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Treatment

On The Case: Knee Pain

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In our new On The Case series, we’ll be taking a look at some of the real-life challenges our patients face and how we helped them regain their mobility!

About nine months ago, Henry* came to the clinic indicating pain on the inside of his knee. When he would climb small hills, take the stairs, squat, engage in other activities like gardening, he would experience pain for the rest of the day. This pain started affecting his regular activities like walking, golfing and curling. Henry also mentioned he experienced stiffness in his knee for the first 10 minutes of walking every morning. The inside knee pain wasn’t something Henry could shake off.

After consulting with his nurse practitioner, Henry went for X-rays which confirmed mild to moderate arthritis in his knee. He was given a referral for physiotherapy and he showed up, limping, at our office one morning last September.

On assessment, we observed that Henry had difficulty bending his knee past 90 degrees, climbing stairs and squatting lightly. He felt pain when we touched the inside of his knee and we also noted a weakness of the buttock muscle and poor control of the kneecap (patella) tracking.  This was a key finding for this arthritic knee.

 

Clinical tidbit:  Cases of mild to moderate knee arthritis are often accompanied with weak buttock muscles which result in poor thigh control. This condition puts a strain on the inside of the knee and contributes to  over-strained ligament and tendon structures.

 

After this preliminary evaluation, we worked to make Henry’s knee more comfortable and less stiff.  The intervention focused on improving range of motion, and also included a discussion on muscle flexibility, balance exercises and how to manage pain and activities at home. He was given a buttock strengthening program that would not increase his knee pain. And he was also fitted with a supportive knee brace. Henry reported a reduction in the pain which was a result of the compression and stabilizing design of the brace.

We saw Henry for a total of seven visits over a month-long period.  In the first week, he reported a 30 to 40% reduction of his knee symptoms. Over the course of his subsequent visit, we gradually progressed the strengthening and flexibility program and noted an improvement in Henry’s knee bending and straightening.

By the third week, Henry was not yet ready to walk his regular three to four kilometres but we encouraged him to find alternative or modified activities to accelerate the healing (and avoid further aggravation of the knee).

Our suggestions included:

  • Walking for the same amount of time in a pool would reduce the load on the knee
  • Throwing the rock with the curling stick would avoid the deep squat but keep Henry in the game
  • Golfing with a cart would avoid the excessive walking and hill climbing.

By the fourth and fifth week, Henry reported that 90% of his discomfort had dissipated.  This was a good spot to be in. In this phase of rehabilitation, strengthening of the legs (specifically gluteus, quadriceps and hamstring muscles) is key.  The common mistake here is to stop progressing the exercises. Failing to continue would most likely result in another flare-up. Luckily, Henry kept with the program and did his exercises once and at times twice daily.

At this point, he was able to resume one to two kilometre walks without symptoms, and could handle stairs and hills without knee pain—when not repetitious.  We provided Henry with a home exercise program and a follow-up visit for the next month.

One month later, Henry had returned fully to his activities. He integrated our prescribed exercise program into his weekly routine. Henry sometimes feels occasional knee stiffness when he increases load but overall, he reports he has been pain-free.

In Henry’s case, integrating flexibility and strengthening exercise changed the impact of his mild to moderate arthritic knee on his everyday activities.

If he should continue with his program, the effects will be long-lasting.

Let’s remember: Exercise is medicine. Not only does it allow us to function with fewer symptoms, but can prevent further progression of hip and knee arthritis. Ask me for the research on this—there is no shortage of it!

 

* Name changed to protect confidentiality.

Get Support: The Importance of Good Bracing

By | Bracing, Treatment | No Comments

Bracing is a topic we often discuss at Active Sport Physiotherapy Clinic—with our patients and amongst our staff. It’s a therapy option that we sometimes recommend to our patients when they’ve experienced an injury or injury, or suffer from a chronic condition that requires extra support for their joints or limbs.

Since we get asked a lot of questions about bracing, this month’s post answers some of your most frequently asked questions.

Q: What are the benefits of using a brace?

A: Whether you’re an athlete or not, wearing a brace can help keep your joints moving naturally and help prevent injury. For those who have sustained previous injuries, a brace can provide added support and stabilization so you can return to sports or work, accomplish everyday tasks without pain or weakness. Apart from the physical benefits, the right brace can also give you the confidence to move more freely, without the worry of hurting yourself again.

Q: Are there different types of braces or are they all the same?

A. Not all braces are designed for the same purpose.

For ankles, knees, and joints, the options are:

  • Supportive braces are designed to support your joints or limbs after you’ve injured yourself and until you’ve completely recovered.
  • Functional braces allow an earlier return to sport or activity and can reduce the chance to re-injury.
  • Rehabilitation braces are used temporarily to allow for progression range of motion of your joint. These are typically used after surgery.
  • Light Arthritic or Proprioceptive braces are designed for light support and compression. These come in the form of braces, sleeves or wraps.
  • Immobilization braces are meant for splinting, partially or completely immobilizing your joint.

Lower back braces sit in a category of their own. They can help you remain comfortable in an acute state. But be cautious: research has shown that back braces do not reduce the chance of injury.

Back braces have various grades of support:

  • The lighter compressive model is meant for comfort and spasm prevention
  • The medium compression model can immobilize your back to a certain extent and will prevent you from moving in a painful manner.
  • The last and sturdier model is meant to immobilize you if you’ve suffered from a back fracture or other acute and severe back conditions.

Q: What about slings?

A: Slings are meant to be used for upper arm injuries—things like supporting the arm and unloading the shoulder. Using a sling can help with your recovery while avoiding constant re-aggravation.

  • A generic sling supports the forearm with a padded strap over the shoulder and sometimes a strap around the waist to avoid movement of the arm when walking.
  • Some specialized slings have “pie shaped” cushion between the body and the forearm to position the shoulder at the desired angle—those slings are typically used after rotator cuff surgeries.
  • Some other slings have a variation of shoulder straps to spread the load of the arm and avoid neck pain.

Q: Why is fit so important?

When buying a brace, fit is important but so is making sure that you get the right brace to address your injury and that the design works for you.

The right brace will help with proper joint alignment, support your injured area and/or help restrict movement that could further injure you or cause you pain.

Q: How do I know what brace is right for me?

A: Our team is here to help identify the best bracing options for your condition, as well and measure and fit your brace appropriately. We’ll make sure you have the optimal support you need.

Q: What is the cost of a good brace?

A:  Depending on your needs, your slings or brace can range in cost. Until we know exactly what type of support or stabilization, it’s difficult to say. An off-the-shelf brace option is the most affordable option but we only recommend these in the right conditions.  When an off-the-shelf brace isn’t right for you, the custom brace is the best solution though it does comes with a higher price tag.  Remember: you can’t put a price on extra support for your joints and limbs!

Q: Do I need to go to Ottawa or Montreal to buy my brace?

A: We make a point of carrying top of the line braces here at our Brace Corner in Cornwall so you can avoid travelling out of town. We offer off-the-shelf and custom support and orthotics, including ankle supports, knee braces, tennis elbow straps, post-surgical braces and slings, and more.

If you have any other questions about bracing, reach out to us. We’re here to answer all your questions!

How to Recover from a Concussion

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No doubt you’ve heard lots about concussions in the news. Perhaps you’re already aware that hits to the head could result in concussions and the symptoms that accompany them:  headache, pressure in the head, neck pain, nausea or vomiting, dizziness, blurred vision, balance issues, visual disturbance, sensitivity to light, memory loss, concentration issues, confusion, depression, emotional changes and sleeping disorder. That’s the short list. There are many other symptoms, too many to name.

The way concussions are managed has changed greatly in the past five years,  especially in the past year.  Concussion management has become a multidisciplinary approach that addresses more than headaches and difficulties related to concentrating.  

Concussion care is a multidisciplinary venture involving child, parent, coach, teacher, physiotherapist, physician, nurse practitioner and optometrist.  When needed, neurologist, ENT specialist, psychologist, neuropsychologist and other medical specialist may be called in to help.

Recognize the signs

The first thing to do is to recognize the signs and remove the person from playing whatever sport they are engaged in. Continuing to play could aggravate the condition and has been shown to double the recovery time. For parents, coaches and trainers, there is a Concussion Recognition Tool (for use with adults and children) that can be downloaded hereIt’s a good idea to carry a printout in your first aid kit!

 

Seek out a professional assessment

If you’re the person who has suffered the concussion, it’s important to have the get a full assessment from a physician, physiotherapist or nurse practitioner trained in concussion assessment to acquire a post-injury baseline and to monitor changes over the following weeks.  Typically, they’ll use the SCAT 5 (Sport Concussion Assessment Tool – 5th Edition), developed by world leaders and researchers in the field. It’s important to note that SCAT 5 is endorsed by the Canadian medical community, the International Olympic Committee and several international sport federations.

 

Have a rest period

It is important to have 48 hours of rest following the injury. This is very important.  (Note: Sometimes the concussion signs can be delayed and a longer rest period is needed.)  Following this rest period, if appropriate, your medical practitioner may decide on a return to light activities—walking, occasional text or email, occasional reading can be introduced during a trial period.

Children affected with concussion need to be assessed differently – they are not simply smaller adults.  It is important to prioritize a symptom-free return to school before a symptom-free return to sports/activities.

 

Progress to light activities, cardio and tasks

If symptom-free, your medical practitioner will help you progress gradually in intensity. First attempt light activities and light cardio, then move on to sport-specific light tasks.  Make sure you work with a health professional trained in concussion management to monitor you for headaches and other symptoms of concussion, balance, endurance, visual disturbances, concentration, processing and memory.

 

Be patient

At times, symptoms are persistent despite your best effort to rest and resume normal daily activities. Things don’t always progress quickly or at least as quickly as you’d like. A trained medical personnel needs to establish if the persistence of symptoms is due to neck troubles, vestibular dysfunctions (inner ear) or if you require Cognitive Behaviour Therapy (for depression, mood or behaviour issues).

 

Understand what physiotherapy will do for you

When you first visit your physiotherapist, they’ll inventory your symptoms and how they affect you.  As the neck can be a contributor to headaches and dizziness, they’ll assess the impact of its dysfunctions on your symptoms.  

They’ll follow that up with a series of balance tests to identify the source of the lack of balance and/or dizziness.  Remember that your physiotherapist’s role is to treat neck dysfunctions and labyrinth (inner ear)/balance problems. If they detect dysfunctions outside their spectrum of care, they’ll be sure to refer you to another specialist.

If they do identify neck or balance problems, or general conditioning issues, they’ll engage in a series of interventions to address these.

 

Don’t do it alone

Recovering from a concussion can be overwhelming and the symptoms can affect physical and mental health. Your progress need to be monitored objectively and medically.  Assessment and follow-up with your physician/nurse practitioner is essential. Working with a sport physiotherapist trained in concussion management, (like those at Active Sport Physiotherapy Clinic), is an important part of getting you back on your feet quickly.

 

Get trained

If you are a coach, athletic therapist, trainer, first aider or parent, you might be interested in booking a  FREE Concussion Recognition and Management Clinic. Please reach out to learn more.  It’s part of our community service program!