MUSCLE SORENESS v. JOINT PAIN

Many of our patients come into the clinic after a few sessions complaining that their joint pain has increased since their initial evaluation. This is not meant to whitewash those concerns, as an increase in joint pain due to a specific exercise is fairly common. However, typically the significant increases in joint pain will only come while performing that specific exercise, and subside significantly, if not entirely, a short time after. 

An increase in pain for longer periods of time, like 1-2 days, is more indicative of muscle soreness - not joint pain. While muscle soreness can be just as, if not more, debilitating compared to joint pain, muscle soreness is a good sign. 

Most of the time when patients come in with joint pain, they'll have been limiting activity that could increase that joint pain. For example: a patient comes in, chief complaint is knee pain, they'll likely have been avoiding stairs, bending down or squatting to pick something up or participate in hobbies, such as gardening, and moving slowly and cautiously. In physical therapy, to first lessen the pressure on the inflamed joint, we'll need to strengthen the muscles around the joint. To do so, patients will complete a number of exercises that don't necessarily aggravate those painful symptoms at the time, but can lead to soreness later. The soreness occurs because the muscles surrounding the joints are likely very out of practice - as your natural instinct to avoid an increase in pain is to minimize all causes of the pain. In turn, the muscle soreness will increase as they adapt to the newly added activities. 

Fortunately, muscle soreness doesn't last forever. It lasts a few days, maximum, and will decrease thereafter - usually leaving patients in less pain than they started. Patients need not worry that they'll reproduce that soreness each time, as each time they complete their Home Exercise Program, the muscles will continue to strengthen and therefore, adapt faster. Most of the time, patients will not be sore after a few visits to the clinic - given that they're doing their exercises as prescribed. Soreness from that point on will only increase as the intensity or difficulty of the exercises increase, but increases in difficulty means progression. 

Differences in joint pain versus muscle soreness include:

- Joint pain is sharp, stabbing, debilitating, while muscle soreness is dull, burning, achey

- Muscle soreness leads to problems you may not be used to: say your knee pain was below the kneecap, but now is above and on the sides of the kneecap

- Joint pain will increase during a specific movement, and decrease after the movement, whereas muscle soreness will decrease or become more manageable the more the movement is performed

- Muscle soreness only lasts 1-3 days, whereas joint pain will continue to hurt each time you do specific movements for an undefined amount of time, and can possibly even get worse

Still think it's joint pain? There are tests we can do here at CHAMPION Performance and Physical Therapy that can help us as professionals determine where the pain is stemming. It's our job as therapists to educate you on the circumstances of your pain.  Keep in mind, every patient is unique and your pain may continue to stem from the joint as we progress - and that's a bridge we'll cross when we get there. Our goal is to improve your quality of life back to functionality status at the very least, or in other words, give you the ability to do the things you love. 

PREVENTING OSTEOARTHRITIS IN THE KNEE

WHAT IS IT?

Osteoarthritis is the medical term for the more common "arthritis" and refers to the general deterioration of cartilage that leads to damage on articulating surfaces of joints. 

Osteoarthritis can occur in any joint, some as small as the bones in the hand/fingers, and as large as the hip and knee joints. 

Preventing osteoarthritis in the knee, or delaying onset, is a lifetime practice, as many of the causes that lead to deterioration of bone articulating cartilage are due to overuse during youth, adolescence, and early adulthood. Other increased risks come from lifestyles, and habits that are typically formed at a younger age. 

INCREASED LIFESTYLE RISK FACTORS INCLUDE, BUT ARE NOT LIMITED TO: 

• Extremely active lifestyle, where the joints take a beating
  • Participating in physical activity that heavily load the joint, such as running, put large loads onto the body that continuously put stress on the cartilage and articulations of joints, running the articulation cartilage thin.
• Extremely sedentary lifestyle, where the joints receive very little to no load
  • Sedentary lifestyles tend to lead to a decrease in bone density, and a decrease in bone density leads to an increase risk of osteoarthritis
• Ligament, tendon, or cartilage tears
  • Tearing your ACL, MCL, and PCL all show an increase risk for early onset osteoarthritis, as the joint lacks stability, and therefore overloads cartilage 
• Misalignments
  • Having leg length discrepancies, wearing shoes that lack arch/medial support, etc. lead to increased pressure on one side of the body compared to the contralateral side, and results in deterioration of cartilage
• Musculoskeletal discrepancies
  • Having weak muscles on one aspect of the leg compared to the other leads to decreased stabilization in the knee, which leads to increased load on one aspect of the joint. 
  • This is the highest, non-impact cause that is correlated with an increased risk of developing osteoarthritis in both adults and children

WHAT CAN YOU DO? 

Prevention is key. Having musculoskeletal evaluations, leg length, joint alignment measured by a physical therapist prior to your child starting physical activity is key to identifying potential problems early. Children are resilient, physically, but those same joints may not be so quick to heal at age 40, and like wearing sunscreen, it's extremely necessary to attempt prevention at a young age. 

Preventative physical therapists, including us here at CHAMPION, can take your children, or even you through preventative programs to help decrease risk, delay onset, or even delay surgical repair. 

IT BAND SYNDROME

What is it?
The iliotibial band (“IT band”) is a thick band of fascia (a kind of hard flesh) that extends down the outside of the upper thigh. It begins on the pelvis, crosses the hip and knee, and attaches just below the knee. Pain is a result of friction or rubbing of the iliotibial band against the bone on the outside of the knee, which results in irritation of the band. It is one of the most common knee injuries (second only to patellofemoral pain syndrome) and has been reported in as many as 12 percent of runners. Athletes involved in cycling, weightlifting, football, soccer and tennis may also experience pain from the IT band. 

Symptoms

• Pain on the outer part of the knee with sporting activities
• Popping or rubbing sensation on the outer knee
• Pain after sitting for long periods of time with the knee bent
• Pain typically worsening with activities

Sports Medicine Evaluation and Treatment
A sports medicine physician will ask an athlete questions about potential risk factors for ITBS, including running mileage, change in mileage, uphill and downhill running routines, and track workouts. Running the same direction around a track for a long time may worsen ITBS symptoms. A sports medicine physician will perform a thorough physical exam of the athlete’s knee and leg. The provider may look at muscle imbalances, flexibility, leg length, hip and knee alignment, running gait, foot arches and footwear.

For ITBS, imaging is not usually necessary, unless the physician suspects that other causes within the knee may be causing the pain. Treatment of ITBS includes rest, ice and anti-inflammatory medications. Athletes may also have to alter training routines during the recovery period to avoid activities that cause pain. Stretching is an important component to the treatment of ITBS, as well as identifying and correcting strength imbalances. Other treatment options include steroid injections, foot orthotics and very rarely, surgical referral.

Injury Prevention
Athletes should maintain appropriate flexibility and strength, and ensure a proper warm-up prior to activity. 

Return to Play
Athletes may expect to return to activity once the symptoms have improved. Cross training is often a useful tool to use to aid in recovery. Once symptoms are improved, the athlete can gradually return to activity, generally over a period of about four to six weeks.

Authors: AMSSM Members Raul Raudales, MD, and David Berkoff, MD

COULD YOU HAVE PATELLOFEMORAL PAIN SYNDROME?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap (patella). PFPS is one of the most common types of knee pain experienced in the United States, particularly among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men and accounts for 20% to 25% of all reported knee pain - and is very, very common in adolescence and young adulthood for active or athletic individuals. Physical therapists design exercise and treatment programs for people experiencing PFPS to help them reduce their pain, restore normal movement, and avoid future injury.

What is Patellofemoral Pain?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint.) Pain occurs when friction is created between the undersurface of the kneecap and the thigh bone (femur). The pain also is usually accompanied by tenderness along the edges of the kneecap.

Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee. Other contributing factors may include:

• Weakness, tightness, or stiffness in the muscles around the knee and hip
• An abnormality in the way the lower leg lines up with the hip, knee, and foot
• Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the undersurface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. The kneecap also may fail to track properly in the femoral groove when the quadriceps muscle on the inside front of the thigh is weak, and the hip muscles on the outside of the thigh are tight. The kneecap gets pulled in the direction of the tight hip muscles and can track or tilt to the side, which irritates the tissues around the kneecap.

PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, such as running, stair climbing, squatting, or repeated carrying of heavy loads. Older adults may experience age-related changes that cause the cartilage on the undersurface of the kneecap to wear out, resulting in pain and difficulty completing daily tasks without pain.

How Does it Feel?

People with PFPS may experience:

• Pain when walking up or down stairs or hills
• Pain when walking on uneven surfaces
• Pain that increases with activity and improves with rest
• Pain that develops after sitting for long periods of time with the knee bent
• A "crack" or "pop" when bending or straightening the knee

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Your physical therapist also will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.

Generally, X-rays are not needed to diagnose PFPS. Your physical therapist may consult with an orthopedic physician who may order an X-ray to rule out other conditions.

How Can a Physical Therapist Help?

After a comprehensive evaluation, your physical therapist will analyze the findings and, if PFPS is present, your therapist will prescribe an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises targeted at the hip (specifically, the muscles of the buttock and thigh), the knee (specifically, the quadriceps muscle located on the front of your thigh that straightens your knee), and the ankle. Strengthening these muscles will help relieve pressure on the knee, as you perform your daily activities.

Stretching exercises. Your physical therapist also will choose exercises to gently stretch the muscles of the hip, knee, and ankle. Increasing the flexibility of these muscles will help reduce any abnormal forces on the knee and kneecap.

Positional training. Based on your activity level, your physical therapist may teach you proper form and positioning when performing activities, such as rising from a chair to a standing position, stair climbing, squatting, or lunging, to minimize excessive forces on the kneecap. This type of training is particularly effective for athletes.

Cross-training guidance. PFPS is often caused by overuse and repetitive activities. Athletes and active individuals can benefit from a physical therapist’s guidance about proper cross-training techniques to minimize stress on the knees.

Taping or bracing. Your physical therapist may choose to tape the kneecap to reduce your pain and retrain your muscles to work efficiently. There are many forms of knee taping, including some types of tape that help align the kneecap and some that just provide mild support to irritated tissues around it. In some cases, a brace may be required to hold the knee in the best position to ensure proper healing.

Electrical stimulation. Your physical therapist may prescribe treatments with gentle electrical stimulation to reduce pain and support the healing process.

Activity-based exercises. If you are having difficulty performing specific daily activities, or are an athlete who wants to return to a specific sport, your physical therapist will design individualized exercises to rebuild your strength and performance levels.

Fitting for an orthosis. If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by low or high arches.

Can this Injury or Condition be Prevented?

PFPS is much easier to treat if it is caught early. Timely treatment by a physical therapist may help stop any underlying problems before they become worse. If you are experiencing knee pain, contact a physical therapist immediately. 

Your physical therapist can show you how to adjust your daily activities to safeguard your knees, and teach you exercises to do at home to strengthen your muscles and bones—and help prevent PFPS.

Physical therapists can assess athletic footwear and recommend proper choices for runners and daily walkers alike. Wearing the correct type of shoes for your activity and changing them when they are no longer supportive is essential to injury prevention.

DIAGNOSED WITH OSTEOARTHRITIS

Our last post, ARE YOU AT RISK FOR OSTEOARTHRITIS? focused on the "before" aspect of a diagnosis, and what risk factors increase your chances for a diagnosis. DIAGNOSED WITH OSTEOARTHRITIS is going to focus on the "after" aspect - what to do after you've been diagnosed. 

1. First and foremost: do not self diagnose.

See your primary care physician, or an orthopaedic specialist. A series of tests and health history questions will allow most medical practitioners to be positive about an osteoarthritis diagnosis, but for physical proof, you'll need either an X-ray or an MRI. 

Why an X-ray? More advanced cases of osteoarthritis will be visible in an X-ray.  Severe cartilage degeneration will be visible (or more realistically, will be nonexistent) by recognizing what's out of place in comparison to where they're anatomically in place.  Joints that are suffering from osteoarthritis will look noticeably different in an X-ray compared to that of a healthy joint. 

2. Talk to your doctor about your options.

Depending on the severity of your case, your doctor may present you with a multitude of paths to assess, or potentially just a fair few.

Non-surgical opportunities include but are not limited to: steroid injections to lessen inflammation and reduce pain, physical therapy to strengthen muscles and therefore lighten the load on the joint, or pain medications to allow you to continue functioning with minimal pain.

Surgical opportunities, or joint replacements, are extremely common. Depending on age or the severity of your case, you may be a prime candidate for a partial or total joint replacement. This will require physical therapy to aide your body in returning to full range of motion and strength, but most cases are completely successful and will allow you to return to the lifestyle you enjoy with less pain than in you have had in probably 5 or more years. 

3. In the meantime: less is not more.

While it may feel as though movement is going to aggravate and inflame that joint, lack of movement is consequentially worse. The lack of movement weakens the muscles, and therefore, adding more pressure on the joint when it's loaded. Lack of movement will essentially make it significantly more painful to move - and therefore, making the condition feel much worse. Movement, as well as strengthening, is key to maintaining a quality of life until the correct treatment option for you can be identified and agreed upon. 

4. Ice, and Anti-inflammatories

Icing the joints can lead to some stiffness, but it can also decrease the activity of inflammatory responses that lead to increased swelling from bone-on-bone activity and therefore, decreases the residual pain. Not only does it limit the inflammatory response by constricting the blood flow into that joint, but also allows you to feel relief temporarily until the numbness from the cold entirely wears off. An anti-inflammatory can help aide in minimizing your inflammatory (immune) response, but be sure to talk with your doctor about which anti-inflammatory works best for you and your specific medication protocol. 

MEET THE PHYSICIANS: DRISKO, FEE, & PARKINS - PART II

DRISKO, FEE, & PARKINS
2790 CLAY EDWARDS DRIVE, SUITE 600
KANSAS CITY, MISSOURI 64116
P: (816) 561 - 3003

19550 EAST 39TH STREET, SUITE 410
INDEPENDENCE, MISSOURI 64057
(816) 303 - 2400

2040 HUTTON ROAD
KANSAS CITY, KANSAS 66109
P: (816) 561 - 3003

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Jeffrey Krempec, MD

Focus lies within the lower extremity, with focuses in the hip and knee. Dr. Krempec's primary focus in the hip is preservation, by means of resurfacing, revision, and replacement. He treats a wide range of ages, however, with expertise in the treatment of hip injuries in young adults, ranging from labral tears to dysplasia, with top-of-the-line techniques. 

Paul Nassab, MD

Focus lies within the upper extremity, with specialties in trauma, reconstruction, and disorders of the hand, elbow, and shoulder. Dr. Nassab is a former member of the United States Army, spending his years of service as an Urgent Care Center Physician, Flight Surgeon, and Dive Medical Officer. 

Craig Satterlee, MD

Focus lies within the upper extremity - primarily the shoulder and elbow - but is however a general surgeon who treats a multitude of disorders, diseases, and injuries. Dr. Satterlee is Kansas City's only standing member of the prestigious American Shoulder and Elbow Surgeons society, with published works he's presented internationally. He is among Kansas City's top shoulder and elbow surgeons, with high patient ratings across the board. 

Alexandra Strong, MD

Focus lies within sports medicine, with subspecialties in the shoulder and knee, but is listed as a general orthopaedic surgeon as she treats a multitude of injuries and disorders across various joints. Dr. Strong is a Board Certified Sports Medicine surgeon, with clinical interest in the female athlete. She is a standing partner of Drisko, Fee, & Parkins, LC medical group, and was named to the 2013-2015 Missouri Super Doctor's list. 

Christopher Wise, MD

Focus lies within the lower extremity, with subspecialties ranging through orthopaedic traumas. Dr. Wise's listed clinical interests include complex fractures of the pelvis, acetabulum, and lower extremity, as well as fractures that have failed to heal correctly. He even teaches his techniques to other physicians in the Kansas City area!

For more information, please visit http://www.dfportho.com/

Our blog segment titled MEET THE PHYSICIANS provides general focus information of some of the best, and most prominent orthopedic clinics in the Kansas City metro area, respectively. From these clinics, a number of their most prominent surgeons refer to us here at CHAMPION Performance and Physical Therapy. 

MENISCUS TEARS - WHAT ARE THEY AND WHAT DOES RECOVERY LOOK LIKE?

Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.

They are not uncommon to see in an athlete and with physical therapy and minimal complications, can be recovered from within the year. Here at Champion Performance and Physical Therapy, we specialize in musculoskeletal injuries and pre/post-operational recovery, among others, and take pride in the quick recovery many of our patients succeed in!

Normal Knee Anatomy

Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella).

Two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable.

Description

Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.

Sports-related meniscus tears often occur along with other knee injuries, such as anterior cruciate ligament tears.

Cause

Sudden meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.

Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Symptoms

You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.

The most common symptoms of meniscus tear are:

• Pain
• Stiffness and swelling
• Catching or locking of your knee
• The sensation of your knee "giving way"
• You are not able to move your knee through its full range of motion

Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop, or lock.

Doctor Examination

Physical Examination and Patient History

After discussing your symptoms and medical history, your doctor will examine your knee. He or she will check for tenderness along the joint line where the meniscus sits. This often signals a tear.

One of the main tests for meniscus tears is the McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscus tear, this movement will cause a clicking sound. Your knee will click each time your doctor does the test.

Imaging Tests

Because other knee problems cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis.

X-rays. Although x-rays do not show meniscus tears, they may show other causes of knee pain, such as osteoarthritis.

Magnetic resonance imaging (MRI). This study can create better images of the soft tissues of your knee joint, like a meniscus.

Treatment

How your orthopaedic surgeon treats your tear will depend on the type of tear you have, its size, and location.

The outside one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.

In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.

Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.

Nonsurgical Treatment

If your tear is small and on the outer edge of the meniscus, it may not require surgical repair. As long as your symptoms do not persist and your knee is stable, nonsurgical treatment may be all you need.

RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.

• Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
• Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
• Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
• Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.

Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.

Surgical Treatment

If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery.

Procedure. Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision (portal). This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other portals to trim or repair the tear.

Knee arthroscopy

• Partial meniscectomy. In this procedure, the damaged meniscus tissue is trimmed away. 
• Meniscus repair. Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.

Rehabilitation. After surgery, your doctor may put your knee in a cast or brace to keep it from moving. If you have had a meniscus repair procedure, you will need to use crutches for about a month to keep weight off of your knee.

Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.

For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy. Rehabilitation time for a meniscus repair is about 3 months. A meniscectomy requires less time for healing — approximately 3 to 4 weeks.

Recovery

Meniscus tears are extremely common knee injuries. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities.