My Knee Pain is due to Arthritis, how can Physical Therapy Help?

“I have arthritis in my knee, can Physical Therapy get rid of the arthritis”?

No, it wont. Anybody that tells you differently is wrong.

In fact, you can replace the diagnosis with nearly any degenerative diagnosis for the knee.

Can Physical Therapy heal the torn meniscus?

No.

Can Physical Therapy heal the remove the cyst found under the patella.

No.

But, there’s a caveat. After confirming the patients correct belief that physical therapy cannot make the anatomical change which is the source of pain, the education typically goes something like this:

“Physical Therapy will not remove the arthritis found in your knee, but it’s possible that we can identify how your movement, flexibility, and/or strength issues may be placing excessive stress through your arthritic joint, therefore causing the pain. While we can’t remove the arthritis, if we relieve the stress we may remove the pain allowing you to perform your desired activity”.

Potential further education may be:

“In fact, the profession has done studies in which individuals without pain have similar radiographic findings as your x-rays. Potentially it is not the arthritis that causes the pain, but the stress placed on that arthritic joint during walking, ascending stairs, squatting, or any other movements is causing the pain”.

Let’s optimize movement to relieve the knee pain.

This is important education for Physical Therapists to give to their patients to assist in defining what the profession can do. Physical Therapists can help optimize movement to reduce the stress placed on the body. The switch from pain is due to the tissue source needs to be changed to the pain is due to the excessive stress placed on the tissue source.

How can changing movement change the amount of stress through the knee? Take a look at this research article which focuses on the amount of torque placed on the hip and knee during a common squat exercise.

Keep in mind that the squat is a very functional movement. What I mean by functional, is that this is a motion which is performed often by nearly all individuals. A simple motion of sitting in a chair, or lifting an item from the floor is a squat. Minimizing the amount of stress through the knee during a squat, therefore decreases the amount of stress through the knee during other functional tasks.

In this picture the amount of force placed through the knee is cut by 30% simply by cueing the individual to squat with his knees behind his toes. Imagine how much force could be eliminated when his strength and flexibility are even further optimized.

Check out www.OptimalMovementPT.com to learn how you can reduce the amount of stress through your painful knee, or any painful areas during your desired functional task.

TRX Corrective Exercises for Pitchers

You don’t run to get in shape, you get in shape so that you can run. Simply running every day will not improve your running ability. Cross training, improving muscle imbalances through corrective exercises, and strength training are all required in order to improve performance with running, and minimize the risk of overuse injuries.

You can take the same concept with any activity which requires repetitive motion, especially pitching. Simply throwing every day as hard as you can will only decrease performance and increase the likelihood of injury. There is a certain amount of core strength, rotator cuff stability, hip flexibility, and lower quarter stability that is required to optimize the movement of an overhead athlete. When an athlete has reached a certain level of strength and flexibility, I encourage using a TRX suspension strap to train these elements of pitching. My favorite TRX exercises for pitchers are listed below, but with a disclaimer: as healthcare professionals, we cannot simply prescribe exercises without a thorough examination of the athlete. These exercises should only be performed after an assessment and under the instruction of your healthcare specialist.

1) TRX Side Lunge

The stride phase of the pitch may be the most important phase of pitching. The stride length of a professional pitcher is approximately the length of the pitchers height, and the shoulder has to move towards end range of external rotation. Needless to say, in order to maintain proper mechanics the pitcher requires a certain amount of trunk control. Therefore, the TRX side lunge becomes a great exercise to work on adductor length of the stance leg (ensuring increased stride length) and trunk control during this motion.

2. TRX W Deltoid Fly

This exercise is named for the large deltoid muscle which assists with the abduction of the shoulder, but I like to use it to work the external rotators of the shoulder. This is also important for the stride phase of pitching, and requires a certain amount of instruction without the TRX before it can be done appropriately. After a pitcher learns appropriate joint centration of the glen0-humeral joint (to be discussed in a future blog) he can begin to train the rotator cuff to maintain the stability of the joint during pure external rotation. Again, all of this is being done while maintaining trunk control.

3. TRX T-Deltoid Fly

The cocking phase of the pitch requires scapula adduction and full external rotation of the gleno-humeral joint. At this phase of throwing, the middle trapezius operates at approximately 50% Maximal Voluntary Isometric Contraction (MVIC) and the Infraspinatus works at 74% MVIC. This exercise places works on these muscles to place the scapula and glen-humeral joint in the appropriate position for this phase of throwing.

4. TRX Lunge

 

Of particular note, at this time all exercises have focused on  phases of pitching before the ball is released (showing the emphasis I place on the early phases of pitching). The most important component of the pitch after the ball is released is the follow through. Flexing through the hip and trunk can attenuate the force developed in prior phases from the shoulder. The TRX lunge can work on strengthening the gluteals and hinging from the hip to assist with this phase of throwing.

This form of training requires appropriate flexibility, strength, and supervision, but it can greatly improve your pitching mechanics. If you live in the Redlands area, a great spot for TRX training is at The Energy Lab. Check them out for their TRX classes and all fitness goals.

For rehabilitation, movement screenings, and to work towards your fitness goals, check out OMPT and email me at alan@optimalmovementpt.com

 

http://www.optimalmovementpt.com

World Physical Therapy Day!!!

World Physical Therapy Day is September 8, 2014!!!

World Physical Therapy Day is a day to recognize the profession and all the benefits a Physical Therapist provides to the community. Are you currently participating in therapy? Have you had therapy in the past? How has therapy helped you? How could therapy help you?

For most individuals who have participated in therapy they are aware of the importance of the Physical Therapist as well as the role a therapist can provide in improving movement and function. For those of you who are not aware, the benefit therapy can provide is different for every individual. Every person you encounter has their own concerns and fears. My profession gives me the time to really understand and empathize with concerns and fears, which opens a window into making a real change on the individual level.

Whether it’s running that extra mile, picking up a grandson, getting up the stairs at night, or simply making it through the work day, Physical Therapists help individuals meet their specific goals. A Physical Therapist is a specialist on movement and can help optimize performance, return from an injury, and prevent future injuries from occurring. Imagine the health benefits of having a Physical Therapist who knows you. Think about it, most individuals have their own personal Physician and Dentist. Why not having your own Physical Therapist who can screen and educate on proper movements to maintain optimal health.

Optimal Movement Physical Therapy provides these benefits to many resident in the Redlands area. If you need someone on your team, we would be happy to listen to your concerns. Check out our website here. If you would like to learn more about World PT day, check out the World Confederation for Physical Therapy website.

In celebration of World PT Day we’re holding a contest! If your life has been significantly impacted by a Physical Therapist, let us know in the comments for a chance to win a $25 gift certificate to one of our favorite stores that encourages movement – REI! Follow us on Facebook, Instagram and Twitter for additional entries! Please leave individual comments letting us know where you’re following us! Giveaway ends Monday, September 15th at noon PST. Winner will be chosen by random draw and will be posted Monday evening!

Disclaimer: we are not affiliated with REI in any way. We just really like them and what they stand for!

http://www.OptimalMovementPT.com

A winner has been chosen for World PT Day contest. Thomas has been selected via the website random.org. Please email me at alan@optimalmovementpt.com.

Running Assessment

This is why I wanted to be a Physical Therapist…

I just completed my first running evaluation at Optimal Movement Physical Therapy. My client, marathon runner, John Hackney, has been having some knee pain of late during his runs. I think even more frustrating is the recurrence of a hamstring strain during his marathon competitions. Seeking a biomechanical evaluation with his insurance and scouring the internet for some information yielded little results. I was very happy to be able to provide some answers.

Running is hard to analyze. The movements occur so fast that it becomes very hard to see the movement faults. One second you think you see something important, but the next second it has disappeared. The best way to break down a runner is with video analysis, but the problem with this technique is that it requires more time than most therapists have with their patients. I have come to realize through several of Chris Powers’ lectures and discussions, that the only way to provide a meaningful assessment to high level athletes is by giving them the time they need to be thoroughly assessed. In fact, pain and movement can be so confusing, that the majority of clients need more time than most therapists can give in order to clear up the confusion (but more on that subject in a later blog…).

Seeing the majority of clients (especially high level athletes) leave a clinic without a thorough understanding of their problem is part of the reason I started Optimal Movement Physical Therapy. Within John’s first session, we were able to analyze not only his running, but several other functional tasks including squats, step downs, and single leg stance. Further, the video analysis provided by Simi provided specific metrics on all functional movements. The measurements taken of body angles during running and step downs will allow a post treatment comparison after John has completed some corrective exercises. After analyzing all of the functional movements, I still had time to measure John’s strength and flexibility (decreased hamstring length, decreased gluteal activation, and quad dominant movements – no surprise there). Lastly, John and I had time to discuss the problem, strategize how he can reach his goals, and determine the most appropriate corrective exercises for him (again, more on specific corrective exercises of individuals in a later post).

Motion analysis of marathon runner in saggital view.

In my opinion, this is the way physical therapy evaluations should be. Full of information on the individual’s specific movement with measurements and goals to attain. Oftentimes, a client is left to simply trust a therapist’s or healthcare professional’s word. When given specific measurements, a client can better understand the problem and is more motivated to correct the problem. At first glance, John does not have a lot of faulty movements or impairments, but after 26.2 miles every impairment is magnified. In order to identify and measure these impairments, skilled physical therapists need only spend a little more time with their patients.