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.

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.

“Pre-hab”: Physiotherapy Before Surgery

UK Physiotherapy SalfordIt 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 

4 Exercises You Can Do at Work

Many Canadians spend the majority of the work day sitting at a desk. Although sitting may not seem like a high risk activity, sedentary jobs can have a negative impact on overall health. These types of jobs contribute to obesity and can lead to various other health issues such as tendonitis and neck and back strain injuries. Fortunately, there is something you can do. Here are 5 exercises that you can do at work to help keep you active, healthy and injury free at work.

1. Stretch

Stretching regularly will help to decrease tension and tightness in your muscles. Here are 10 simple stretches you can do at your desk. Try to perform a few of these stretches, 3-4 times a day. Hold each stretch for 20-30 seconds. Stretching should be pain free. (If any of these stretches cause pain, numbness or tingling, contact a health care professional)

2. Strengthen Muscles

-Glute squeeze: while sitting at your desk, tighten your buttocks, hold for 5 seconds, then relax. Repeat 10 times

-Heel raises: if you are taking a standing break, raise up on the balls of your feet by lifting your heels off the ground. Repeat 20 times

-Chair Squat:  without using your hands stand up and sit back down in your chair. Repeat 10 times

-Leg raises: When sitting, tighten your thigh muscle and kick your leg out straight. Hold for 5 seconds, repeat 20 times.

3. Stand Up

Every 15-20 minutes, take a break and stand up. Standing helps to improve circulation and posture, relieves stress and can decrease low back pain.

4. Go for a Walk

On your lunch break, go for a walk. Walking for just 10 minutes can help to control blood sugar and cholesterol, burn fat, increase energy and decrease stress. If possible, change into walking shoes to ensure your feet are well supported.

Preventing Knee Injuries

Deutsch: Knie, rechtes Röntgen von der Seite A...

The Knee (xray)

An in depth look into the world of your knees, their strengths and weakness.

Focusing on elite athletes as well as the average athlete, our Athletic Therapist has provided you with a full spectrum of information on the knee and how to prevent injury. From reviewing strengthening exercises for one of the most important joints in your body to looking at statistics about knee injury and how to avoid it, this article provides readers with everything they need to know about their knees.    Preventing Knee Injuries