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The Origin of Knee Pain – The Medial Compartment

12 Oct

The four compartments of the knee (anterior/front, medial/inside, posterior/back, and lateral/outside) are like dominos. Meaning, when one is injured, the others “start to fall.” This is due to compensatory changes in function—when one compartment is problematic, this places added strain or stress to another compartment(s). Hence, managing knee conditions often requires work on multiple compartments.

The medial/inside compartment of the knee includes muscle, tendon, ligament, and medial meniscus, or “cartilage” attachments. These attachments connect to the top of the tibia/shin bone and/or the end of the femur/thigh bone. The ligaments are strong, non-elastic bands that hold the joint together while the muscles and their attaching tendons move the joint.

Movements of the knee joint include primarily flexion and extension (bending and straightening the leg at the knee). When something “blocks” the knee from fully straightening, an individual may change their gait pattern, possibly walking with a noticeable limp. The meniscus, or fibroelastic cartilage, lies between the ends of the femur and tibia, and when torn or frayed, it can cause the inability to “lock” the joint or to fully extend.

The medial compartment includes the medial collateral ligament, which “checks” the joint from moving excessively inward. Injuries occur when the force is directed to the outside of the knee, such as when a football player is tackled from the side with his foot planted on the ground. Because some of the medial meniscus attaches to the medial collateral ligament, a tear occurring in one often involves a tear of the other.

Moving to the middle of the knee joint, the two ligaments that “check” the joint from front to back are called the cruciate ligaments—specifically, the anterior (front) and posterior (back) cruciates. Injuries to these often occur when excessive force occurs from the front or back of the knee, such as a Due to the intimate relationship between the four compartments, most knee injuries affect multiple structures. For example, the classic tackle from the side can not only tear the medial collateral ligament, but the medial meniscus and anterior cruciate ligament can be injured as well.

Due to the intimate relationship between the four compartments, most knee injuries affect multiple structures. For example, the classic tackle from the side can not only tear the medial collateral ligament, but the medial meniscus and anterior cruciate ligament can be injured as well.

Doctors of chiropractic manage many knee conditions using a combination of joint manipulation, mobilization, different modalities, bracing, and exercise training.

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Hip Pain and Iliotibial Band Syndrome

14 Sep

WHAT IS IT? Iliotibial band syndrome (ITBS) is one of the most common causes of hip and/or knee pain among athletes. The pain is caused from swelling or inflammation of a muscle group (including the tensor fascia lata or TFL, gluteus medius, and minimus muscles), the tendons that attach muscles to the knee or hip, and/or the bursa that surrounds the attachments at the hip and/or knee.

How common is it? Experts estimate that the prevalence of ITBS may be as high as 12% among participants in sports that involve running. This is also common during basic training—with ITBS reported by between 5.3% to 22.2% of United States Marine Corps recruits.

What is the clinical presentation? Typically, ITBS presents with a history of pain with activity (walking, running, cycling, etc.), with soreness at the outside of the knee just above the joint. Pain can radiate up or down and include the hip and/or ankle. Climbing steps and running downhill are common irritating activities. Rest can help alleviate symptoms in the short term but isn’t a long-term remedy.

What are some physical exam findings? ITBS patients may exhibit an abnormal gait or walking pattern in which knee flexion (bending) is avoided. They may also have tenderness to touch above the knee joint on the outside and/or along the iliac crest (where the TFL inserts). Squatting can reproduce pain, and lying on the side with the leg extended backward and dropped toward the floor from a bench often reproduces pain (called “Ober’s Test”).

Treatment Options: Because these are “overuse” injuries, changing the frequency, intensity, and/or duration of the sport or injury-causing activity is often necessary. Consider changing up your routine by cross training. If your athletic shoes are worn down, replace them and stay within the rated mileage of the shoe.

For those with ankle pronation (where the ankle shifts inwards), a foot orthotic with a measured rearfoot post can “make or break” a successful, long-term outcome. Similarly, if one leg is measurably shorter compared to the other, a heel or heel-sole combination lift is also very helpful.

If the muscles that move the hip are weak or if there is altered/abnormal muscle activity, then proper exercises to improve the neuro-motor pattern and/or strengthen the weak muscle group are a must! The inclusion of a gait/walking and running assessment can also reap great benefits for long-term success. Your doctor of chiropractic can help you with this assessment.

Chiropractors are trained to evaluate and treat ITBS and other hip/knee conditions, whether they are sports-related or not.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Shoulder Pain

14 Aug

Shoulder pain can arise from a multitude of places—from joints, muscles, tendons, and bursa in and around the shoulder region as well as from more distant locations like the neck, upper back, or even referred pain from the gall bladder. The onset of shoulder pain is highly variable as it can arise without an obvious cause or be related to a specific mechanism of injury such as a work or sports injury. Shoulder pain can also occur as a result of repetitive trauma over time, such as a job requiring overhead reaching. Neurological injuries such as stroke or a pinched nerve in the neck can cause shoulder pain as well. Experts estimate that as much as half of the population experiences shoulder pain each year, though many people often decide to “just live with it” and therefore, don’t seek treatment. However, shoulder and neck disorders do account for 18% of disability payments for MSK pain.

These following factors contribute to shoulder pain, either alone or in combination with each other:

  • Inflammatory conditions: Tendonitis, bursitis (the bursa are the fluid-filled sacs that lubricate the surrounding tissues), osteoarthritis (the “wearing out” kind), and rheumatoid arthritis (the autoimmune kind). Inflammatory conditions are a common cause of shoulder impingement (see below).
  • Excessive Motion: Instability can arise from tearing of the joint capsule, tendons, and/or ligaments that become lax after healing. The terms “strain” and “sprain” refer to tears of muscles and/or tendons (strains) vs. ligaments (sprains). Trauma typically results in instability in one direction vs. congenital (or “born with”) problems where instability can be multi-directional. This can result in a subluxation and/or a dislocation of the shoulder.
  • Limited Motion: This occurs when the joint capsule and ligaments are tight and restrict freedom of movement. This can happen after prolonged immobilization (use of a sling) and can result in impingement and/or “frozen shoulder” (adhesive capsulitis).
  • Muscle Weakness/Imbalance: The muscles in front, on top, behind, and those that connect from below must be in proper balance for the ball and socket joint of the shoulder to function properly. Weakness in any of these muscles can alter the normal balance and result in shoulder pain due to poor, inefficient shoulder motion. A common example of this is forward head posture with shoulder protraction (forward, rounded shoulders) that many of us “suffer” from as a result of using electronics (smartphones, computers, television). Overtraining of any of these muscles (like the chest muscles), stroke, or pinched nerves can also alter muscle balance.

Impingement is a common cause of shoulder pain that arises from swelling or inflammation of the tendons and/or bursae. Here, the ability to raise the arm is limited. Chiropractors are trained to diagnose and treat shoulder conditions using the standard approaches like mobilization, exercise, ice, job modifications, and anti-inflammatory measures (modalities and nutritional approaches), as well as those unique to chiropractic such as shoulder joint manipulation, which can reduce impingement.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

The Relationship of the Hip, the Low Back, and Knee

12 Jun

The hip is a very unique joint. The depth of the socket, the strength of the muscles and ligaments surrounding it, and the way it functions in weight bearing activities is unlike any other joint in the body. The focus this month is on the relationship between the hip and the rest of the body.

The hip joint is a synovial joint, meaning it moves freely. It is a ball-and-socket joint that is made up of the femoral head (the “ball”) and the acetabulum (the “socket”). The ball is largely contained within the cup or socket, though there are genetic and cultural differences with regards to the depth and shape of the hip joint in any one individual.

The relationship between the hip and the surrounding joints is intimate in that each joint affects the next. For instance, ankle pronation—or the inward rolling of the foot and ankle—results in a knocked knee, which can then shift the hip outwards. The pelvis then drops down on that side, the tailbone or sacrum becomes unleveled or sloped, and the lower spine curves to compensate with the ultimate goal of keeping your eyes level. Hence, when your hip hurts, your doctor of chiropractic will examine and treat the ENTIRE lower kinetic chain—the foot, ankle, knee, hip, pelvis, and spine—as ALL are so closely related to each other. When it comes to managing you and your hip pain, be prepared for management of any of the following:

  • Ankle pronation: This is the inward rolling of the ankle often associated with a flat foot. When viewing someone with ankle pronation from behind, the angle from the Achilles tendon to the ground will lean inward when it normally should be perpendicular. A valgus correction in a “rear foot post”—a heel wedge thicker on the inside—of a foot orthotic (customized arch support) is needed to correct this.
  • Knocked-knees: Ankle pronation can result in “knocked-knees” (genu valgus) which overloads or jams the outer knee joint, over-stretching the inner knee joint and ligaments. The knee cap (patella) then rides excessively hard on the outer surface of the femoral groove in which it glides as one bends and straightens their knee, causing knee cap pain.
  • Hip inward angulation (or coxa vera): As the knee shifts inward or knocks, the head of the femur moves outward, leaving the joint less stable. Leg length deficiency (LLD)—or a short leg—occurs when the pelvis drops on that side further destabilizing the lower kinetic chain.

Once ankle pronation is properly corrected with a rear foot post and the hind foot is repositioned back to neutral (if LLD persists) a heel lift can be placed under the foot orthotic to corrective this imbalance. ONLY then will the pelvis become level and stable so it can properly serve as a strong foundation for the spine the rest of the body to rest on!

We haven’t touched the subject of muscle imbalance, strengthening of commonly weak hip extensor muscles, or stretching of overly tight hip flexors and adductor muscles—topics for another day! The good news—doctors of chiropractic can help you with this common problem!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Have You Tried These Movements Before Considering Shoulder Surgery?

11 May

If you suffer from shoulder pain, here are some exercises you can do at home that really work to improve flexibility and strength. Just remember to ALWAYS stay within reasonable pain boundaries and work BOTH sides of your body, NOT just the injured shoulder!

For flexibility, start with the “Codman” Pendulum exercise. Stand or sit and lean forward so that your arm can swing like the pendulum of a clock while holding a light weight (2-5 lbs, or .9-2.26 kg initially). Move the weight in a clockwise, counter-clockwise, left-to-right, and/or forward-backward ALLOWING the shoulder to RELAX. DO NOT shrug your shoulder upward—let the shoulder go. This is usually comfortable and therefore can be done MANY times a day!

Another great beginning exercise is the Finger Wall-Walk. Stand in front of a wall and slowly walk your fingers up a wall staying within a comfortable range. Go slow and repeat several times. As you improve, rotate your trunk or stand with your body 45º, 60º, and later, 90º to the wall.

To perform the Crossover Arm Stretch, relax your shoulders and gently pull your arm across your chest using the uninvolved arm/hand to assist in the movement. Hold for up to 30 seconds and repeat with the other arm.

The Passive Internal Rotation (stick behind the back) and External Rotation (stick in front) requires a broomstick held parallel to the floor. Grip the stick with both hands held shoulder width apart and allow one arm to move the relaxed arm inward and outward. Do this as two separate exercises. Hold the end-range for up to 30 seconds each, repeat one to three times, as tolerated.

For Strengthening, the use of Thera-Tube or Band works well when anchored into the hinged side of a door. Pretend you are standing on a clock (12, 3, 6, and 9 o’clock positions) and SLOWLY pull and release the tubing three times in each of the four “clock positions,” ALWAYS staying in the pain-free range.

Your “ultimate guide” for advancing in reps, sets, and type of exercise is the comfort factor – AVOID sharp, lancinating painful movements/exercises or those that leave you sore for more than 24-48 hours afterwards. Track your recovery time after exercising to determine safety.

 

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Is a Labral Tear Causing Your Hip Pain?

13 Mar

One of the structures that is frequently blamed for hip pain is called the labrum—the rubbery tissue that surrounds the socket helping to stabilize the hip joint. This tissue often wears and tears with age, but it can also be torn as a result of a trauma or sports-related injury.

The clinical significance of a labral tear of the hip is controversial, as these can be found in people who don’t have any pain at all. We know from studies of the intervertebral disks located in the lower back that disk herniation is often found in pain-free subjects—between 20-50% of the normal population.  In other words, the presence of abnormalities on an MRI is often poorly associated with patient symptoms, and the presence of a labral tear of the hip appears to be quite similar.

For instance, in a study of 45 volunteers (average age 38, range: 15–66 years old; 60% males) with no history of hip pain, symptoms, injury, or prior surgery, MRIs reviewed by three board-certified radiologists revealed a total of 73% of the hips had abnormalities, of which more than two-thirds were labral tears.

Another interesting study found an equal number of labral tears in a group of professional ballet dancers (both with and without hip pain) and in non-dancer control subjects of similar age and gender.

Another study showed that diagnostic blocks—a pain killer injected into the hip for diagnostic purposes to determine if it’s a pain generator—failed to offer relief for those with labral tears.

Doctors of chiropractic are trained to identify the origins of pain arising from the low back, pelvis, hip, and knee, all of which can mimic or produce hip symptoms.  Utilizing information derived from a careful history, examination, imaging (when appropriate), and functional tests, chiropractors can offer a nonsurgical, noninvasive, safe method of managing hip pain.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org