A Guide to Understanding Knee Pain...How PT can help!

Physical Therapist's Guide to Knee Pain

Knee pain can be caused by disease or injury. The most common disease affecting the knee is osteoarthritis. Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of movement. Knee pain caused by an injury is most often associated with knee cartilage tears, such as meniscal tears, or ligament tears, such as anterior cruciate ligament tears.

What is Knee Pain?

Knee pain can be caused by disease or injury. Knee pain can restrict movement, affect muscle control in the sore leg, and reduce the strength and endurance of the muscles that support the knee.

The most common disease affecting the knee is osteoarthritis, which is caused by the cartilage in the knee gradually wearing away, resulting in pain and swelling.

Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of motion, as can happen in sports, recreational activities, a fall, or a motor vehicle accident. Knee pain caused by an injury often is associated with tears in the knee cartilage or ligaments. Knee pain also can be the result of repeated stress, as often occurs with the kneecap, also known as patellofemoral pain syndrome. Very rarely, with extreme trauma, a bone may break at the knee.

How Does it Feel?

You may feel knee pain in different parts of your knee joint, depending on the problem affecting you. Identifying the location of your pain can help your physical therapist determine its cause.

How Is It Diagnosed?

Your physical therapist will make a diagnosis based on your symptoms, medical history, and a thorough examination. X-ray and magnetic resonance imaging (MRI) results may also be used to complete the diagnosis.

To help diagnose your condition, your physical therapist may ask you questions like these:

o    Where exactly on your knee is the pain?

o    Did you twist your knee?

o    Did you feel a "tearing" sensation at the time of injury?

o    Do you notice swelling?

o    Have you ever felt like your knee joint is "catching," or "locking," or will give way?

o    Do you have difficulty walking up and down stairs?

o    Do you have difficulty sitting with your knee bent for long periods, as on an airplane or at the movies?

o    Does your pain increase when you straighten or bend your knee?

o    Does your knee hurt if you have to twist or turn quickly?

The physical therapist will perform tests to find out whether you have:

o    Pain or discomfort with bending or straightening your knee

o    Tenderness at the knee joint

o    Limited motion in your knee

o    Weakness in the muscles around your knee

o    Difficulty putting weight on your knee when standing or walking

The physical therapist also is concerned about how well you are able to use your injured knee in daily life. To assess this, the therapist may use such tests as a single-limb hop test, a 6-minute walk test, or a timed up and go test.

How Can a Physical Therapist Help?

Based on the evaluation, your physical therapist will develop a customized rehabilitation program, including a specific set of knee exercises, for you.

If you already have knee problems, your physical therapist can help with a plan of exercise that will strengthen your knee without increasing the risk of injury or further damage. As a general rule, you should choose gentle exercises such as swimming, aquatic exercise, or walking rather than jarring exercises such as jogging or high-impact aerobics.

Consult your physical therapist about specific ways to maintain your knee health following injury or surgery. Your physical therapist has the relevant educational background and expertise to evaluate your knee health and to refer you to another health care provider if necessary.

Depending on the severity of your knee problem, your age, and your lifestyle, the therapist may select such treatments as:

Strength training and functional exercises, which are designed to increase strength, endurance, and function of your leg muscles (quadriceps and hamstrings). This in turn helps support the knee and reduce stress to the knee joint.

Electrical stimulation of the knee, which further increases leg muscle strength and can help reduce knee pain. To increase strength, electrical impulses are generated by a device and delivered through electrodes to stimulate the primary muscle that supports the knee, the quadriceps femoris. To reduce your knee pain, the electrodes are placed on the skin to gently stimulate the nerves around the knee.

Your physical therapist can determine just how much you may need to limit physical activity involving the affected knee. He or she also can gauge your knee’s progress in function during your rehabilitation.

How Can a Physical Therapist Help Before & After Surgery?

Your physical therapist, in consultation with your surgeon, will be able to tell you how much activity you can do depending on the type of knee surgery (such as total knee replacement) you undergo. Your therapist and surgeon also might have you participate in physical therapy prior to surgery to increase your strength and motion. This can sometimes help with recovery after surgery.

Following surgery, your physical therapist will design a personalized rehabilitation program for you and help you gain the strength, movement, and endurance you need to return to performing the daily activities you did before.

Can this Injury or Condition be Prevented?

Ideally, everyone should regularly get 3 types of exercise to prevent injury to all parts of the body, including the knees:

o    Range-of-motion exercises to help maintain normal joint movement and relieve stiffness.

o    Strengthening exercises to keep or increase muscle strength.

o    Aerobic or endurance exercises (such as walking or swimming) to improve function of the heart and circulation and to help control weight. Weight control can be important to people who have arthritis because extra weight puts pressure on many joints, including the knee.

To keep knee pain and other musculoskeletal pain at bay, it’s important to maintain an overall healthy lifestyle, exercise, get adequate rest, and eat healthy foods. It’s also important for runners and other athletes to perform physical therapist-approved stretching and warm-up exercises on a daily basis—especially before beginning physical activity. 

Real Life Experiences

At age 56, Monica was in very good health—eating right, maintaining her weight, and exercising daily at home. One day she fell off her exercise equipment and twisted her knee. The pain was excruciating. Even though she could walk short distances, using her sore leg during her daily activities soon became impossible. Monica made an appointment with her physical therapist. The therapist reviewed her medical history, conducted a thorough examination, and consulted with Monica’s physician regarding the need for a series of X-rays to ensure no bones were broken in the fall.

Consultation with an orthopedic surgeon confirmed that there were no broken bones and no need for surgery. Monica's physical therapist developed a program of strength training and functional exercises to increase her hip, knee, and ankle muscle strength and endurance. The physical therapist also recommended electrical stimulation of the knee to increase her quadriceps (thigh) muscle strength.

By following the physical therapist's regimen, Monica decreased her knee pain, and her mobility improved dramatically. Regular ongoing strength-training knee exercises—and more careful use of her exercise equipment—have helped Monica remain free of knee pain.

What Kind of Physical Therapist Do I Need?

Although all physical therapists are prepared through education and experience to treat people with knee pain, you may want to consider:

o    A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems

o    A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy, giving the therapist advanced knowledge, experience, and skills that may apply to your condition

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

o    Get recommendations from family and friends or from other health care providers.

o    When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with TKR.

During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Article originally appeared on http://www.apta.org/, click the following link to read the original article: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=b92021cb-a1ec-4f20-8b7e-37d62bc1a52e

Physical Therapists Help You Get Fit!

This was a news release from last year by the American Physical Therapy Association (APTA) but is very applicable in the beginning of this new year with everyone's resolutions to get fit.  Read more to learn how to stay safe in your new endeavors of physical fitness...

New to the Gym? Physical Therapists Help You Get Fit – Safely – in 2011

ALEXANDRIA, VA, January 7, 2011 — New Years’ resolutions have an 80 percent rate of failure

by Valentine’s Day, but Americans can increase their success by sharing their commitment with

others. The American Physical Therapy Association’s (APTA’s) Move Forward campaign is

helping individuals keep commitments by starting the conversation online and providing fitness

tips for those who are heading to the gym.

For new, potential, and even returning gym members, APTA launched 12 instructional videos

featuring physical therapist and APTA member Robert Gillanders, PT, DPT. Dr. Gillanders

demonstrates correct posture and form for selected core, leg, shoulder and arm exercises. These

exercises, in conjunction with a regular cardiovascular routine, will help individuals strengthen

target areas. Gillanders’ advice will also help individuals exercise with less risk of injury.

“One of the most important things to remember is the overall form of the exercise,” Gillanders

said. “It’s going to help you be less vulnerable to injury. Physical therapists have extensive

knowledge of the way the body moves and are also able to adjust workouts for pre-existing

conditions, and these videos will help get Americans off to a good start in 2011.”

To help individuals stick to their New Years’ fitness resolutions, @MoveForwardPT invites people

to share their progress every Friday in January on Facebook and on Twitter via #MovePT. Join

the Move Forward PT community on Facebook, YouTube and Twitter via @MoveForwardPT. For

more information on how a physical therapist can help individuals achieve their fitness goals, visit

MoveForwardPT.com and read more about the benefits of physical activity.

About APTA

The American Physical Therapy Association (APTA) represents more than 74,000 physical

therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more

about conditions physical therapists can treat and find a physical therapist in your area.

Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.

Physical and Occupational Therapy for Arthritis

Physical and Occupational Therapy for Arthritis

Arthritis treatment may include physical therapy and/or occupational therapy.

People with arthritis often have stiff joints -- largely because they avoid movements that can increase pain. By not moving arthritic joints, however, the stiffness and pain only get worse. Therefore, people with arthritis often benefit from physical therapy. A physical therapist can teach you how to work out stiffness without further damaging your joint. Physical therapy also is useful after an injury, such as from a fall, and after joint surgery, especially for artificial joint replacement.

Occupational therapy can teach you how to reduce strain on your joints during daily activities. Occupational therapists can show you how to modify your home and workplace environments to reduce motions that may aggravate arthritis. They also may provide splints for your hands or wrists, and recommend assistive devices to aid in tasks such as driving, bathing, dressing, housekeeping, and certain work activities.

What Is the Goal of Physical Therapy?

The goal of physical therapy is to get a person back to the point where he or she can perform normal, everyday activities without difficulty.

Preserving good range of motion is key to maintain the ability to perform daily activities. Therefore, increasing the range of motion of a joint is the primary focus of physical therapy. Building strength in the involved muscles surrounding the joint also is extremely important, since stronger muscles can better stabilize a weakened joint.

Physical therapists provide exercises designed to preserve the strength and use of your joints. They can show you the best way to move from one position to another and can also teach you how to use walking aids such as crutches, a walker or a cane, if necessary.

What Are Some Benefits of Occupational and Physical Therapy?

If you have arthritis, there are many benefits to participating in a physical and occupational therapy program, including:

·         You gain education about your type of arthritis, so that you can be well informed.

·         If you are overweight, a dietary plan can be created to reduce the stress of excess weight on supporting joints of the back, legs, and feet. As yet, no specific diet -- other than a diet designed for weight loss -- has proved helpful for arthritis.

·         You gain foot-care advice, including choice of well-fitting shoes with shock-absorbing outer soles and sculptured (orthotic) insoles molded exactly to the contour of each foot.

·         You will learn therapeutic methods to relieve discomfort and improve performance through various physical techniques and activity modifications.

What Techniques Will I Learn?

You'll learn several techniques, including:

·         Rest. Bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints. Custom splints can be made to rest and support inflamed joints and a soft collar can support the neck while you are sitting or standing.

·         Thermal modalities. Applying ice packs or heating pads, as well as deep heat provided by ultrasound and hot packs, can help relieve local pain. Heat also relaxes muscle spasm around inflamed joints. Heating joints and muscles with a warm bath or shower before exercising may help you exercise more easily.

·         Exercise . Exercise is an important part of arthritis treatment that is most effective when done properly every day. Your doctor and therapist will prescribe a program for you that may vary as your needs change.

What Therapy Is Offered for People Recovering From Joint Replacement?

Preoperative programs of education and exercise, started before joint replacement surgery, are continued at home. They may be changed in the hospital after surgery to fit new needs during the rehabilitation period. These exercises may be added to your usual exercise regimen, and you may find your ability to exercise has improved after surgery.

What Joint Protection Techniques Are Offered?

There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these include:

·         Controlling your weight to avoid putting extra stress on weight-bearing joints such as the back, hips, knees, and feet.

·         Being aware of body position, using good posture to protect your back and the joints of your legs and feet. When possible, sit down to do a job instead of standing. Change position often since staying in one position for a long time tends to increase stiffness and pain.

·         Conserving energy by allowing for rest periods, both during the workday and during an activity.

·         Respecting pain. It is your body's way of telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.

An occupational therapist can show you ways to do everyday tasks without worsening pain or causing joint damage. Some joint protection techniques include:

·         Using proper body mechanics for getting in and out of a car, chair or tub, as well as for lifting objects.

·         Using your strongest joints and muscles to reduce the stress on smaller joints. For example, carrying a purse or briefcase with a shoulder strap rather than with your hand.

·         Distributing pressure to minimize stress on any one joint. Lifting dishes with both palms rather than with your fingers and carrying heavy loads in your arms instead of with your hands.

·         If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing, and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.

What Are Assistive Devices for Arthritis?

If you have arthritis, many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist can suggest devices that will be helpful for tasks you may find difficult at home or at work.

A few examples of helpful devices include a bath stool for use in the shower or tub, grab bars around the toilet or tub, and long-handled shoehorns or sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices

Call us today to schedule an appointment if you or someone you love suffers from arthritis pain and are looking for relief!  
1-386-898-0443

Physical Therapy and the Camaraderie of Healing

I found this wonderful article written by an author about her experiences as a physical therapy patient.  It really speaks to the bond and relationship patients and Physical Therapists develop during the course of treatment... 

Physical Therapy and the Camaraderie of Healing

Brian Stauffer

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ClosI first had physical therapy at 27, after I slipped on an icy Montreal sidewalk and tore the ligaments in my left ankle. I had it again at 42 and 43, after surgery on my right and left knees, and most recently I’ve had it on both shoulders.

My orthopedist likes to say surgery is half the battle. If so, it’s the easy half.

The slow and repetitive work of physical therapy often starts the next day, and for an injury like a tear in an anterior cruciate ligament, it can take up to six months. Before you’ve done it, it’s hard to imagine anything is going to take so long and hurt so much.

Part of the challenge is the nature of arthroscopic surgery, whose multiple incisions are often so tiny they barely leave a trace. I’ve had torn meniscus (cartilage) removed from both my knees, and I have to look really hard to find my scars. Removal of bone spurs from my shoulder through four incisions left my skin almost smooth. Surely this is a good thing.

But those minuscule entry points make it difficult to comprehend what has been done in there. After only 45 minutes under general anesthetic and with no huge incision or bloody wound, why am I in so much pain? And why do I have to keep doing these silly exercises?

Surgeons have little time, and sometimes less appetite, to discuss the minutiae of a procedure’s aftereffects. Often it’s the physical therapists who patiently explain what the physician did and why we now have to relinquish huge chunks of our time to rehabilitation.

Physical therapy, or P.T., demands the month-after-month tedium of spending hours in a room filled with strangers stretching colored rubber bands or spinning their arms in circles.

The rituals are oddly and intimately public. Patients of every age, race and income level share a large, sunny room. We do our leg-raises side by side on wide beds. We wait in line for the pulley, the elliptical and the arm bike. We learn a new language and its tools: the strap, the stick, shrugs and pinches.

Everyone ends up in P.T. — lithe teenage athletes, construction workers and police officers with job-related strains, C.E.O.’s with skiing injuries, older people with replaced knees and hips. I’ve commiserated there with an Episcopal minister, an Ivy League economics professor and a firefighter.

The rituals become routine, starting with a heating pad and nerve stimulation, ending with the soothing benediction of a black rubber ice pack. We learn to bend our lives around the inexorable, unfashionable truth — healing takes work and it takes time.

Camaraderie grows as patients compare notes on the frustration of needing help for tasks as simple as pulling up your trousers or opening a can of soup. Women commiserate with the new knowledge that a bra strap can pinch a healing shoulder like steel cable. Struggling to complete even the simplest of tasks in a room full of fellow adults is humbling. When I see someone’s jaw clench with effort, I remember that lifting a one-pound weight can be tough.

I never expected to forge a multiyear relationship with my physical therapists, but I have. I like Helen and Matt and Stephanie and Richard. Really. I just hope I never see them again.

I don’t envy them their job, stretching and shaking and manipulating our joints to loosen them and keep them flexible. It has left me gasping in pain, sometimes even tears. I can’t imagine having to intentionally inflict pain, but that, one quickly learns, is an inevitable part of healing.

It must be difficult for our physical therapists to cheer us on for what are, in other circumstances, a toddler’s proud achievements — when we have regained the ability to tie our shoelaces or walk steadily across a room or throw a ball.

There is an upside. Because we see them so frequently for months, we get to know our physical therapists, and they us, in ways we’ll never know our doctors. We learn where they live and go on vacation, who has a new puppy, whose husband changed careers.

It’s not an intimacy we would choose. But, shoved out of our private, busy lives, whether reluctantly or gratefully, we fall into their strong, skilled, waiting hands.

Caitlin Kelly is the author of “Blown Away: American Women and Guns.”

New Study Proves PT is the Best Choice in Tendon Injuries....

For Tendon Pain, Think Beyond the Needle

By JANE E. BRODY Published: February 28, 2011

Two time-honored remedies for injured tendons seem to be falling on their faces in well-designed clinical trials.

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The first, corticosteroid injections into the injured tendon, has been shown to provide only short-term relief, sometimes with poorer long-term results than doing nothing at all.

The second, resting the injured joint, is supposed to prevent matters from getting worse. But it may also fail to make them any better.

Rather, working the joint in a way that doesn’t aggravate the injury but strengthens supporting tissues and stimulates blood flow to the painful area may promote healing faster than “a tincture of time.”
And researchers (supported by my own experience with an injured tendon, as well as that of a friend) suggest that some counterintuitive remedies may work just as well or better.

A review of 41 “high-quality” studies involving 2,672 patients, published in November in The Lancet, revealed only short-lived benefit from corticosteroid injections. For the very common problem of tennis elbow, injections of platelet-rich plasma derived from patients’ own blood had better long-term results.
Still, the authors, from the University of Queensland and Griffith University in Australia, emphasized the need for more and better clinical research to determine which among the many suggested remedies works best for treating different tendons.

My own problem was precipitated one autumn by eight days of pulling a heavy suitcase through six airports. My shoulder hurt nearly all the time (not a happy circumstance for a daily swimmer), and trying to retrieve something even slightly behind me produced a stabbing pain. Diagnosis: tendinitis and arthritis. Treatment: rest and physical therapy.

Two months of physical therapy did help somewhat, as did avoiding motions that caused acute pain. The therapist had some useful tips on adjusting my swimming stroke to minimize stress on the tendon while the injury gradually began to heal.

The following spring, although I still had some pain and feared a relapse, I attacked my garden with a vengeance. Much to my surprise, I was able to do heavy-duty digging and lugging without shoulder pain.
Could the intense workout and perhaps the increased blood flow to my shoulder have enhanced my recovery? A friend, Richard Erde, had an instructive experience.

An avid tennis player at 70, he began having twinges in his right shoulder while playing. Soon, simple motions like slipping out of a shirt sleeve caused serious pain. The diagnosis, based on a physical exam, was injury of the tendon that attaches the biceps muscle of his upper arm to the bones of the shoulder’s rotator cuff.
He was advised to see a rheumatologist, who declined to do a corticosteroid injection and instead recommended physical therapy and rest.

“I stopped playing tennis for a month, and it didn’t help at all,” Mr. Erde told me. “The physical therapist found I had very poor range of motion and had me do a variety of exercises, which improved my flexibility and reduced the pain somewhat.” After two months, he stopped the therapy.

Then several weeks ago, after watching the Australian Open, he thought he should do more to strengthen his arm and shoulder muscles and decided to try playing tennis more vigorously. “The pain started to drop off dramatically,” he said, “and in just 10 days the pain had eased more than 90 percent.”

A Frustrating Injury

Tendinopathies, as these injuries are called, are particularly vexing orthopedic problems that remain poorly understood despite their frequency. “Tendinitis” is a misnomer: rarely are there signs of inflammation, which no doubt accounts for the lack of lasting improvement with steroid shots and anti-inflammatory drugs. They may relieve pain temporarily, but don’t cure the problem.

The underlying pathology of tendinopathies is still a mystery. Even when patients recover, their tendons may continue to look awful, say therapists who do imaging studies. Without a better understanding of the actual causes of tendon pain, it’s hard to develop rational treatments, and even the best specialists may be reduced to trial and error. What works best for one tendon — or one patient — may do little or nothing for another.

Most tendinopathies are precipitated by overuse and commonly afflict overzealous athletes, amateur and professional alike. With or without treatment, they usually take a long time to heal — many months, even a year or more. They can be frustrating and often costly, especially for professional athletes and physically active people like me and Mr. Erde.

In a commentary accompanying the Lancet report, Alexander Scott and Karim M. Khan of the University of British Columbia noted that although “corticosteroid injection does not impair recovery of shoulder tendinopathy, patients should be advised that evidence for even short-term benefits at the shoulder is limited.” Like the Australian reviewers, the commentators concluded that “specific exercise therapy might produce more cures at 6 and 12 months than one or more corticosteroid injections.”

Treatments to Try

Now the question is: What kind of physical therapy gives the best results? Most therapists prescribe eccentric exercises, which involve muscle contractions as the muscle fibers lengthen (for example, when a hand-held weight is lowered from the waist to the thigh). Eccentric exercises must be performed in a controlled manner; uncontrolled eccentric contractions are a common cause of injuries like groin pulls or hamstring strains.

Marilyn Moffat, professor of physical therapy at New York University and president of the World Confederation for Physical Therapy, prefers “very protective” isometric exercises, at least at the outset of treatment until the tendon injury begins to heal. These exercises involve no movement at all, allowing muscles to contract without producing pain. For example, in treating shoulder tendinopathy, she said in an interview, the patient would push the fists against a wall with upper arms against the body and elbows bent at 90 degrees.

In another exercise, the patient sits holding one end of a dense elastic Thera-Band in each hand and, with thumbs up, upper arms at the sides and elbows bent at 90 degrees, tries to pull the hands apart.
“The stronger the shoulder muscles are when the tendinopathy calms down, the better shape the shoulder is in to take over movement without further injury,” Dr. Moffat said. “You don’t want the muscles to weaken, which is what happens when you rest and do nothing. That leaves you vulnerable to further injury.”

(article originally appeared in the NY Times.  http://www.nytimes.com/2011/03/01/health/01brody.html?_r=1&ref=physicaltherapy)