Knee pain

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Running Shoes: Comfort vs. Function

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

Have you ever stood in front of a wall of running shoes wondering which shoe is right for you? Maybe the Hokas with the super cushioned sole that feel like you’re running on clouds? Or the Brooks trail runners since the trails have cleared up and you’ve been wanting to try out the North Cottonwood trail? Or maybe the Saucony minimalist shoes because you’ve recently read about the benefits of minimalist running? Or my personal favorite, the hot pink shoes with tie-dye laces?! 

You may think that based on the available technology for running shoes and advancements in materials used to create modern running shoes that a plethora of running shoe research would be available. However, this is not necessarily the case.

Although the modern running shoe has been around for the past 40 years since the running boom in the 1970s, research specific to running shoes and injury is relatively new within the past few years. A wide variety of shoe functions exist in running shoes from a cushioned sole for shock absorption, motion control to decrease over pronation, a trail runner, or a minimalist shoe. While some runners may benefit from a specific type of shoes, recent studies on footwear for runners suggest that when shoes or orthotics are selected for comfort rather than function this results in a decreased frequency of running related injury.

So, unfortunately, you can’t base your choice on shoe color alone, but if the pink shoes with tie-dye laces have the best fit and are the most comfortable, they are also the most likely to keep you out of an injury!

Megan Peach, DPT, OCS, CSCS specializes in manual treatment of spinal dysfunction, as well as knee and shoulder pain and is a member of the Excel Physical Therapy running specialist PT team. Megan’s philosophy for physical therapy treatment embraces educating patients about the tools they need for enhancement of proper body movements during work and play to promote a pain and injury free active lifestyle. 

Injury Prevention in Nordic Skiing: Knee Pain

By Jason Lunden, DPT, SCS
jason@excelptmt.com

Patellofemoral pain, or anterior knee pain, is the most common type of knee pain in Nordic skiing.   Repetitive stress to the soft tissue around the patella (knee cap) occurs due to poor tracking of the patella in the femoral groove.  This poor tracking can be the result of hip weakness causing poor control of movement of the femur (thigh bone), poor stabilization from the foot and ankle, and poor skiing technique.

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Technique & the Prevention of Alpine Ski Injuries: Part 4

By Jason Lunden, DPT, SCS
jason@excelptmt.com

Nearly all injuries in alpine skiing are classified as traumatic, or due to a fall.  As mentioned earlier, under Strength & Injury Prevention, the majority of knee injuries in alpine skiing occur on the left knee.   Therefore it is important to work on your ski technique to be able to turn equally well to your right and left.  With the snowpack being shallower and conditions not yet epic, the early season is a great time to work on perfecting your turns.  Aim to stay balanced on your skis with your hips centered and perfect your turns to both sides.  A Professional Ski Instructor or coach can make all the difference, so take the time to perfect your technique by taking a lesson at one or our local ski resorts, or sign-up for coaching from a community ski team such as the Bridger Ski Foundation (BSF).

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Strength and Injury Prevention in Alpine Skiing: Part 2

By Jason Lunden, DPT, SCS
jason@excelptmt.com

Developing and performing a proper pre-season/dry-land strengthening program can help to reduce your risk of injury and improve your performance.  Alpine skiing is unique in that it places equal demands on both sides of the body, as one has to be able to turn equally well to the right and the left.  Research has found that the left knee is most often injured in alpine skiing1.  Therefore it is important to compare the strength of your right and left legs to get the most out of your workouts.  (more…)

"Got to Keep on Moving" by Matt Heyliger, DPT

By Matt Heyliger, DPT
matt@excelptmt.com

I have recently been thinking quite a bit about the importance of joint mobility, not strictly for function, but for joint health. In manual therapy, assessment of a given joint in the body always consists of consideration of joint mobility. Is there enough mobility? If not, why not? Does the joint itself have a motion restriction? Or is there perhaps some tissue outside the joint, like a tight muscle, that is limiting mobility? While it makes sense that a certain degree of motion is important for functional tasks, like bending your knee a certain amount to ascend stairs, mobility is also critical for joint health. (more…)

Recent Research on Patellofemoral Knee Pain - It's All About the Angle

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

Do you have patellofemoral knee pain? A recent study by Christopher Powers et al. in the Journal of Orthopaedic & Sports Physical Therapy suggests that knee angle during quadriceps strengthening exercises affects patellofemoral joint stress. Because excessive joint stress may contribute to patellofemoral pain, the author’s purpose was to determine which exercises were minimally stressful to the knee.

                                                                                                       

During the squat exercise, joint stress was the least in the standing position, and increased as a subject descended into the squat position, peaking at 90 degrees of knee flexion. In an open chain seated leg extension exercise the joint stress was variable depending on the type of weight used, however joint stress was generally greater when the leg was fully extended.

 

The authors suggest that a squat exercise from standing to 45 degrees knee flexion coupled with an open chain seated leg extension from 90 degrees to 45 degrees knee range of motion is the best combination to minimize patellofemoral joint stress and therefore strengthen the quads without increasing pain.

 

We can help you if you suffer from patellofemoral knee pain. Call us at 406-556-0562 (Bozeman) or 406-284-4262 (Manhattan). 

Pain on the Bottom of your Foot? Plantar Intrinsic Training is a Solution

By Matt Heyliger, DPT
matt@excelptmt.com

Plantar Intrinsic Training

by Matt Heyliger, DPT, Excel Physical Therapy

Over-pronation (the inward roll of the foot while walking or running) is a common contributing factor in the development of several lower extremity injuries including plantar fasciitis, Achilles tendinopathy, patellafemoral knee pain and other overuse conditions. Recent research addressing the contributing factors to the development of plantar foot pain (pain at the bottom of your foot) has emphasized the importance of training the muscles of the foot to keep the arch from collapsing inward. It has been proposed that the intrinsic plantar muscles of the foot play a similar role in arch preservation as the core muscles play in the stabilization of the trunk and spine. This concept provides a great foundation for direct treatment of conditions associated with over-pronation.

 

A recent study by Mulligan and Cook, published in the journal “Manual Therapy,” presented this concept and sought to test if the performance of a series of exercises (named “Short Foot Exercises”) directed at isolating the recruitment of the plantar foot muscles could decrease pronation after four weeks of training. They discovered a small, but significant difference in arch height and these differences were preserved after eight weeks without continued training. While these exercises are tedious and initially challenging, our patients here at Excel Physical Therapy are responding well to these exercises. If you have been dealing with plantar foot pain and are not responding to other therapies or orthotics, consider training the “core” of your feet with Short Foot Exercises.

 

Be sure to contact a licensed health professional before starting any exercise plan and for a thorough evaluation or diagnosis of your issue. We can help. Call us in Bozeman at 406.556.0562 or in Manhattan at 406.284.4262.

 

About Matt Heyliger, DPT:

Matt completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington. During his clinical experience with the Sports Medicine and Extremities team at The Orthopedic Specialty Hospital in Salt Lake City, Matt was exposed to a wide variety of surgical and non-surgical conditions and developed a solid foundation for the assessment and treatment of orthopedic conditions related to the extremities.
Matt is an avid rock climber, telemark/backcountry skier and mountain biker. Matt regularly practices yoga and enjoys frequent adventures in the mountains with his wife and their Alaskan Malamute.

 

How Your Knees Can Predict the Weather

By Tiffany Coletta
tiffany@excelptmt.com

Our patients have found this information interesting so we are sharing the following article from the Wall Street Journal’s Health Journal:

 

How Your Knees Can Predict the Weather

Granny was right: Scientists find link between achy joints and the forecast

By

Melinda Beck
 
Oct. 14, 2013 7:12 p.m. ET

The Wolff family of Paramus, N.J., was eyeing the gathering clouds and debating whether to cancel a planned park trip when 6-year-old Leora piped up with an idea: “Let’s call Grandma. Her knees always know when it’s going to rain!”

Leora’s grandmother, Esther Polatsek, says she started being sensitive to the weather in her 20s, when a fracture in her foot would ache whenever a snowstorm approached. Now 66 and plagued by rheumatoid arthritis, Mrs. Polatsek says she suffers flare-ups whenever the weather is about to change.

“It’s just uncanny. Sometimes it’ll be gorgeous out, but I’ll have this awful pain. And sure enough, the next morning it rains,” she says. “It may be just a few drops, but it makes my body crazy.”

Do weather conditions really aggravate physical pain?

It is one of the longest running controversies in medicine.

Weathering the Pain

You can’t change the forecast, but you can lessen its impact.

  • Take a pain reliever or anti-inflammatory in advance if a storm or cold weather is forecast.
  • Dress warmly in the cold, including thermal socks, gloves and a vest.
  • Keep out drafts at home by sealing doors and windows and carpeting floors.
  • Apply heat to aching joints.
  • Use a dehumidifier to avoid spikes in dampness.
  • Consider visiting a warm, dry climate, although the benefits may wear off after a prolonged stay.
  • Maintain a healthy body weight.
  • Stay active, keeping muscles strong around damaged joints.

Hippocrates in 400 B.C. noticed that some illnesses were seasonal. The traditional Chinese medicine term for rheumatism (fengshi bing) translates to “wind-damp disease.”

But modern scholars have gotten inconsistent results in studies that tried to match weather patterns to reported pain symptoms—leading some to dismiss the connection as highly subjective or all in sufferers’ minds.

“People’s beliefs about arthritis pain and the weather may tell more about the workings of the mind than of the body,” concluded the late Stanford psychologist Amos Tversky in the mid-1990s, after comparing the pain reports of 18 rheumatoid-arthritis patients with local weather conditions for a year and finding no connection.

Still, other studies have linked changes in temperature, humidity or barometric pressure to worsening pain from rheumatoid arthritis and osteoarthritis, as well as headaches, tooth aches, jaw pain, scar pain, low-back pain, pelvic pain, fibromyalgia, trigeminal neuralgia (a searing pain in the face), gout and phantom-limb pain.

 

Bill Balderaz had a rheumatoid-arthritis flare-up last year—just before a surprise storm hit Ohio. Jason Joseph

Scientists don’t understand all the mechanisms involved in weather-related pain, but one leading theory holds that the falling barometric pressure that frequently precedes a storm alters the pressure inside joints. Those connections between bones, held together with tendons and ligaments, are surrounded and cushioned by sacs of fluid and trapped gasses.

“Think of a balloon that has as much air pressure on the outside pushing in as on the inside pushing out,” says Robert Jamison, a professor of anesthesia and psychiatry at Harvard Medical School. As the outside pressure drops, the balloon—or joint—expands, pressing against surrounding nerves and other tissues. “That’s probably the effect that people are feeling, particularly if those nerves are irritated in the first place,” Dr. Jamison says.

Not everyone with arthritis has weather-related pain, says Patience White, a rheumatologist at George Washington University School of Medicine and a vice president of the Arthritis Foundation. “It’s much more common in people with some sort of effusion,” an abnormal buildup of fluid in or around a joint that frequently occurs with inflammation.

Many patients swear that certain weather conditions exacerbate their pain. Consequently, orthopedists, rheumatologists, neurologists, family physicians, chiropractors, physical therapists—even personal trainers—report an increase in grousing among their clients when the temperature drops or a storm approaches.

“I can tell you emphatically there are certain days where practically every patient complains of increased pain,” says Aviva Wolff, an occupational therapist at the Hospital for Special Surgery in New York City, and Mrs. Polatsek’s daughter. “The more dramatic the weather change, the more obvious it is.”

Both the Weather Channel and AccuWeather have indexes on their websites that calculate the likelihood of aches and pains across the country, based on barometric pressure, temperature, humidity and wind. Changes in those conditions tend to affect joints even more than current conditions do, says AccuWeather meteorologist Michael Steinberg, which is why the Arthritis Index shows more risk the day before a storm or a sharp drop in temperature is forecast.

Some sufferers say their joints can be more accurate than meteorologists. Rheumatoid-arthritis sufferer Bill Balderaz, 38, president of a digital-marketing firm in Columbus, Ohio, recalls feeling “the worst arthritis pain I’ve ever had—I could barely move” one day last year, even though it was sunny and clear. By midafternoon, a land-based hurricane known as a derecho with 80 mile-per-hour winds unexpectedly buffeted Ohio and three other states, traveling 600 miles in 10 hours and knocking out power for 10 days. “The storm caught everyone off guard. It was clear one minute and then the skies opened up,” Mr. Balderaz says.

Tests on animals seem to bear out the impact of weather. In one study, guinea pigs with induced back pain exhibited signs of increased pain by pulling in their hindpaws in low barometric pressure.

Cold weather seems to raise the risk of stroke, heart attacks and sudden cardiac death, some research shows. Heart-attack risk rose 7% for every 10 degrees Celsius (18 degrees Fahrenheit) drop in temperature, according to a study of nearly 16,000 patients in Belgium, presented at the European Society of Cardiology last month. British researchers studying years of data on implanted defibrillators found that the risk of ventricular arrhythmia—an abnormal heart rhythm that can lead to sudden death—rose 1.2% for every 1.8 degrees Fahrenheit drop, according to a study in the International Journal of Biometerology last month.

Once blamed on physically demanding tasks like shoveling snow, the increased heart risk due to cold may be due to thickening blood and constricting blood vessels, researchers think.

And rising humidity may cause joints to swell and stiffen. In fact, tendons, ligaments, muscles, bones and other tissues all have varying densities, so they may expand or contract in different ways in changing conditions, Dr. Jamison says.

In people with chronic inflammation from arthritis or past injuries, even slight irritations due to the weather can aggravate sensory nerve cells, known as nociceptors, that relay pain signals to the brain. That may explain why some people with neuropathic pain and phantom-limb pain also report weather-related flare-ups.

“Fibromyalgia patients seem to be the most sensitive,” says Susan Goodman, a rheumatologist at the Hospital for Special Surgery. She also notes that while some people seem to be extremely sensitive to weather, others with similar conditions aren’t, for reasons that aren’t clear. That may explain why many studies find no clear association, she says.

Some weather conditions seem to relieve pain. In one study, the warm, high-pressure Chinook winds common to western Canada lessened patients’ neuropathic pain, the kind brought on by disease or injury. For other patients, the same climate increased migraines and sinus headaches.

Some pain sufferers say they feel better in warm, dry climates where weather conditions seldom change. When she went to Israel in the 1990s, “I felt like I was 20 years younger when I stepped off the plane,” says Mrs. Polatsek, the rheumatoid-arthritis patient.

But studies haven’t consistently borne out the benefits of one climate over another. “There really is no place in the U.S. where people report more or less weather-related pain,” says Dr. Jamison. He surveyed 557 arthritis sufferers in four cities in 1995 and found that more than 60% believed the weather affected their pain—regardless of whether they lived in San Diego, Boston, Nashville, Tenn., or Worcester, Mass.

Visiting a warm, dry climate may bring temporary relief, Dr. Jamison adds. “But if you live there full time, your body seems to acclimatize and you become sensitive to even subtle weather changes.”

Write to Melinda Beck at HealthJournal@wsj.com

From Wall Street Journal : http://online.wsj.com/news/articles/SB10001424052702304500404579127833656537554

Effects of High Heels on Body

By Tiffany Coletta
tiffany@excelptmt.com

Now we love a good pair of heels too, but we saw this information and wanted to pass it on.  Perhaps worn more in moderation…. “Ever wondered the effects of high heels on your feet and body? Often painstakingly selected to complete outfits, high heels put stress not just on feet, but on ankles, knees and backs, contributing to the approximately $3.5 billion spent annually in the United States for women’s foot surgeries, which cause them to lose 15 million work days yearly.”

https://i1.wp.com/www.mainstreetphysio.ca/blog/wp-content/uploads/2013/08/HighHeels18.jpg?resize=588%2C1111

 

SOURCE: American Academy of Orthopaedic Surgeons, American Apparel & Footwear Association, American Orthopaedic Foot & Ankle Society, Mayo Clinic, Society of Chiropodists and Podiatrists, “Women’s Shoes and Knee Osteoarthritis,” by D. Casey Kerrigan, Jenn.

"Matt was exceptionally knowledgeable and gave me personalized treatment. All the staff were organized and genuinely friendly. Thank you Matt and Excel PT for getting me back to running and dancing! :)" -- Bozeman patient.

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