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.

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.

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

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

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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

  • new-years-resolution-for-siteIt 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.

Ankle Sprains

What is the anatomy of the ankle?

ankle joint

The ankle joint is composed of 3 bones: the tibia, fibula and talus. Ligaments provide the ankle with stability.  Ligaments are like thick elastic bands and hold a joint together by attaching one bone to another. Muscles that come from below the knee and attach to the bones of the foot help to move the ankle.

What is an ankle spain?

Sprains are injuries to ligaments.  An ankle sprain occurs when the ligaments of the ankle are over stretched, partially torn or completely torn. This occurs when foot moves beyond its normal range of motion.

Ankle sprains can range from mild to severe. Depending on the amount of ligament that is damaged, an ankle sprain is classified as: grade 1= mild sprain, grade 2= moderate sprain, grade 3= severe sprain.  Most ankle sprains are due to injury of the ligaments on the outside (lateral side) of the ankle.

lat ankle strain

What is the immediate treatment after an ankle sprain?

The RICE (Rest Ice Compression Elevation) method should be used as soon as possible and for the next 72 hours after the injury. RICE helps to decrease pain and swelling around the ankle joint and promotes healing. The use of a gait aid, such as crutches, may be required depending on the severity of the sprain.

How long does it take for an ankle sprain to heal?

Most ankle sprains will heal in 3-8 weeks. The move severe the sprain, the longer it takes the ligaments to heal. Physiotherapy can help to decrease pain, increase ankle movement and get you back to normal activities more quickly.

What is the S.M.A.R.T. approach?

The Canadian Physiotherapy Association recommends the S.M.A.R.T. approach to assist early recovery and rehabilitation of most ankle sprains. S.M.A.R.T. stands for Stretch, Move, Add it up, Reduce strain, Talk to a physiotherapist.

STRETCH: Stretching will help to regain full ankle movement, increase circulation to aid the healing process, maintain muscle flexibility and strength.

MOVE: The severity of the ankle sprain will determine when and how much you start moving the joint. A physiotherapist will develop a progressive exercise program to promote range of motion and muscle strengthening while preventing further damage.

ADD IT UP: When recovering from an ankle sprain, you need to consider the effect of all the activities you do during the entire day. Planing time for rest during the day is important for continued healing.

REDUCE STRAIN: There are a number of things that can be done to protect the ankle when it is healing to reduce the risk of re-injury. These include: wearing an ankle brace, having a physiotherapist tape your ankle, taking part in a progressive exercise program, avoid activities on slippery or uneven surfaces, warm up and cool down before and after exercise.

TALK TO A PHYSIOTHERAPIST: A physiotherapist will perform a thorough assessment of your ankle and plan a personalized rehabilitation program to help reduce swelling and pain, improve range of motion, strengthen the ankle and help you attain your rehabilitation goals.  For more information or to set up an appointment, contact Kinetic Physiotherapy via phone 905-637-1414 or email: info@kineticphysiotherapy.ca