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:
b.pfsmlThe 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

calf-crampMuscle 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. CalfStretches

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

Evgeni-Plushenko-back-injury-russia-withdraw-02132014The 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.

Back pain PID 1The 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.Bulging-Disc

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

1297523994615_ORIGINALThe 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.

nucleus-medical-art-illustration-of-the-thoracic-chest-and-back-skeletal-anatomy-featuring-the-ribs-sternum

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?

core-muscles-diagramThe 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.

manage_abs5The “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.

 

Leg Flow

Here at Kinetic Physiotherapy, we believe in helping you holistically achieve your health and fitness goals.  Our highly skilled staff are very enthusiastic in helping you recover from and prevent injuries, attain equilibrium in your body, and ensure that you are following through with your rehabilitation program. Because of this we will be creating regular videos  to help you stay healthy and injury free.

For our first video, Shawna guides you through a leg flow series to help increase lower extremity flexibility.  Great for preventing injuries, reducing low back pain, and increasing circulation, energy, and overall wellbeing.

Stay tuned for regular Kinetic Videos!