About Knee Pain
The knee is the most complex joint in the body. It has to bear the weight of the body while moving through an incredible range of 130 degrees or more. When running the knee absorbs up to 6 times the weight of your body in force! In a lifetime, it is estimated that the average person will take over 216 million steps and walk 108,000 miles. With this amount of use, at times things can go wrong and lead to knee pain.
Most knee pain stems from the loss of what is called “accessory motions”. Accessory motions are the knee’s smaller movements that are sliding side-to-side, back and forth as well as spinning and rotating. Without consistent stretching and especially without being very active, the tissues around the knee become tight. In addition, if the muscles in the front or back of the knee become weaker, that can lead to more abnormal forces on the knee joint.
All of these problems lead to increased friction and wear on the knee. The normal response is one of inflammation that can be felt as pain in and around the knee. A good rule of thumb is that if your pain is achy, a lack of normal joint fluid flow is occurring as well as possible decreased circulation around the knee to the muscles and tissues. However, with sharp pain during movement, an area in the knee is being severely pressed upon and the movement of the joint is not normal.
How physical therapy helps
Physical therapy is one of the most important treatments for knee pain. Whether it is from a sports injury, tight musculature, altered joint mechanics or arthritis, we can help!
The first step is to pinpoint the exact mechanism of why your knee pain is occurring. We perform a thorough evaluation of your posture, knee motion, knee and hip strength, walking analysis and joint mobility. From this we can discover the main reason for your knee pain and formulate a treatment plan that will alleviate it quickly.
Our physical therapists perform hands-on therapy to improve your knee joint mobility, reducing pain quickly. Modalities such as ultrasound may be used to reduce swelling and pain. Specific exercises will be performed to enhance your leg strength and address any unbalanced muscles that are contributing to your knee pain. Call us today to find out how we can quickly and effectively alleviate your knee pain!
Information coming soon!
What is Bursitis?
The ending of the word “itis” is defined as inflammation. Therefore, bursitis is inflammation of a bursa and tendonitis is inflammation of a tendon. A bursa is a fluid filled sac that sits between muscles or tissues to cushion and reduce friction.
This bursa can often become inflamed due to abnormal joint movements, poor posture and weakness of the surrounding musculature. This causes strain to the tissues and excessive friction on the bursa. People tend to feel pain with prolonged walking or standing. It is often, very tender to touch.
How physical therapy helps
Physical therapy is the first line in conservative treatment for bursitis. Since most bursitis is due to underlying abnormal movement and weakness, our trained physical therapists evaluate your movement to pinpoint the source of the trouble. Modalities may be used to alleviate pain and discomfort, while hands-on therapy improves joint mechanics and range of motion.
Finally, gentle strengthening exercises and joint coordination exercises help to restore stability to the affected area and prevent re-occurrence of the symptoms. To find out more on how we can help your bursitis call today!
Iliotibial band syndrome (ITBS) is one of the most common causes of knee pain, particularly in individuals involved in endurance sports. It accounts for up to 12% of running injuries and up to 24% of cycling injuries. ITBS is typically managed conservatively through physical therapy and temporary activity modification.
What is Iliotibial Band Syndrome (ITBS)?
Iliotibial band syndrome (ITBS) occurs when excessive irritation causes pain at the outside (or lateral) part of the knee. The iliotibial band (ITB), often referred to as the “IT band” is a type of soft tissue that runs along the side of the thigh from the pelvis to the knee. As it approaches the knee, its shape thickens as it crosses a prominent area of the thigh (femur) bone, called the lateral femoral condyle. Near the pelvis, it attaches to 2 important hip muscles, the tensor fascia latae (TFL) and the gluteus maximus.
How Can a Physical Therapist Help?
Your physical therapist will use treatment strategies to focus on:
Range of motion
Often, abnormal motion of the hip and knee and foot joint can cause ITBS because of how the band attaches to hip muscles. Your therapist will assess the motion of your injury leg compared with expected normal motion and the motion of the hip on your uninvolved leg.
Hip and core weakness can contribute to ITBS. The “core” refers to the muscles of the abdomen, low back, and pelvis. Core strength is important, as a strong midsection will allow greater stability through the body as the arms and legs go through various motions. For athletes performing endurance sports, it is important to have a strong core to stabilize the hip and knee joints during repetitive leg motions. Your physical therapist will be able to determine which muscles are weak and provide specific exercises to target these areas.
Many physical therapists are trained in manual therapy, which means they use their hands to move and manipulate muscles and joints to improve motion and strength. These techniques can target areas that are difficult to treat on your own.
Even when an individual has normal motion and strength, it is important to teach the body how to perform controlled and coordinated movements so there is no longer excessive stress at the previously injured structures. Your physical therapist will develop a functional training program specific to your desired activity. This means creating exercises that will replicate your activities and challenge your body to learn the correct way to move.
Your physical therapist will also work with you to develop an individualized treatment program specific to your personal goals. He or she will offer tips to help you prevent your injury from reoccurring.
About Meniscus Injury
The meniscus is a ring of cartilage on the lower part of the knee (the tibial plateau) that the end of the large femur bone rides on. The meniscus is responsible for providing cushioning and stability of the knee joint while guiding movement. It is connected on the outer edges to the thick ligaments around the knee. The inside part of knee (medial meniscus) bears more weight and often sustains more damage than the outside part (lateral meniscus).
The meniscus is supposed to be smooth to ensure good gliding of the knee when it is bending. With injuries, poor alignment or weak musculature, the meniscus can become bruised and even torn. The outside edges of the meniscus have more blood flow than the inner portions. This means, depending on the area were the damage is located the healing process can be slow.
Many times, meniscus injuries are mild to moderate and can be rehabilitated with physical therapy. However, at times surgical intervention may be necessary to clean and shave down the torn areas of the meniscus. Physical therapy is very important in the full recovery after this surgical procedure.
How physical therapy helps
Physical therapy is a very important part of recovering from a meniscus injury. Most injuries are mild and involve small tears, bruising or irritation. Physical therapy can pinpoint where there are limitations in movement of the knee joint and weakened musculature support. By pinpointing the mechanisms of injury, our treatments can focus on reducing your pain and swelling quickly. Then, we focus on improving your range of motion, joint mobility and strengthening to make sure your meniscus receives the necessary support.
If surgery is necessary, we work closely with your physician and the rehabilitation protocol. The primary focus is on eliminating swelling quickly, resolving pain, improving range of motion, restoring normal walking and strengthening the supporting muscles around the knee. We then show you what to do to maintain a healthy knee with physical activities and sports. Call us today to see how we can help you recover quickly from a meniscus injury.
As is often the case with many diagnoses ending in “Syndrome,” Restless Legs Syndrome (RLS) can be elusive and challenging to diagnose, treat, and understand. While we sometimes work with patients who come to us primarily for help with RLS (yes, we do treat it), more often they are seeking treatment for some other problem and happen to mention they have RLS. In an effort to promote understanding of this condition, we have compiled this summary from the limited literature on RLS as well as our clinical experience.
What is RLS?
RLS is generally characterized by an urge to move and the feeling of unpleasant sensations inside the lower legs.1 Generally symptoms will affect both lower legs. Symptoms of RLS usually occur during periods of inactivity and resolve with movement or exercise. Typically at night time when attempting to rest is when symptoms are the worst, but problems can also be present during the day.
How is it Diagnosed?
As with many “syndromes,” there are no tests that absolutely confirm RLS. It is a diagnosis based purely on symptomology and the absence of other diagnoses that would account for the symptoms. The International Restless Legs Syndrome Study Group established criteria for diagnosis which include: a desire to move the limbs, usually associated with paraesthesia (pins and needles sensation) or dysaesthesia (abnormal sensation); motor restlessness; symptoms worse or exclusively present at rest; symptoms worse in the evening or night.2,3 Additional features that may accompany these signs or symptoms include: sleep disturbance, periodic limb movements in sleep, a normal neurological examination, chronic symptoms with exacerbations and remissions, and a positive family history.2 The establishment of such criteria indicate there are enough people with these complaints to justify studying them. However, establishing these criteria does not provide an explanation as to the cause or provide guidelines for treatment.
Why does it occur?
There are several unproven hypotheses attempting to explain RLS. The most common one cites iron deficiency, which can be identified with basic blood testing. But consider this: many people with iron deficiency do not have RLS, and many people with RLS do not exhibit iron deficiency. Then there are those with iron deficiency who still suffer with RLS even after their iron levels have been normalized. Certainly, normalizing iron levels in the body is desirable for many reasons. But logic dictates that this does not fully explain or address the problem for many individuals. If iron deficiency was the cause and the solution supplementation, then there would be no market for pharmaceuticals specifically targeting RLS. Yet the two most frequently prescribed medications, Pramipexole (Mirapex) and Ropinirole (Requip), are in high demand. Another proposed cause of RLS is dysfunction of dopamine (a neuro-transmitter affecting movement), although this also is unproven.
There is a growing body of literature and evidence supporting the phenomenon of myofascial trigger points, fascial densifications, and faulty movement patterns/habits as contributing to many neuro-musculo-skeletal dysfunctions. This is logical and believable when one considers the expansive network of muscle and fascia (connective tissue) throughout the body, and how tissue overload and trauma can lead to dysfunction. The symptoms of many of these disorders are similar to those associated with RLS. While at this time there are no studies proving a correlation, one must consider that there is no more evidence supporting iron deficiency as the primary cause of RLS.
How is RLS treated?
As discussed earlier, simple blood testing may identify iron deficiencies which should be addressed. More commonly, RLS is treated with medication as noted above.3 While these medications function to diminish the symptoms of RLS, they do not resolve any underlying cause. This necessitates long-term use, which can be expensive, and in 40% of users medications can cause undesirable side effects such as drowsiness, dizziness, and nausea. Other more severe symptoms can occur including cardiac arrest, delirium, and aneurysm although these are less common.
Currently there is very little research concerning the effectiveness of exercise on RLS. A small study that compared exercise (resistance and aerobic) to no intervention showed improvement in symptoms at 6 weeks and this improvement was maintained through 3 months (the length of the study).3 There has also been very limited research conducted to investigate the effectiveness of soft tissue techniques (massage, myofascial release) on symptoms, although case studies have shown promising results.4
It has been our clinical experience that addressing myofascial trigger points in muscles, densifications in fascia, and faulty movement patterns that overload soft tissues in the trunk and extremities can help to diminish/resolve the symptoms of RLS. Our evaluation emphasizing movement assessment and palpation typically exposes soft tissue movement restrictions and biomechanical movement dysfunctions in the legs and other areas of the body.5 Very often, patients suffering with RLS demonstrate fascial restrictions in the feet and pelvic regions, which makes sense if you consider that the legs are then caught in the middle of a connective tissue tug of war. Often (although not always) RLS patients have a history of dysfunction involving the feet such as heel pain/spurs, plantar fasciitis, and bunions. Some relate a history dating back to childhood, often sadly diagnosed as “growing pains.”
Effective interventions we often utilize include a combination of dry needling, Fascial Manipulation®, and exercise including Postural Restoration® techniques. These approaches are utilized wherever needed throughout the trunk and extremities, as a global total-body approach is typically most successful. Home exercises are essential for addressing strength and movement issues that cause overload and dysfunction to the soft tissues. Education as to faulty habits and postures perpetuating problems is also essential to resolving the symptoms.
Many people are unaware of the options available to them in the management and resolution of RLS. We hope that this information has been helpful for you, and strongly encourage anyone suffering with RLS to explore these options. For further information or to speak with one of our therapists please contact our office.
- Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of internal medicine, 266(5), 419-431.
- Chaudhuri, K. R., Appiah-Kubi, L. S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.
- Aukerman, M. M., Aukerman, D., Bayard, M., Tudiver, F., Thorp, L., & Bailey, B. (2006). Exercise and restless legs syndrome: a randomized controlled trial. The Journal of the American Board of Family Medicine, 19(5), 487-493.
- Russell, M. (2007). Massage therapy and restless legs syndrome. Journal of Bodywork and Movement Therapies, 11(2), 146-150.
- Day, J. A., Copetti, L., & Rucli, G. (2012). From clinical experience to a model for the human fascial system. Journal of bodywork and movement therapies, 16(3), 372-380.
Information coming soon!
The anterior cruciate ligament (ACL) is located in the knee and can be injured or torn when it is harshly twisted in the wrong way. ACL tears are especially common in athletes, including those who participate in sports such as gymnastics, football, soccer, tennis, or downhill skiing. All these sports require sudden stops and changes in direction, making the risk higher for twisting the knee the wrong way and sustaining an ACL injury.
An ACL injury is painful and debilitating. Those suffering from this type of injury typically experience severe pain, swelling, limited range of motion, and instability when trying to bear weight. Fortunately, our Harrisonburg, Broadway, and Pinehurst physical therapy services can help treat your ACL injury and provide some much-needed relief.
According to GetPT1st, “research shows that 26% of non-contact ACL injuries could be prevented by specific exercise programs.” At Appalachian Physical Therapy, we are dedicated not only to helping you recover from your ACL injury, but we are also able to help you prevent further injuries from occurring in the future. Our Harrisonburg, Broadway, and Pinehurst physical therapists will conduct several tests to gauge your injury risk, such as the Landing Error Scoring System (LESS). This is a jump-landing test, used to determine whether or not you are at high-risk for a non-contact ACL injury.
After diagnostic tests and physical examinations are complete, our physical therapists will design a specialized treatment plan based on your specific needs. Your treatment plan may include a combination of methods, including manual therapy, ice and heat therapies, ultrasound, or targeted exercises, all aimed at providing relief and rehabilitation.
If you are suffering from an ACL injury, contact Appalachian Physical Therapy today to schedule your initial appointment. We will get you started on your path toward recovery and long-lasting relief!