be skinny, she is also incredibly unhealthy. Your focus should be on being fit and healthy—NOT skinny!

Losing fat mass and gaining muscle mass is critical to achieving health and fitness. Losing fat mass and gaining muscle mass does not only improve your aesthetics,  but also improves blood chemistry, reduces the risk of certain heart conditions, improves bone density, and increases overall strength, along with a whole laundry list of other benefits. Therefore, exercise is critical to overall health—although your diet is most important factor in losing weight.  With that said, I think it’s important to note that you should not just cut your calorie intake by eating less or simply not eating.

How should I diet?

Crash diets will work in the short run but will always fail! I do not say “always” lightly. The reason why these diets always ultimately fail is because the body is designed to require nutrition and will always seek it out. If you think of an engine, it is designed to require several elements to run. The engine requires gasoline, air, a spark, coolant and oil among other things. If any of these elements are eliminated, the engine will not run correctly or fail to run at all. The same goes for the human body. If you’re not eating correctly and you’re lacking elements of nutrition, your body will not run correctly. Likewise, if you’re consuming all the necessary elements but you’re not consuming them in the correct ratios, your body will not run correctly. These elements at the basic levels are the following: Protein, Carbohydrates, Fat and Fatty Acids, Minerals, Vitamins, and the most often forgotten—WATER!!! (Coffee and diet coke DO NOT COUNT.)  If you’re finding that you’re lacking in some of these areas, a good place to start is our Maven Shake, which combines the basics with a little extra something that’ll give you an extra boost. (Note: This isn’t just a shameless plug. I started drinking the Maven Shake every morning and I notice a legit difference.) 

My Achilles Heel! Is my Achilles heel…?

So as the weather warms I am seeing an influx of Achilles related injuries. So I wanted to shed some light onto what the Achilles is and what injuries are associated with it. 

What is the Achilles tendon?

-          The Achilles tendon (calcaneal tendon) is the common tendon of the ankle that attaches the calf to the foot. The “calf” muscle is comprised of 2 major muscle groups of the gastrocnemius (gastroc) and the soleus. These two muscles are in charge of flexing the foot down towards the floor or technically referred to as plantarflexion. You can feel your Achilles tendon by touching the back of your ankle and feeling for the large cord like tendon that extends down to the heel.

Why is the Achilles often injured?

-          

     The tricky part about Achilles issues is that it can caused by many things. The Achilles plays a major function in all weightbearing movement from standing to sprinting. Any issue with the Achilles will drastically affect ones function throughout a normal day. Some problems with the Achilles are the following:

o   Located in a vulnerable area susceptible to injury from outside forces such as a slide tackle.

o   Takes the majority of the load during jumping activities.

o   Used constantly throughout day and exercise.

o   Relatively small tendon for girth of muscle it attaches to.

o   Tendon attaches to calcaneus (heel) but also shares tissue with bottom of heel and effects plantar fascia.

What are some common injuries?

-           Some common injuries sustained to the Achilles tendon and possibly associated with the Achilles tendon are:

o   Achilles tendinitis or tendinosis – Inflammation of Achilles tendon. This is indicated by pain when touching the Achilles and pain with all running and jumping activities. May see slight swelling of tendon.

o   Achilles rupture – Tendon ruptures are very painful and require immediate medial attention. Full Achilles ruptures are immensely painful and require surgical repair and can be diagnosed by use of the Thompson test. The Thompson test is when the effected calf is squeezed and a positive finding is when the foot does not flex down (plantarflex).  Partial tears can be seen when a dip in the actual tendon (looks like a pothole in the tendon).

o   Achilles apophysitis (mostly just children) – Also called Severs Disease, Achilles apophysitis is when the Achilles tendon pulls away from the heel causing pain and swelling. Much care must be taken to avoid over stretching.

o   Heels Spurs (secondary) – Tight Achilles will sometimes contribute to heels spurs which are boney growths are an attachment of a plantar fascia.

o   Plantar fasciitis (secondary) – Inflammation of the plantar fascia of the foot (arch of the foot). Tightness of the Achilles will contribute to plantar fasciitis by placing the foot in poor alignment and causing increases stress across the plantar fascia.

What are some causes for injury?

-          Some causes for Achilles injuries are often preventable

o   Over use – Weekend warriors and avid runners with poor running technique will sometimes develop Achilles tendinitis.  See my last post about running technique.

o   Tight calves – Stretching is very important. One way you can tell if your calfs are tight is if you are unable to flex your foot towards your head >90 degrees. Be sure to warm up >10mins before stretching any muscles.

o   Improper footwear – High heeled shoes and flip flops do not support your foot properly and could eventually cause Achilles injuries. 

Running Tips For the Dog Days of Summer

As the temperature rises and beach season approaches we see more and more runners come into the office. Not all complain of the same issue but most boil down to the same root causes, poor running form. You might think to yourself, “I know how to run! You just go out there and run!” Although running may seem intuitive there is more to it than you might think. Here are a few things you should look out for:

1.       

• Wear the right shoes: So many people don’t understand that footwear is of the utmost importance. Get yourself fitted for the correct shoes at places like…

a  .     Road Runner Sports - http://www.roadrunnersports.com

b.      Jack Rabbit - http://jackrabbitsports.com      

      

These stores will be able to fit you for the proper shoe for your foot and your running level

• Heel – Toe is wrong: Traditionally we think we should be running on our heels but actually you shouldn’t. Running heel to toe actually puts a large amount of force on the shins and the lower leg and can possibly lead to “shin splints” or knee problems. You should land on your mid-foot or slightly behind the balls of your feet.
  
•  Running not jumping: There should be very little vertical movement with proper stride length. Next time you take a run, pass by a store front and look at how much your head bobs up and down, I think you’ll be surprised.
  
• Running surface: Running on asphalt and concrete all the time will eventually take its toll on your knees, hips and back. Change up your running surface every now and then. Try running on a soft track or grass every now and then.
  
• Treadmills are not always good: Running on treadmills all the time can sometimes lead to alterations in stride length, poor body mechanics and poor posture. This is mostly due to the fact that treadmills do half of the work for you by propelling your body. 

Hopefully these tips are helpful! But if you are currently in pain because of your running get assessed by a qualified PT or specialist. Happy running everyone!

David Kwon, PT, DPT, CSCS

SNOW SNOW SNOW!!!

As the northeast has been slammed with snow this winter, I have seen an increase in patients coming in with snow removal related injuries. Obviously snow doesn’t remove itself (unless you live in an apartment building) thus snow removal is necessary. Shoveling snow is an extremely strenuous activity that could lead to several injuries.

Possible Injuries:

•           Strained back muscles
•           Herniated discs
•           Impingements syndrome
•           Bone fractures (from falls)
•           Torn rotator cuffs
•           Shoulder strains
•           Wrist and hand ligament tears
•           Neck strains

With all the possible injuries that can occur with shoveling there are some very simple tips a physical therapist can use to help avoid injuries.

TIPS:

Know your limits! You may think you can move two tons of snow at once but maybe it’s not necessary. Take breaks and avoid long bouts of shoveling at a time. Over loading your muscles for a prolonged period will almost always lead to injury. During breaks make sure you rehydrate and eat something. Dehydration and hunger will lead to weakened muscles and injury.

“Lift with your legs!” When shoveling you must first remember that your legs are stronger than your arms.

     Step 1: When lifting that heavy shovel full of snow first use your legs to push the shovel.

     Step 2: Before lifting re-grip hands so that one hand is closer to the actual shovel.

     Step 3: Get the shovel close to your body.

     Step 4: TIGHTEN YOUR STOMACH! This is the most overlooked step. When you tighten you stomach       you stabilize your “core” this will protect your back.

     Step 5: Lift the shovel parallel to the ground keeping the snow as close to your body as you can. This will  decrease the torque on your back.

Avoid throwing snow. Walk snow over to where you want to put it. Throwing snow will almost always end in shoulder injuries.

BEST WAY TO AVOID INJURY! Hire someone else to do it! But if you can’t, please follow these guidelines. 

New Year Resolution… MORE PAIN!

As the clock strikes 12 on December 31^st, millions of people around the globe make resolutions to “lose weight” and to “get back into shape”. With this resolution come a few dangers that everyone should be aware of.  

Did you know? According to some sources there are more gym related injuries in the first month of January than all other months combined?

Common Mistakes that lead to injury

Being too aggressive: It is possible that injuries are prevalent in the month of January because people will be too aggressive when they return to exercises.

TIP: If you have not worked out in a few weeks (months or years!), progress your exercises. Start out slowly and don’t expect to be able to lift as much as you did when you stopped working out.

Your body requires a few weeks of consistent exercise and activity before your body is “re-educated”, meaning, that the mind and the body must accommodate for this new level of activity. Being too aggressive at the start of therapy could lead to injury simply because your body is not “used to it”.

Not warming up: When first starting any exercise it is imperative to “warm up”. Warming up increase peripheral blood flow to extremities (e.g. Legs, hands, arms) and increases tissue extensibility (ability to stretch). Imagine that your body is a car on an icy winter day. You have to warm your car up before you redline it! Same goes for your body.

TIP: Brisk walking on the treadmill for 10 mins, should be sufficient. If you are not sweating slightly after your warm-up, you did not warm up! If you are performing upper extremity exercises try a row machine.

Not stretching: Stretching is not only one of the most neglected activities; it is also the most incorrectly performed activities. Stretching should be performed after a warm up. Stretching should be specific to the body part that is being exercised that day. Stretches should last at least 15 seconds.

TIP: Do not bounce during stretching activities. There are little sensors in your muscles that detect rapid stretching, which compensate and increase muscle contraction. When you bounce and stretch (as seen in many Jane Fonda work outs) you can activate these sensors, meaning you are essentially making your muscles tighter!

Hopefully 2011 will be a healthier, stronger, injury free year for all of you! Good luck!