Knee

Ann Arbor Woman Overcomes Agonizing Pain Following a "Pop" In Her Knee

Ever have that moment in life when you stepped wrong or twisted unexpectedly and felt a "pop" in your knee? 

If this story sounds familiar, you are not alone!

In fact, we treat many people successfully who have experienced this very same knee injury

patti.png

It's very easy to believe that rest and ibuprofen will make it better....

You've probably already tried something like that before, after all that's the general advice you've probably come to expect when going to the doctor.

So if you are currently having difficulty with things like going up/down stairs or squatting know that it can get better!

But don't blame us if 6 weeks roll by and all you have tried is rest, ice, and ibuprofen with no noticeable change in both pain and your ability to do necessary things like go up/down stairs, yard work, and play with the kids or grandchildren.

The biggest factor in this injury is pressure.

Our bodies have developed tendencies over years of use on how we place pressure through our joints. The hip and foot are most notorious for this!

Think about it for a second. Does your foot turn outward all the time when you stand? Do you cross your legs a certain way when you sit? There are many more signs like this...

The first step is to bring your awareness to the daily habits continuously provoking the symptoms. Limit those habits for the time being while we work on things that not only help your pain, but also restore the capacity of your injured knee again.

This way you can be assured that you will in fact be able to go up/down stairs again uncompensated!

You will be able to squat without fear of it hurting or being "bad for your knees" (more poor advice from the doctor...how about you learn to do it properly to EVENLY distribute force through your legs instead of putting all the pressure directly to your knee).

And you will be able to play with your kids or grandkids again!

If you are looking to eliminate that daily annoying ache in the knee....Even if you felt a "pop" when it happened! Sign up for one of our FREE Discovery Sessions. Out of curtusy to our current clients, we limit these discovery session each week, so be sure you inquire today before the spaces fill up!

Head pic.jpg

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Why Your Knee Hurts With Squats and Stairs

Pain in the front or side of your knee?

Clicking or popping around the kneecap?

Don't be so quick to blame the knee! We see this all the time at On Track Physiotherapy. Client comes in with knee pain and has difficulty with squatting, stairs, etc. 

Often times people think that this is a knee issue. When quite often it actually has more to do with the hips and foot than anything. 

When people think about the knee, many believe that it just bends and straightens. When in reality there is actually a decent amount of rotation that is normal and should occur at the knee with various different tasks. 

This is because you hips and ankles have more degrees of freedom than the knee. Move your ankle or hip around for a moment. Then move you knee. Notice how many more options are available to the ankle and hip.

This puts your knee "a.k.a the middle man" at the mercy of the hip and ankle. Your body is like a tetor toter, if one end moves, the opposite end is going to do something as a result. 

So if you hip or ankle do not have the motion necessary to accomplish the task, it causes the knee to work overtime.

If your hip and ankle don't have stability and control, then the knee takes the brunt of the stress.

Your body needs controlled motion available throughout the lower extremity to distribute forces and start feeling better.

Listen to the video above, as I explain this in more detail. 

Real Solutions For Knee Pain| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Stop Daily Annoying Knee Pain Without Taking Painkillers Or Having Surgery

Knee pain is one of the most commonly treated and surgically operated injuries in the world. It impacts you daily by making stairs or frequent lifting a nightmare. It might be stopping you from playing a sport with your child or going for a round of golf with your buddies.  Maybe you have had an x-ray performed, and been told you have degeneration or arthritis in your joint? While x-rays certainly do not lie, they also do not tell the entire story.

In fact, one study by Katz and fellow researchers showed that getting physical therapy first helped 60%-70% of knee osteoarthritis patients avoid surgery.  

Another study of 180 patients with osteoarthritis were separated into three groups: two different types of arthroscopic surgery, and a placebo (fake) arthroscopic surgery. Interestingly, the two arthroscopic surgeries were no more effective than the placebo (fake) surgery.

Staggering information isn’t it? That’s a lot of money to throw at a surgery with questionable outcomes. Not to mention you probably will have to go to therapy after surgery anyways. Fortunately to both you and me “arthritis” is a normal change in the body that happens over years of accumulated stress and as a result can often be improved through conservative measures.

Why Does My Knee Still Hurt?

The knee often takes the brunt of the force for lack of mobility or control in the hip or ankle. The degrees of freedom in the knee are much less than the ankle or the hip. If motion limitations exist in the hip or ankle, the knee will start creating wear patterns as a result. This wear pattern typically presents itself in some form of faulty orientation of the knee. The body will always take the path of least resistance. So if the hip and ankle orientation are not optimal due to restrictions, this creates a twisting mechanism at the knee as it tries to adapt and accommodate for other structures that are not functioning at optimal capacity.

As you can imagine, this makes the knee much less adaptable and resilient.

Maybe you have had a previous injury to the knee? If optimal function and adaptability was never restored in the knee afterwards, then the overall level of resiliency to injury of the knee will remain low as well.

So how do we reduce pain in the knee so you can squat, go up and down stairs, and walk without that annoying pain?

1) Perform exercises that will get the muscles around the hip strong. This program is often much trickier than going to the gym and working out. Remember we have adaptive changes to deal with that have occurred in the body as a result of dysfunctional or overused movement patterns (most likely both).

Because the body currently has a very low level of resiliency we need to be careful of the amount of load applied to the knee. This is one reason why a low impact endurance program can be very beneficial such as riding a bike 10-30 minutes a couple times per week at about 75% effort. In fact, a lot of research has actually shown that endurance training can increase pain tolerance.

But ultimately, we need to gradually start to load the knee again in a functional way to improve tolerance to activity. We can do this by improving hip function, this will help take some of the stress off of the knee. Here are a couple options that may be helpful. 

As part of a physical therapy treatment, we can perform different manual techniques such as dry needling that can help modulate pain. However, if we never address other limitations above and below the knee joint, the pain may remain or linger much longer than necessary. This is why a detailed assessment is required, so specific interventions can be given to restore optimal function and abolish pain.

Looking at the way you move through different ranges of motion and see where limitations might exist in both the hip and ankle. This will often direct which set of particular exercises and manual therapy techniques would be most important for your particular set of limitations. This is why we at On Track Physical Therapy will take you through a movement assessment every visit and multiple times per visit. It allows us to be very targeted in what we do as opposed to throwing things out and hoping something sticks, which unfortunately is what many other providers do. This allows us to help you get off painkillers, get some sleep, and keep an active lifestyle. If that sounds like something you’d enjoy, then schedule an appointment or a FREE discovery session to take things for a test drive.  

References

Katz, Jeffrey N., et al. "Surgery versus physical therapy for a meniscal tear and osteoarthritis." New England Journal of Medicine 368.18 (2013): 1675-1684.

Moseley, J. Bruce, et al. "A controlled trial of arthroscopic surgery for osteoarthritis of the knee." New England Journal of Medicine 347.2 (2002): 81-88.

Jones, Matthew D., et al. "Aerobic training increases pain tolerance in healthy individuals." Med Sci Sports Exerc 46.8 (2014): 1640-7.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Dry Needling For Hip and Knee Pain

Ann Arbor, Mi - At On Track Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling is one of those treatments and can potentially works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

Vastus_Lateralis_TP_39_s.jpg

Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created by my mentor Joe Heiler at Elite Physical Therapy in Traverse City for the website Sports Rehab Expert which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using IASTM and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at On Track Physical Therapy and Sports Performance.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Patellar Tendinitis (a.k.a. Jumper’s Knee) – Ann Arbor, Mi

Ann Arbor, Mi - Maybe you have heard of Osgood Schlatter Disease, Patellofemoral Pain Syndrome, Patellar Tendinitis or “Jumper’s Knee” before? These diagnoses are very similar, and are common diagnoses given to athletes or active individuals of all ages. Osgood Schlatter’s Disease is a diagnosis commonly given to children, to boys between the ages of 12-15 and girls between the ages of 8-12.  This is generally due to the rapid changes in body composition these adolescent children are experiencing in conjunction with increased participation in sports1.

Patellofemoral Pain Syndrome is a fancy way of saying that the kneecap (patella) is having issues tracking properly across the knee joint, thus causing your pain. More on this a little later.

Patellar Tendinitis or “Jumper’s Knee” explains everything you need to know in the title about one of the possible causation factors. Sports involving dynamic activity such as jumping, bounding, plyometrics, and change of direction inherently places you at a higher risk for developing this type of painful experience. However, it is also very possible to manifest itself in the general population as well, with frequent bouts of activities such as squatting, lifting, or carrying objects up and down stairs.

Related Article: Is Plyometric Training Causing Knee Injuries?

All these types of diagnoses tend to have very similar limitations and symptoms, and error on the side of overuse injuries. No matter your age or activity level, a painful experience can generally be explained by a sudden increase in activity that your body was not prepared to handle, or an accumulation of repetitive physical stress without ample rest.

With that being said, there are usually very predictable limitations that occur in the body which predispose an individual to any of the previously mentioned injuries. In most cases, when these limitations are addressed and external causation factors are managed properly, the outcomes tend to be very positive.

Maybe you have noticed that most of these diagnoses make mention of the patella. In fact, one of them actually has a syndrome named after it (Patellofemoral Pain Syndrome and Patellar Tendinitis). Unfortunately for the patella, it is the most prominent and superficial part of the knee. As such, it usually takes the brunt of the criticism for causing knee related pain. However, if we take a deeper look into how the body operates, we understand that the patella really is just the result of an underlying positional problem. Understand that the patella is just a sesamoid bone (free floating), that rides on the groove of the femur as it connects to the tibia to create leverage in the quad muscle.

The common analogy used for the patella is that it acts like a “train” that rides on the “tracks” of the femur. If the femur or “track” is in a poor position, then the patella cannot run properly across its groove. This analogy holds true not just for Patellofemoral Pain Syndrome, but rather every one of the diagnoses mentioned (Osgood Schlatter’s Disease, Patellar Tendinitis/Jumper’s Knee). If a person is unable to maintain proper position with various demands the body may encounter, then a lot of torque is placed on the knee and patellar tendon, which may result in a painful experience over time.

We all know the function of the knee is to bend because it’s a hinge joint.  However, it also has rotational capabilities because of the hip and the ankle. This rotational component from the hip and ankle when functioning on all cylinders is how the knee absorbs forces. Without it, the adaptability of the knee is minimal. Think about hitting a pothole with your car. Without shocks, chances are your car goes out of commission pretty quick.

As part of a physical therapy treatment, we can perform different manual techniques such as taping, active release, IASTM or dry needling that can help modulate pain. However, if we never address other limitations above and below the knee joint, then pain may remain or linger much longer than necessary. This is why a detailed assessment is required, so specific interventions can be given to restore optimal function and abolish pain.

At On Track Physical Therapy, we provide a one-on-one treatment approach unlike any other. Full one-on-one, uninterrupted hour long treatment sessions with a Doctor of Physical Therapy at every appointment. This allows for detailed assessments and frequent reassessments during the treatment session, to ensure we address the issue appropriately.

Click the image below for your FREE sports injury report and discover how pro athletes recover from injury FAST!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.