Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a common cause of knee pain in both adolescents and adults.  It is especially prevalent in runners and is sometimes called “Runner’s knee”. PFPS is typically characterized by pain at the front of the knee.

Anatomy:
The patellofemoral joint is comprised of the patella (knee cap) and the femur (thigh bone). The patella sits in a groove on the femur. When the knee bends, the patella moves along this groove. This is referred to as “patellar tracking”. A combination of dynamic (quadricep muscles and ITB)  and static (articular capsule, medial and lateral retinacula, bony structure and ligaments) stabilizers control patellar tracking.

 

Symptoms:

• Pain around or under the patella
• Aggravated by activities such as squatting, going down stairs, kneeling, lunging, running and prolonged periods of sitting
• Knee may feel stiff
• May notice clicking or grinding with knee movement
• Minimal swelling

Causes:
There are 3 primary contributing factors that increase the risk of PFPS.

1) Muscular imbalance

• Quadricep muscle weakness can impair patellar tracking. When the inner quadricep muscle is weak and the outer quadricep muscles and ITB are tight, the patella is pulled towards the outside, impairing its tracking. Tight hamstrings and calves can also contribute to PFPS. Furthermore, weak gluteus muscles decreases pelvic stability and increase the force placed on the knee which increases risk of PFPS.

2) Malalignment

• Large Q-angle (wide hips), knock knees and asymmetrical kneecaps can contribute to PFPS. Additionally, over pronation (excessive rolling-in) of the feet can cause the lower leg to rotate inwards, increasing stress on the knee joint.

3) Overactivity

• Increasing your running/training mileage, speed, intensity and hill work  too quickly without enough rest are common training errors that can cause PFPS.

Treatment:

Physiotherapy can effectively treat PFPS. The first step of treatment is identifying the cause of the problem. A treatment plan will then be created to deal with the cause and prevent injury recurrence. Initially, resting and icing the knee will be important to decrease pain and inflammation. A variety of soft tissue techniques, andjoint mobilization, as well stretching and strengthening exercises will be used to further rehabilitate the knee and surrounding structures. If necessary taping techniques, knee bracing and foot orthotics may recommended to deal with malalignment issues. It is important to note that addressing this issue early will promote faster recovery.

For more information about Kinetic Physiotherapy, visit our website:http://www.kineticphysiotherapy.ca  Contact Kinetic Physiotherapy via e-mail:info@kineticphysiotherapy.ca or phone: 905-637-1414 to set up an appointment.

Muscle cramps: Why you get them and what you can do

Muscle cramps are involuntary muscle contractions of one or more muscles. These spasms can be quite painful lasting a couple seconds to 15 minutes or longer. A muscle cramp can recur several times before it resolves.  Muscles of the feet, calves, thighs, hands, arms and abdomen are  prone to spasm. Whether you are out for a run, in the car or  going to sleep, muscle cramps come without warning.  A common question we get at our clinic is what causes these cramps and how can you relieve them?

Potential Causes of Muscle Cramps
Injury: Following an injury, muscle cramps can occur as a protective mechanism. Muscle spasms help to minimize movement, stabilizing the injured area.

Vigorous activity: Exercise related cramps are likely caused by muscle fatigue. In normal functioning muscles, inhibitory messages are sent to the muscle to prevent it from contracting too strongly. When the muscle fatigue, this inhibitory message is decreased causing overstimulation to the muscle. This results in a muscle cramp.

Dehydration: Dehydration can occur through excessive fluid loss when sweating and/or inadequate fluid intake. Dehydration increases the likelihood of muscle cramps.

Muscle cramps can also be caused by an underlying factor:
Mineral deficiency: Low levels of calcium or magnesium in the blood causes increased excitability of the nerves and the muscles that they stimulate. Increased muscle stimulation can result in muscle cramping.

Nerve compression: Spinal nerve irritation or compression can cause cramp-like pain.
This may be accompanied by weakness or sensory changes.

Poor circulation: If blood vessels become narrow due to arteriosclerosis, blood supply to the extremities become decreased. This can result in muscle cramps that are more likely to occur when you are walking or exercising but stops with rest.

Kidney, thyroid, hormone and liver disorders: Muscle cramps can be complications of an organ disorder. For example, hypoglycemia and anemia can cause muscle cramps.

Drug side effect: Various drugs such as those used for blood pressure, Alzheimer’s disease, high cholesterol and others can cause muscle cramps.

What can you do?

Stretch: Most muscle cramps will relax if the muscle is stretched. This can sometimes be accomplished by standing up and walking around or changing positions. Stretching the specific muscle group in spasm may also be required. For instance, if your calf is in spasm, stretch is by performing these 2 stretches.

Massage: Gently massaging the muscle in spasm may help to relax the muscle.

Heat: Applying a heat pack to the muscle cramp or having a warm bath may also help to get the muscle to relax.

Prevent the cramp: There are a number of things you can do to prevent muscle cramps from happening in the first place:
a) Stay well hydrated
b) Ensure adequate dietary intake of nutrients and minerals
c) Stretch before and after physical activity
d) Rest: get enough sleep and allow sufficient time for muscles to rest and recover after exercise

Physical therapy: If your muscle cramp is the result of an injury, physical therapy can help to decrease muscle tone and spasm and rehabilitate underlying injuries.

Note: Cramps that are a result of organ disorders, nerve compression, poor circulation or drug complications may need further medical investigation for appropriate treatment.

For more information about Kinetic Physiotherapy, visit our website:http://www.kineticphysiotherapy.ca  Contact Kinetic Physiotherapy via e-mail:info@kineticphysiotherapy.ca or phone: 905-637-1414 to set up an appointment.

Olympians and Disc Herniations

The 2014 Winter Olympics have been a wonderful display of determination, speed, strength, agility and athletic performance. As the athletes pushed their bodies to the limits, injuries inevitably occurred. Disc herniations were one common injury that plagued athletes. Craig Pickering (Great Britain, bobsled), Evgeni Plushenko (Russia, figure skating), Henrik Zetterberg ( Sweden, ice hockey), and Brendan Green (Canada, biathlon) all experienced disc herniations, which in most cases prevented them from competing in the games.

The spine is composed of 24 bones (vertebrae) that are stacked on top of one another. A small disc is located between each vertebra and acts as a cushion and shock absorber.  These discs have a tough outer layer called the annulus that surrounds a jelly-like substance called the nucleus.

A disc herniation begins when wear and tear or a sudden injury causes the jelly substance to push against the tough outer layer. If severely injured, the nucleus can break or herniate through the outer layer. Since there is limited space in the spinal column, the herniated disc can press on the spinal nerve causing pain.

Causes
1) Sudden unexpected load: traumatic situations such as a motor vehicle accident, lifting and twisting, or a fall. Any sudden event that cause an unexpected load to the disc may result in disc herniation.

2) Accumulated micro trauma: repeated micro injury to the disc over a period of time can result in disc herniation. For example, poor posture when sitting, standing and working can cause over stretching and weakness of the outer layer of the disc. Over time this weakens the disc and increases the risk of the nucleus herniating. 

Symptoms
Symptoms of disc herniation can include one or all of the following:
-back pain
-leg and/or foot pain
-weakness in leg or foot
-numbness or tingling sensation in leg or foot
-loss of bowl or bladder control: this is very rare but may indicate a more serious condition called caudal equine syndrome. Immediate medical attention is required.

Diagnosis
Your doctor or physiotherapist will suspect a disc herniation based on your symptoms and the history of your injury. A physiotherapist can perform clinical tests to determine if there is disc injury and nerve compression. MRI and CT scans are the most accurate diagnostic tests to confirm disc herniation.

Treatment
Conservative treatment is appropriate for minor and moderate disc herniations. Physiotherapy treatment can include a variety of methods such as ice therapy, traction, electrotherapy, taping techniques, soft tissue massage, acupuncture, joint mobilization, postural advice and home exercise program. More serious cases may require surgical intervention.

For more information about Kinetic Physiotherapy, visit our website:http://www.kineticphysiotherapy.ca  Contact Kinetic Physiotherapy via e-mail:info@kineticphysiotherapy.ca or phone: 905-637-1414 to set up an appointment.

Bronze with a Broken Rib

The Sochi 2014 Olympics are now underway and it has been a great day for team Canada. The day started with a bronze medal finish by our very own, Mark McMorris, in Men’s Slopestyle Snowboard. Winning Canada’s first medal is quite an accomplishment, especially given the athlete’s injury.  McMorris fractured one of his ribs 2 weeks before the Olympics, which posed a big concern for the medal hopeful. However, with determination and intensive therapy, McMorris persevered  in order to fulfil his Olympic dream.  This is an incredible feat as most would be unable to compete with such an injury.

What is a rib fracture?
A rib fracture is a break of any of the 12 rib bones. The ribs form a cage around the torso, attaching to the spine at the back and traveling around to the front of the chest. Ribs 1-7 attach to the sternum, ribs 8-10 attach to the rib above via cartilage, and ribs 11-12 are considered ‘floating ribs’ because they do not attach to the chest.

Fractures are typically the result of trauma to the chest caused by a fall, direct impact to the chest, or motor vehicle accident. In serious cases, the rib can be become displaced, which may result in organ damage to the lungs, liver, kidney, spleen or blood vessels.

Signs and symptoms of a rib fracture can include:
-chest, midback, side pain that may radiate into the shoulder, neck or back
-pain with breathing
-pain in the chest with coughing and sneezing
-pain with movement, especially bending and twisting (McMorris was doing a lot of this)
-visible bruising on the chest
-tender to touch the area of the fracture

Rib fracture treatment:
Depending on the severity and presentation of symptoms, physiotherapists utilize a number of techniques to treat rib fractures. These include: advice on activity limitations/restriction, taping, postural correction, protective padding, soft tissue work, joint mobilization (post fracture healing), graduated return to sport/activity plan, electrotherapy, fall prevention programs and exercises to improve range of motion, strength and flexibility.

It is amazing the Mark McMorris fought through this injury today to bring home the bronze. We are so proud of all of our Canadian athletes and look forward to more inspiring stories to come. GO CANADA GO!

For more information about Kinetic Physiotherapy, visit our website:http://www.kineticphysiotherapy.ca  Contact Kinetic Physiotherapy via e-mail:info@kineticphysiotherapy.ca or phone: 905-637-1414 to set up an appointment.

Connect With Your Core

What is my core?

The core can be divided in to two groups of muscles, the “inner core” and the “outer core”.

The “inner core” is composed of 4 deep stabilizing muscles: the transversus abdominus, multifidus, diaphragm and pelvic floor muscles.  These muscles do not create any specific movement. Instead, when correctly working together, these muscles turn on before you move your body to provide stability to the spine and pelvis. Therefore, having a strong inner core helps to prevent back injury. It also provides a strong base of support for leg and arm movement which can help to prevent and rehabilitate neck, shoulder, elbow, hip, knee and ankle injuries.

Conversely, when these muscles don’t work correctly, the body must resort to less efficient movement strategies to perform various tasks. This increases your risk for injury, dysfunction and recurrent pain. Research shows that following a back injury, the anticipatory co-contraction of the inner core muscles is impaired. This can create a cycle of: injury, pain, impaired “inner core” muscles and increased risk of injury. This cycle can be broken through targeted “inner core” strengthening.

The “outer core” is composed of the rectus abdominis (“six-pack” muscle), inner and outer obliques and the back extensor muscles known as the erector spinae. These are the muscles that are normally targeted during abdominal exercise programs and “core” exercise classes. The problem with this is that the “inner core” muscles remain untrained and weak while the “outer core” muscles get stronger. During injury, the outer core muscles can tighten up in an attempt to compensate for “inner core” muscle weakness. This can actually contribute to and exacerbate back pain.

Strengthening Your Core
It is very important to add inner core strengthening to your daily routine. We normally do not think consciously about engaging these muscles and you may not even know how to isolate them. A physiotherapist can assess your current inner core strength and co-contraction, teach you how to contract these muscles and provide progressive exercises to strengthen these deep stabilizing muscles. You can also check out this video by Shawna, who takes your through an inner core workout.

Easing Your Neck and Shoulder Tension

The neck and shoulders are often the victims of stress and pain.  Although there are multiple potential causes of neck and shoulder pain, symptoms are frequently the result of structural stress caused by our day-to-day activities. For instance, activities such as holding a phone between your shoulder and ear, doing repetitive overhead work (e.g. painting or lifting boxes), and typing at a keyboard that is too high can all cause muscle tension in the neck and shoulders. Additionally, sitting and standing in a poor posture with the head and shoulders forward and upper back slouched causes strain and tension in the muscles. Anxiety and chronic stress can also contribute to this problem as it can cause the body to adopt a self-protection posture with the shoulders raised, jaw clenched and neck jutting forward.

There are things you can do to decrease tension in your neck and shoulders:

1) Maintain good posture throughout the day. You can check out our previous post here for more information.

2) Drink plenty of water. Water is necessary for proper muscle and joint function. Try to drink at least 8, 8oz glasses of water a day.

3) See a physiotherapist. A physiotherapist can assess your neck and shoulders to determine the cause of your pain and develop a treatment plan to address any issues.

4) Stretch. Check out our newest video for an easy shoulder and neck yoga sequence that will help to decrease tension and stress.

 

Don’t Get Trapped in the Boom-Bust Cycle

Do you have a persistent injury that just does not seem to go away? Do you get better for a while but are plagued with set backs? Do you ever feel  like you are never 100% recovered from your injury? If so, you might be trapped in the boom-bust cycle.

Chronic injuries are undoubtably very frustrating and rehabilitation can feel painstakingly slow.  People with persistent injuries tend to ‘overdo’ an activity which causes a ‘pain flare’ and results in a set back.  This process is known as the boom-bust cycle.

Boom-Bust Cycle

So, what is the solution? How can you prevent this boom-bust cycle? Here is some advice:

We hope this advice will help you avoid the boom-bust cycle and lead you on the path to recovery.

For more information about Kinetic Physiotherapy, visit our website: http://www.kineticphysiotherapy.ca  Contact Kinetic Physiotherapy via e-mail: info@kineticphysiotherapy.ca or phone: 905-637-1414 to set up an appointment.

Successful New Year Resolutions

• It is hard to believe that 2014 is already here. With a new year just beginning, many people are thinking about self-improvement and the term “New Year Resolution” has been a popular topic of conversation. Everyone has high hopes of… getting  fit, losing weight, eating better, spending more time with family etc. Although motivation  is high right now, enthusiasm tends to dwindle as the month and year continues. The question is, how do we stay motivated to successfully accomplish our New Year’s Resolutions?  One way to succeed is by creating SMART goals. We use these types of goals in the physiotherapy setting to help people succeed in rehabilitation. However, the same principles can be applied to any goal you have and can help you succeed with your New Year resolution.

A “SMART” goal is:

Specific: Goals should be simplistically written and clearly state exactly what you want to achieve (who, what, where, when, which, why, how). You are more likely to accomplish a specific goal than a general one.
Example of a general goal: Get fit.
Example of a specific goal: Join a gym and work out 3 days a week.

Measurable: Goals should be measurable so that you can evaluate when the goal has been met. To determine if your goal is measurable ask questions such as: how much, how many and how will I know when it is accomplished?
Example of a non measurable goal: Get healthy.
Example of a measurable goal: Become more healthy as measured by lowering my blood pressure to a healthy range (120/80 mmHg).

Achievable: Goals should challenge you but be achievable. This requires you to reflect on the strengths, weaknesses and resources that you possess that will enable you to reach your goal.

Realistic: Goals must represent an objective that you are both able and willing to work towards.

Time-Bound: Goals should be grounded within a time frame. This will provide a sense of urgency to help you start working towards your goal.
Example of a goal that is not time-bound: Learn something new.
Example of a time-bound goal: Take a cake decorating class within the next 3 months.

Reflect on your New Year Resolutions. Are they SMART? If not, revise them so that they are. Write your goals down and tell someone to help keep you accountable. We wish you all the best in this New Year and hope these principles will help you succeed with all of your New Year Resolutions.

“Pre-hab”: Physiotherapy Before Surgery

It is widely accepted that physiotherapy is beneficial after  an ACL repair, hip or knee replacement and various other surgeries. However, the idea of “pre-hab” or pre-surgical rehabilitation is becoming increasingly popular… and for a good reason. Studies have found that a person’s strength, flexibility, functional ability and pain prior to surgery, such as a total knee replacement, significantly predicts the outcome of his or her recovery after surgery. In other words, the stronger, less painful and more flexible a person is prior to surgery, the more likely they are to have a faster and easier recovery.

Why “Pre-hab”?

It is inevitable that a wait time will be involved before to surgery. This time can be valuable if it is used to prepare the body for surgery. Research shows that people who participate in pre-hab regain function and return to normal daily activities faster than those who do not. Decreased range of motion and strength is often associated with surgery.  Taking part in rehabilitation before surgery will help to build muscle so that an individual has a higher starting level of strength. This will help to lessen the effects of muscle atrophy after surgery.

Physiotherapy and “Pre-Hab”

Before surgery, it is common for the area that will be operated on to be painful, inflamed and weak. A physiotherapist will perform a thorough assessment to evaluate your walking pattern, determine your muscle strength, joint range of motion, ability to perform daily tasks, and the amount of help you require from others.

A “pre-hab” program should start at least 6 weeks before surgery. This program will start and progress slowly to prevent aggravating the existing problem or staring a new one. The physiotherapist will develop a treatment plan that will help to reduce inflammation and pain, increase strength and functional ability and improve blood flow.

When designing your program, the physiotherapists will take your goals into consideration along with the known requirements of hospital discharge after surgery. For example: if your goal is to get up out of a chair more easily, the physiotherapist will give exercises and strategies to help you reach this goal. Additionally, if a requirement for discharge after surgery is to go up and down 9 steps, the physiotherapist will work on this task with you before surgery so that you are more equipped to perform this activity after surgery. A physiotherapist can also provide advice about appropriate gait aids to ensure you are safe while walking. In addition, “pre-hab” can help reduce your fears and anxiety about what will happen after surgery. You will have the opportunity to learn and get familiar with exercises you will need to do and gait aids that you may need to use once the surgery is over.

Do you have an upcoming surgery?

If you or someone you know have an upcoming surgery consider “pre-hab” to speed up your recovery. For more information or to set up an appointment, contact Kinetic Physiotherapy via phone 905-637-1414 or email: info@kineticphysiotherapy.ca 

Smart Shovelling

With the first dusting of snow upon us and the reminder that winter on its way, we thought it would be a good time to talk about snow shovelling safety.  Improper snow shovelling technique can place you at an increased risk for injuries ranging from sprains and strains to significant back injuries. It is always important to put safety first and take the necessary precautions to prevent hurting yourself.

Here are some things you should do:

1. Assess your health: Are you feeling under the weather? Do you have any issues with your heart such as heart disease, history of heart attack or high blood pressure? Do you lead a sedentary lifestyle? Although it may not seem like it, shovelling is a physically challenging activity. If you are unsure if it is safe for you to shovel, consult with your family physician.

2. Warm up: Before you start shoveling walk or march in place to warm up your muscles. It is also important to stretch before and after shovelling to help prevent injury.

3. Dress appropriately: Make sure you dress in layers to stay warm but are still able to bend your knees and arms without restriction. Ensure you are wearing boots with good treads to prevent slips and falls.

4. Drink water: Prevent dehydration by drinking plenty of water before and after shovelling.

5. Use a good shovel: An ergonomically designed shovel with a curved handle will help to prevent fatigue and injury. Your shovel should be sturdy but light weight.

6. Take breaks: Don’t push yourself to fatigue. Try shovelling for 5-7 minute then take a 2-3 minute break. Take longer and/or more frequent breaks if necessary.

Proper Shovelling Technique:

1. Always try to push snow instead of lifting it

2. Stand with feet hip width apart

3. Hold shovel close to your body

4. Bend from your knees not from your back

5. Tighten your core muscles when lifting snow

6. Do not twist at the waist. Always point your toes in the direction you are pushing, lifting or throwing the snow.

Stay Safe:

Shovelling snow is a strenuous activity that forces your heart to work very hard. It is important that you monitor the following warning signs: discomfort or heaviness in your chest, arms or neck, feelings of dizziness, nausea or faintness, unusually long period of shortness of breath, and excessive sweating. If you experience any of these symptoms take a break. If you still feel unwell after a rest, or suspect a medical problem, seek emergency medical attention immediately.

Happy Shovelling!