Sports Injury

Pes Anserine Bursitis; What Is It?

~ Dr. Robert Speirs DC ~ Leave a comment

The term “pes anserine” is Latin for goose’s foot, and describes the appearance of three tendons that converge and insert on the inner portion of your knee. The pes anserine bursa is a fluid-filled, friction-reducing cushion, sandwiched between these tendons and your leg bone.

Injuries or irritation can cause the lining of the bursa to produce too much fluid, resulting in painful swelling. Patients with knee osteoarthritis are likely to have chronic irritation of the pes anserine bursa. The condition is more common in overweight patients, diabetics, and females. Runners and athletes in sports that require rapid side-to-side movements (i.e. football, soccer, tennis, etc.) are more likely suffer from the condition. Swimmers who do the breast stroke commonly suffer from pes anserine bursitis.
Symptoms include pain on the inner side of your knee, just below the joint. Your pain is probably worse when you stand up or walk stairs. Discomfort increases during activities that require side-to-side movements (i.e. tennis, dancing). Be sure to tell your doctor if you notice clicking, popping, or locking of your knee, excessive thirst, excessive urination, fever, or pain & swelling in your calf.

In addition to the treatment provided by our office, you may find relief by applying home ice or ice massage for 8-10 minutes. Having flat feet places additional stress on the inside of your knee, so patients with fallen arches will benefit from arch supports or orthotics. Overweight patients will benefit from a diet and exercise program.

Trigger points in the iliopsoas muscle

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This muscle originates on the bodies and disks of T12-L5 and the inner ilium. It inserts on the lesser trochanter of the femur. The psoas flexes the hip when the spine is fixed. When the leg is fixed it extends the lumbar spine increasing lumbar lordosis. This Muscle is often chronically shortened due to inactivity and sitting posture. When trigger points are present they will refer pain primarily to the lower lumbar area and the sacrum as well as into the anterior thigh. Trigger points in the iliopsoas muscle can mimic appendicitis.

Pulled Hammie! Man Down!

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Your hamstring is the group of muscles in the back of your thigh that flex your knee, i.e., moving your heel toward your buttock. The term “strain” means that a muscle or its tendon has been stressed beyond its limit and has frayed, much like a rope that has been pulled too hard. Your hamstring may be “pulled” or “strained” when it is forced to contract beyond its capacity, like during running or from excessive stretch. This tearing leads to bleeding, bruising, swelling, pain and loss of function.

The symptoms of a hamstring strain may vary from mild discomfort to severe pain, depending upon the amount of tissue that has been torn. Over 90% of hamstring strains occur abruptly with a tearing, burning or popping feeling accompanied by immediate pain below your buttock. Your symptoms will likely increase when straightening your leg, walking or flexing forward. You may notice some bruising that starts near the site of injury. Be sure to tell your doctor if you have notable pain in your lower back, if your pain extends into your calf, if your pain worsens with coughing or sneezing, or if you have a rash on the back of your thigh.

Hamstring injuries are more common when your muscles are tired from activity and happen more frequently as we age. Having excessive tightness or weakness in your hamstring, having quadriceps that are significantly stronger than your hamstring, having too little core strength or poor running form also predispose you to injury.

Nearly all hamstring strains can be successfully managed with conservative care, like the type provided in our office. Your healing period will vary based on several factors, including the specific region of your hamstring that has been injured. Tears that involve the part of the muscle closest to your ischial tuberosity (the bones you sit on) take longer to heal than those that occur further down the muscle.

Initially, you should use ice or ice massage over the injured area for 15 minutes at a time, up to once per hour. Our office may advise you to use an ACE wrap or compression bandage to help limit swelling. The use of NSAIDs for hamstring strains is controversial, as some research suggests this may delay healing. Patients who have more severe injuries may need to use crutches. While you are recovering, you may need to limit some activities, like running and jumping and instead, cross train by stationary cycling or swimming. You are more likely to strain your hamstring in the future and recurrent injuries may take twice as long to heal as the initial injury, so be sure to allow yourself adequate healing time, consistently perform your exercises and warm-up properly prior to activity.

Trigger points in the piriformis muscle

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The piriformis muscle is a small muscle deep to glute max and lies over top of the sciatic nerve. It originates on the anterior sacrum, and inserts on the greater trochanter of the femur. It’s main action is to laterally rotate the femur. When trigger points developed in this muscle they will refer pain into the sacro-iliac region, across the posterior hip and down the leg. This muscle can also be a cause of sciatic nerve irritation if it gets tight, causing “sciatica” symptoms.

Piriformis Syndrome; a real bummer.

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Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle.

When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.

Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year olds and affects women more often than men.

Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.

Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.

Trigger points in the gluteus minimus

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The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.

Osgood Schlatter’s Disease

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Children and adolescents have soft “growth plates,” which are areas where their bone is still growing. In children, this growth plate is much weaker than in adults. This means that children are more likely to suffer growth plate injuries than adults, especially during periods of rapid growth.

Osgood Schlatter’s disease, also called tibial epiphysitis, is a painful irritation of the growth plate near the insertion of your quadriceps muscle on your knee. The powerful thigh muscles attach onto your knee through the patellar tendon. When your thigh muscle contracts- like during running or jumping, they place a sheer force on the growth plate of your knee.
Osgood Schlatter’s disease is more common in athletes, particularly those who participate in soccer, gymnastics, basketball, running or track. It is most common between the ages of 10 and 15 and is relatively equally common between boys and girls. Excessively tight thigh or calf muscles may contribute to this problem.

You may experience pain with activity that requires running or jumping. You will often feel tenderness or even bony enlargement of your “tibial tuberosity”, just below your knee. Kneeling or prolonged squatting may be painful.

Some athletes with mild cases may continue activity as long as it does not increase your symptoms. Most cases may require a period of rest to allow the condition to heal. Depending on the severity of your condition, you may need to limit activities that require running and jumping for a while, usually two to eight weeks. You can often cross train in the pool or on a stationary bike.

You should avoid running with a narrow stride “on a line,” as this may increase your symptoms. Our office may recommend use of a patellar tendon strap to assist with your healing. Osgood Schlatter’s disease can temporarily limit your activity, but most of the time, it can be successfully managed, allowing your return to pain-free activity in a relatively short period of time.

Trigger points in the gluteus medius muscle

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The gluteus medius muscle plays an important role in hip and pelvic stability. It originates on the gluteal surface of the ilium, deep to the gluteus Maximus. It inserts on the greater trochanter of the femur. It’s main actions are to abduct the hip and to assist in internal rotation of the hip. It also maintains pelvic stability during walking and running. Trigger points in this muscle will refer pain into the sacrum, the iliac crest, and down the lateral hip and into the thigh. This muscle is often a cause of lower pack pain.

Knee Arthritis; Who, Where, Why and How?

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The bones in your knee have a slick protective covering called “cartilage” on the joint surfaces that touch each other. This cartilage serves as a friction reducer and shock absorber, thereby helping to extend the life of your joints. “Arthritis” means that your cartilage has begun to thin or crack and may eventually wear away, leading to a painful “bone on bone” situation.

Knee arthritis is very common, affecting more than 1/3 of adults over age 65. People who are overweight or have a history of knee injury or surgery are more likely to develop arthritis. Jobs and activities that require repetitive squatting, kneeling, pivoting or stair climbing may cause increased wear. Contrary to popular opinion, runners have no increased risk of developing knee arthritis. Women are two to three times more likely to develop knee arthritis as compared to men.

The pain of knee arthritis is often described as a “deep ache” that is aggravated by activity and relieved by rest. You probably notice morning stiffness that goes away after a short period of activity, but returns after sitting for long periods of time. Some patients have difficulty squatting, bending and walking stairs. You may notice that your knees pop and crack. Eventually, knee arthritis can cause you to walk slower, lose your balance and even fall more often. Many patients notice that their symptoms increase with weather changes.

Although there is no cure for the irreversible wearing associated with arthritis, there is help for your symptoms. Performing your home exercises is very important. The way that your knee is aligned (and wears) is largely based upon how your hip and foot function, so many of your home exercises will target those regions. Our office may prescribe arch supports or orthotics, since people with flat feet are almost twice as likely to suffer from knee arthritis.

Overweight patients should begin or increase low-impact aerobic exercises like walking, stationary cycling, elliptical exercising, water walking or swimming. Be sure to take frequent breaks from prolonged sitting and avoid overly painful activities.

Trigger points in the gluteus Maximus

~ bryancobb ~ Leave a comment

The gluteus Maximus is the buttock muscle. It originates on the gluteal surface of the ilium, lumbar fascia, sacrum and sacrotuberous ligament. It inserts on the gluteal tuberosity of the femur and the iliotibial tract. Extension and lateral rotation of the hip are it’s main actions. This muscle is heavily involved in activities like ice skating and is a common area to develops trigger points. When trigger points do develop they can refer pain in a crescent pattern from the gluteal fold to the sacrum. Trigger points can also refer pain deep into the buttock itself making it feel like other deeper muscles are involved. These symptoms can sometimes be mistaken for s.i. Joint problems.