Archive for July, 2010

This was a 10 minute presentation to a local business networking group.

 In this talk I reveiw our spinal curves and why we loose height as we age. 

 Do you want to know how to sit properly? 

What about spinal degeneration and aging? 

What about treatment? 

I also explain a little bit about the physiology of Intra Muscuar Stimulation (IMS). 

So get comfortable and enjoy the talk.

I give a presentation every year to a local running group on injury prevention and treatment related to running injuries.  The group is participating in a running program to prepare for the Victoria Times Colonist 10 Km run.

In this presentation I will address why the pelvis is important and how muscle imbalances around the pelvis contribute to common running disorders such as iliotibial band syndrom (ITBS), plantar fascitis, and achilles tendon problems. 

You will also be introduced to inner core versus the outer core.  I was introduced to this concept by Diane Lee (http://dianelee.ca/).

 You can find the presentation posted under the video section titled “Smooth Sailing: A Rendition on Running Related Injuries”.

 

Once upon a time there was a young active teenager who was having problems with her knees.  She liked to bike, play basketball, play soccer and hockey. She went to the doctor who diagnosed her with “chodromalaciapatella.”  http://www.mayoclinic.com/health/chondromalacia-patella/DS00777

The doctor told her not to bike or do jumping exercises and started her on a knee strengthening program (“VMO” or “Vastus Medialis Oblique”  muscle). 

 

 

WHY STRENGTHEN THE VMO?

http://en.wikipedia.org/wiki/Vastus_medialis

The thinking is if the VMO muscle (inner thigh) is weak or not firing properly, it creates an abnormal pull around the knee cap. 

It is true that the VMO can stop working after trauma or swelling as a protection to the knee.  It is true that sometimes it needs to be retrained.  But it is not true in all case of knee pain.

THE STORY CONTINUES

The young girl continued to have knee pain. But to be honest she never did stop being active.  Years later she discovered her thigh muscles were not weak but  tight.  What happens when the quadriceps get tight is that the knee cap (patella) gets compressed down into the thigh bone (femur).  The two cones will rub together creating compression and friction.  When you use the quadriceps during running, squatting, climbing stairs, getting into and out of a chair, or biking, the muscle tenses and creates more compression pain.

STRETCHING

The young girl was not very flexible. She has, however, been blessed with short fast twitch muscle fibers that gave her a lot of strength but not flexibility (or so she thougth). She did play sports that worked the quadriceps. She also had an injury to her left quadriceps during a soccer game (kneed right in the muscle). It did not seem to matter how much she stretched, she never got more flexible.

There is no consistent research on how best to stretch and the actual effectiveness of stretching on injury prevention and recovery.

THE BREAKDOWN

Eventually in her early 30’s while playing indoor soccer, both quadriceps went into spasm. What a sight to see her trying to continue to play soccer without being able to kick the ball (three women on the field  needed to continue to play, so she could not let the team down). The recovery took over six weeks. What she realized was that she could no longer sit on her heels and lean back to get her shoulders to the floor (stretching the quadriceps). What ever flexiblity she had was now worse.

THE TREATMENT

What I have been finding cllinically is that by releasing the tight ropy bands of muscle fibers in the quadriceps (using the Intramuscular Stimulation technique), the flexibilty of the quadriceps improves and the knee pain seems to diminish or resolve. A client with a two-year history of knee pain (patellofemoral diagnosis) who could not squat at all, and who could not walk without pain, is back to running. She is also able to fully squat.  She still does have some symptoms going up and down stairs. 

The quadriceps are not the only muscle to consider.  The hamstrings (back of the tight) are an antagonist (opposing) muscle to the quadriceps. If the hamstrings are tight, the quadriceps have to work harder to overcome the tension from the hamstring. You might even need to look at the calf muscles which cross the knee joint and can contribute to knee pain. 

MORE THAN MUSCLE IMBALANCES

It may not just be muscle imbalances around the knee that is causing the pain.  Sometimes even afer releasing the muscle tightness pain continues. What else could be going on? 

1.  Meniscal Injury: 

The meniscus is the rubber “washer” that rests between the bones of the knee (femur and tibia). There are two of them (medial or inner knee and lateral or outer knee). These are within the knee joint and are susceptible to tearing with twisting injuries to the knee. The most common finding on examination that I have noticed (and reported in literature) is tenderness and swelling at the joint line. Typically there is pain on twisting of the knee especially under load (weight bearing or compression).  There may also be a “catching”, “locking” or even a “giving way” of the knee.  These can heal without surgery (mine did), but may also require surgery. 

2. Osteoarthritis:

The meniscus is often confused with the cartilage.  The cartilage is actully the shinny covering on the bone. I like to compare it to a “shelac” or “tephlon.”  It does not have any nerve fibers and offers a smooth surface to the bone. This can be damaged (Osteoarthritis) with trauma to the knee (impact injuries). I have had clients who have ongoing pain from the “arthritis” of the knee even after the muscles have been released. Some of these individuals have benefitted from acupuncture. There are also those who ask about the use of chondroitin. I have not personally read the articles and research on this, but have been told it’s been shown to be effective. It might be something you have to look up yourself. 

3. Joint stiffness:

I have occasionally found that there is full range of motion of the knee, but when I add the twist to the knee when fully bent there is a stiffness or tension. Sometimes just releasing the right muscle corrects the problems, but not always.  Then I will use my hands to mobilize (wiggle) the joint. Once the motion feels normal again, I recheck the painful activity (usually they can’t get into a full squat without the knee pain), to see if it worked. 

4.  I did have one recently where it was actually a stress fracture to the end of the thigh bone (femur). I did not pick this up but knew very quickly that I was not able to locate the problem. I thought it might have been the meniscus or tendonitis of the inner thigh muscles. 

THE REST OF THE STORY

The young girl (older now), has remained active. She still is not as flexible as she would like, but she does not have nearly the discomfort in her knees with exercise as she has in the past. In order to fully get her back to running full time, further treatment is needed for her back (history of disc pathology with sciatic pain) and pelvis (loss of dynamic muscle stability possibly from the injury to the nerve that supplies the muscles of the  pelvis, hip and leg.