Author: Dr. Robert Speirs DC

Runner’s Knee Sucks.

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Patellofemoral pain syndrome (PFPS) describes a painful irritation of the cartilage behind your kneecap. Although anyone may be affected, it is often the result of overuse of the knee in sports that require jumping or running so it is sometimes referred to as “Runner’s knee”. PFPS is the most common cause of knee pain in the general population, affecting an estimated 25% of adults.

One of the most common causes of PFPS is an imbalance between the muscles that help to guide your kneecap in its V-shaped groove at the end of your thigh bone. Repeatedly flexing and extending a misaligned kneecap leads to pain, swelling and eventually arthritis. Misalignment of the kneecap (patella) is often secondary to problems in the hip and foot, especially weakness of your gluteal muscles or flat feet.

PFPS produces a dull pain behind the kneecap that is aggravated by prolonged walking, running, squatting, jumping, stair climbing or arising from a seated position. The pain is often worse when walking downhill or down stairs. Longstanding misalignment can cause damage to the cartilage, which results in popping, grinding or giving way.

Conservative care, like the type provided in this office, is generally successful at relieving your symptoms. Initially, it is important for you to minimize activities that provoke your pain, especially running, jumping and activities that stress you into a “knock-kneed” position. Don’t allow your knees to cross in front of your toes when squatting. Some athletes may need to modify their activity to include swimming or bicycling instead of running.

Performing your home exercises consistently is one of the most important things that you can do to help realign the patella, relieve pain and prevent recurrence. The use of home ice or ice massage applied around your kneecap for 10-15 minutes, several times per day may be helpful.

What is Tarsal Tunnel Syndrome?

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The tarsal tunnel is the space behind the bump on the inside of your ankle. The tibial nerve lives in this tunnel along with some tendons. Tarsal tunnel syndrome means that the tibial nerve is being irritated within the tunnel. This results in pain, numbness or tingling into your heel and the arch of your foot.

The tibial nerve may be irritated by compression (from trauma , arthritic spurs, or swelling of other tissues within the tunnel), or more commonly by constant stretch (from flat feet). Research has shown that tarsal tunnel pressure increases almost 30 fold in people with flat feet.
Tarsal tunnel is slightly more common in women, and high heels are suspect. The condition often affects both feet. Conditions like diabetes and thyroid disorders may aggravate nerve problems like tarsal tunnel. Plantar fasciitis commonly accompanies tarsal tunnel syndrome.

The discomfort is often described as “burning”. Symptoms may increase with long periods of standing, running or exercise. Almost half of patients report increased symptoms at night.

Your doctor will make the diagnosis of tarsal tunnel syndrome based on your history and an exam. Your doctor may take an x-ray to rule out other problems like arthritic spurs or a stress fracture. In severe cases, more sophisticated nerve testing may be necessary.

The first goal of treatment is to allow you to return to pain-free activity as soon as possible. The second goal is to correct the mechanical problem that allowed this condition to begin with.

What is knee tendonitis?

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Tendons are strong bands of fibrous tissue that connect your muscles to your bones. Your “patellar tendon” connects your kneecap (patella) to your shin bone (tibia). “Patellar tendonopathy” results from repetitive straining and micro-tearing of this connection, resulting in pain and inflammation. The condition is referred to as “jumper’s knee,” since damage is thought to often result from repetitive jumping.

The condition should probably be called “landing knee,” since forces on the patellar tendon are twice as great during landing as compared to those created during take off.

Patellar tendinopathy is common, affecting almost 20% of all athletes with a rate as high as 50% in sports that require repetitive forceful jumping, like basketball and volleyball. The condition may affect one or both knees and may be slightly more common in males.

Weakness in the quadriceps muscle of your thigh can allow excessive bending of your knee when you land following a jump. This places your patellar tendon at a greater risk for injury. Having strong quadriceps muscles protects your knee from excessive flexion and injury.

Symptoms of patellar tendinopathy include pain or swelling just below your kneecap. This may begin without an identifiable injury and may come and go for months or years. Symptoms are usually aggravated by activity, but most athletes have been able to continue playing through the pain. Pain often increases during activities that require strong quadriceps contraction, like jumping, squatting, arising from a seated position, stair climbing, or running. Walking down stairs or running down hill seems to be more bothersome than going up.

Some athletes may have unconsciously learned to protect their knee by developing unnatural jumping mechanics. This could include landing with a more rigid knee, or allowing too much hip flexion. You may need to become more conscious of landing with the right amount of knee flexion with your foot in a neutral position and avoiding excessive hip flexion. Your doctor would be able to answer any questions you have about good jumping mechanics.

Patellar tendon straps, like a Cho-pat, can help reduce stress on your patellar tendon and relieve pain. Three fourths of the people who use patellar tendon straps for patellar tendinitis report improvement.

Patellar tendinopathy is treatable. Patients who follow a well-planned strengthening program show similar outcomes to those who have undergone surgery for the problem. Initially, you may need to decrease your training intensity to help protect your knee. You should stay away from activities that produce more than mild pain. You should avoid complete rest, as this could actually increase your risk of recurrence. Using ice packs or ice massage for 10-15 minutes at a time, especially following activity, may help to reduce inflammation.

Do you wake up with numb fingers?

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The term “thoracic outlet” describes an area at the base of your neck, just above your collarbone. Some important nerves and vessels pass through this outlet on their way into your arm. Compression of these tissues causes a condition called “thoracic outlet syndrome” which results in pain, numbness or tingling in your arm.

Several different factors can cause Thoracic Outlet Syndrome,

commonly referred to as TOS. Sometimes TOS is caused from tightness in the muscles of your neck and chest, other times the space between your first rib and collarbone is too small. People who have an extra rib (cervical rib) and people who have recently suffered a neck injury may have a greater chance of having this problem.

The condition is aggravated by poor posture and by occupations that promote “slouching,” i.e., computer users, assembly line workers, supermarket checkers and students. Swimmers, volleyball players, tennis players, baseball pitchers and occupations requiring prolonged overhead activity. i.e., electricians and painters are also prime candidates for TOS.

Symptoms of TOS include arm pain, numbness, tingling and possible weakness. Neck, arm and hand pain may begin slowly and are often aggravated by elevation of the arms or excessive head movement. Loss of grip strength is possible.

Conservative treatment, like the kind we provide, has been shown to be effective at treating TOS. Through our careful exam we have identified your specific sites of compression and will use some of the following treatment to help:

You should avoid carrying heavy loads, especially on your shoulder i.e., carpet rolls. Briefcases, laptop cases or heavy shoulder bags should be lightened. Bra straps may need additional padding or consideration of replacement with a sports bra.

Chiropractic and Headaches

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Yet another study has found that chiropractic care helps headache sufferers: Spinal manipulation seems to have a significant positive effect in reducing hours with headache and intensity of headache and analgesic consumption in cases of cervicogenic headache.

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Nilsson N, Christensen HW, Hartvigsen J. “The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache.” Journal of Manipulative and Physiological Therapeautics, Volume 20, Number 5, June 1998, Pages 326-330.

The all too common knee cartilage tear.

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The meniscus is a piece of tough, smooth, rubbery cartilage in the middle of your knee. Each of your knees have a meniscus on the inside (medial meniscus) and another on the outside (lateral meniscus). Each meniscus attaches to the top of your shin bone (tibia) and acts as a shock absorbent guide for your thigh bone (femur), which rests above.
Meniscus

Damage or tears to the meniscus are common. Males are affected three or four times more often than females. Tears may occur at any age. In children and adolescents, the menisci are more durable and rubbery, so most injures are “traumatic” as a result of a forceful twisting injury. As we age, our meniscus grows weaker, and “degenerative” tears become more likely, often resulting from simple or even unrecognized injuries.

Symptoms of meniscus injury depend on the type and severity of damage. Patients sometimes hear a pop or snap at the time of initial injury. Patients with acute injuries may have difficulty bearing weight and may develop a limp. Stiffness is a common complaint. Clicking, catching, locking or giving-way is possible. Meniscus injuries are usually aggravated by movement and become particularly uncomfortable with deep squatting.

Although some meniscus injuries may require surgery, most can be treated conservatively with the type of treatments provided in our office. Your age roughly correlates with the need for surgery. Approximately 2/3 of acute meniscal tears in children and adolescents will require surgery, but only about 1 in 20 patients over the age of 40 will require knee arthroscopy. Surgery is necessary more often in patients who cannot fully bend or straighten their leg, or whose knee locks and gets stuck in one place.

Home management includes rest, ice, compression and elevation (RICE). You should apply ice over your knee for 15 minutes at a time, three or four times a day. Wrapping an ACE bandage around your knee will provide compression to help minimize swelling. You may elevate your leg by placing a pillow beneath your knee to help reduce swelling.

You may need to limit your activity to prevent further damage while you are recovering from injury. Activities that involve twisting on a weight-bearing flexed knee are the most harmful. You may need to temporarily or permanently discontinue some high energy sports activity. Other activities, like water walking, may be substituted for higher energy sports, like soccer and tennis. Ice or ice massage should be used following activity.

Patients who have undergone surgical repair of their meniscus are more likely to develop arthritis. These patients will also benefit from a well-planned home exercise program.

What is Sever’s Disease?

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Severs disease, also called calcaneal apophysitis, is a painful swelling near the insertion of the Achilles tendon on your heel.

As our bones develop, we have “growth plates” which are softer areas where the bone is still growing. In children, this growth plate is weaker than in adults. This means that children are more likely to suffer growth plate injuries than adults, especially during periods of rapid growth.

The powerful calf muscles attach onto your heel through the Achilles tendon. When your calf muscle contracts (like during running or jumping), it places a shear force on the growth plate of your heel. Severs disease is an irritation to this sensitive growth plate.

Athletically active children, who run and jump frequently in sports like soccer, basketball, gymnastics and track & field are most likely to suffer from this condition. Severs disease is slightly more common in boys and the condition affects both heels about half of the time.

Symptoms usually start as heel pain that gradually worsens during activity. Sometimes this can cause a “limp”. Rest usually temporarily relieves the pain.

Your doctor will make the diagnosis of Severs disease based on your history and an exam. Your doctor may take an x-ray to rule out other injuries like a stress fracture.

The first goal of treatment is to allow you to return to pain-free activity as soon as possible. This may require avoiding stressful activity like running and jumping for a short period of time. Cross training on a bike is usually acceptable. Ice should be applied for 15 minutes after any activity. You should always wear shoes with good arch supports and avoid walking barefoot. Your doctor may recommend a small heel lift to decrease strain on your achilles tendon.

What is a knee sprain?

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“Ligaments” are made up of many individual fibers running parallel to each other and bundled to form a strong fibrous band. These fibrous bands hold your bones together. Just like a rope, when a ligament is stretched too far, it begins to fray or tear. “Sprain” is the term used to describe this tearing of ligament fibers.

Sprains are graded by the amount of damage to the ligament fibers. A Grade I sprain means the ligament has been painfully stretched, but no fibers have been torn. A Grade II sprain means some, but not all of the ligamentous fibers, have been torn. A Grade III sprain means that all of the ligamentous fibers have been torn, and the ligament no longer has the ability to protect the joint. Knee sprains commonly involve one or more of your knee’s ligaments including: the medial collateral, lateral collateral, anterior cruciate, and posterior cruciate.

Most knee sprains begin as the result of a sudden stop, twist, or blow from the side or front. Some patients recall a “pop” or “snap” at the time of injury. Knee sprains cause pain and swelling within the joint. Your knee may be tender to touch, and some patients report a sensation of “giving way” or difficulty walking.

Most knee sprains can be successfully managed without surgery but will require some work on your part. Initially, a period of rest may be necessary in order to help you heal. Mild Grade I sprains may return to activity in a couple of days, while more severe injuries may take six weeks or longer to recover. You can help reduce swelling by elevating your knee and using an ACE wrap for compression. Applying ice or ice massage for 10 minutes each hour may help relieve swelling. Depending upon the severity of your sprain, you may need to wear a knee brace to help protect you from further injury. If walking is painful, crutches may be necessary.

FAI starts you on the road to failure.

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Your hip socket or “acetabulum” is covered by smooth, glassy cartilage extending all the way to its outer rim. The term “Femoroacetabular impingement” (FAI) means that this rim of cartilage is being pinched when you move your hip into certain positions. Repetitive pinching results in irritation, tearing, or even detachment of this cartilage from your hip socket.

FAI occurs because of a mismatch between the head of your femur and the socket of your hip. The mismatch may be from an abnormally shaped hip bone (cam deformity), or having too much cartilage on the rim of your hip socket (pincer deformity). Most frequently, FAI results from a combination of both (combined or mixed deformity).

FAI is most common in young active people. Although the deformity may be present on both sides, symptoms are usually one-sided. The condition is equally common among men and women. Symptoms of FAI include a constant dull pain with periods of sharp pain, made worse by activity. Walking, pivoting, prolonged sitting, stair climbing, and impact activities like running or jumping can aggravate your symptoms. Snapping, locking, and clicking are common.

Our office will help direct a rehab program to maximize your chance of recovery. You should attempt to stay active, but avoid activities that aggravate symptoms. You may consider temporarily switching to low-impact activities, like stationary biking or water-walking. You should avoid motions that combine flexion and internal rotation, like- getting out of a car with one leg at a time, swimming the breaststroke, or performing squats. Patients with FAI should avoid excessive stretching, as this could aggravate the condition, but will likely benefit from strengthening exercises in the type of treatment provided in this office.