Anterior Knee Pain and Manual Therapy

Knee pain is a common condition in both the athletic and general population. The majority of patients with chronic knee pain will present with patellofemoral pain syndrome, or pain generating from the knee cap. The causes of this knee pain are likely multifactorial including physical activity levels, lower extremity strength and flexibility and alignment of the leg's bones and joints. If this pain is unilateral or affects only one leg there is a higher probability of an underlying cause creating these symptoms.

Patients' with this condition often present with significant hip and knee weakness on the affected side creating abnormal shear forces across the patellofemoral joint. Spefically the gluts medius and maximus are affected creating an inability to control the alignment of the leg during functional tasks such as walking and stair climbing. Recent research has shown the effectiveness of manual therapy interventions performed by physical therapists on patients' pain levels with these tasks. Iverson et al. compared the pain levels of patients performing squats and stair climbing activities before and after a manual therapy treatment to the patient's lumbar spine and pelvis. The authors demonstrated a significant reduction of the patient's symptoms on the same tasks following the physical therapy treatment (Iverson et al, JOSPT, June 2008).

Contact your physical therapist for additional information of the interventions available to you in the clinic or to schedule your first appointment.

Pilates and Your Rehab

Pilates is a movement based exercise program, performed on a mat or on an apparatus, focusing on the mind/body connection needed for pain free, efficient movement. The benefits of pilates include increased flexibility, strength, coordination, balance, as well as, enhanced self-awareness and decreased stress (Lange C, et al Journal of Bodywork and Movement Therapy, 4:99-108). This program can be used to rehabilitate chronic overuse injuries (Khan, et al. 1995, Philips, C. 1999, and Cozen D. 2000) and the wellness population with success. To further learn how Pilates can be encorporated into your rehabilitation or exercise program please visit the wellness link on our website www.bodymechanicsatl.com

Atlanta Physical Therapy and Back Pain

from the APTA website, www.apta.org

PHYSICAL THERAPISTS OFFER LOW-COST SOLUTIONTO HIGH-COST EXPENDITURES FOR SPINAL CONDITIONS
Research Shows Physical Therapy Is an Effective Treatment of Choicefor Many Back Pain Patients
ALEXANDRIA, VA, February 15, 2008 — In contrast to a recent study published in the Journal of the American Medical Association (JAMA) suggesting that spine-related expenditures have increased without evidence of improvement, best evidence suggests that patients who receive physical therapy for musculoskeletal disorders, including back and neck pain, report good outcomes at a lower cost than using drugs or surgery,1 the American Physical Therapy Association (APTA) reported today.
For pain of a "mechanical" origin such as back or neck pain, hands-on therapy to mobilize the spine, and exercises designed to alleviate low back pain, have been shown to be particularly effective.2,3 Studies also have shown that patients with lumbar spinal stenosis can benefit from physical therapy, particularly when manual physical therapy, exercise, and a progressive body-weight-supported treadmill walking program is used.4
"Consumers need to know that physical therapist management is a low-cost, high-value alternative to drugs and surgery to deal with musculoskeletal pain," said APTA President R Scott Ward, PT, PhD. "The judicious use of appropriate physical therapist treatment based on best evidence can improve the function of people who struggle with back and neck conditions." Ward added, "Because patients with chronic, disabling low back pain account for a disproportionate share of health care expenditures and workers' compensation costs, the potential cost savings of an early, effective intervention to prevent individuals from progressing to chronic disability may be considerable."
Consumers can find a physical therapist in their area by accessing www.findapt.us - a national database of physical therapist members of APTA. The database allows users to search by zip code and expertise.
Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
The American Physical Therapy Association (www.apta.org) is a national organization representing physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access "Find a PT" to find a physical therapist in their area, and read physical therapy news and information at www.apta.org/consumer.
1 Editorial: Preserving the Quality of the Patient-Therapist Relationship: An Important Consideration for Value-Centered Physical Therapy Care, JOSPT; Vol 38 No. 2, Feb. 2008
2 A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study; John D Childs, PhD, PTMaj; Julie M Fritz, PhD, PT; Timothy W Fynn, PhD, PT; James J Irrgang, PhD, PT; Kevin K Johnson, Jaj; Guy R Maikowski, Maj; and Anthony Delitto, PhD, PT; Ann Intern Med. 21 December 2004, Vol 141, Issue 12, pp 920-928
3 Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Chou R, Huffman LH; American Pain Society; American College of Physicians; Ann Intern Med. 2007 Oct 2; 147(7):492-504.
4 A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, Garger MB, Bennett AC, Fritz JM. Spine, 2006 Oct 15:31 (22):2541-9
[Last updated: 02/15/08 Contact: public-relations@apta.org]

Physical Therapy and Balance

Balance is commonly overlooked within fitness programs in both the athletic and general population. The majority of our clients spend their dedicated workout time on cardiovascular and resistance training programs, but balance training plays an integral role in athletic performance and in fall prevention for older adults. A recent article in the NY Times describes the benefits of exercise and how physical therapists can further enhance this training within any population. Please contact our physical therapists at Body Mechanics Physical Therapy to learn how we can best address your specific rehabilitation and fitness needs.

Please see the link http://www.nytimes.com/2008/01/08/health/08brod.html?_r=2&adxnnl=1&oref=slogin&ref=health&adxnnlx=1203534191-EdTgkK5jB1Dx6bXZzL0bpw

Osteoarthritis and Balance Impairments

Osteoarthritis is a disabling condition affecting a large number of middle to older age patients. Symptoms can include pain, warmth, stiffness (especially in the morning), slower walking speeds and decreased mobility. Recent research has shown these patients demonstrate decreased strength (Maly, et al. 2005) and stabilization of the involved joint (Maly et al, Wegener et al. 1997). These impairments may lead to joint instability, or a sense of giving way, and a higher risk of falls.

The higher risk of falls may be related to decreased proprioception secondary to damaged cartilege and sensory receptors within the joint. Proprioception is the ability of the brain and central nervous system to detect joint movements, overall position sense (ie knee flexion or extension), and aids in the regulation of force output or strength. These sensations strongly contribute to an individual's ability to balance or maintain stability during movement.

A recent article in the Journal of Orthopaedic and Sports Physical Therapy has shown patients with osteoarthritis of the knee joint demonstrated faster walking speeds, improved stair climbing ability, and improved proprioception following a course of physical therapy (Jan, et al. January 2008).

Physical therapy interventions of manual therapy to improve joint movements, safe therapeutic exercise and activities, pain relieving modalities, and balance training can improve the disabling symptoms of osteoarthritis and may decrease the risk of falls in this population.

Please contact your physical therapist at Body Mechanics Physical Therapy in Atlanta for further information or to set up your first appointment.

Overuse Injuries

The following questions and statements may indicate the potential for or presence of an overuse injury (ie tendinitis, bursitis, IT band syndrome) or activity related injury.

1. Previous Injury to the lower extremity joints including hip, knee, ankle, or low back and pelvis?

2. Recent increase/change in exercise duration, frequency of days/week, terrain (track, pavement, grass), or sporting event?

3. Have you performed the same exercise program or training program for over 6-8 weeks?

4. Inability or decrease in a sport type movement to one side vs. another? For example, a player can defend Left, not Right; longer stride on one side; stronger pedal stroke on one side; or decrease in vertical jump from side to side?

5. Point tenderness over the muscle belly, tendon, ligaments, or bone? Note: Point tenderness over a bone with inability to bear weight must be followed up with a physician to rule out fracture.

6. Swelling or heat within a joint not resolved 1-2 hours after exercise or when compared to the other working joints of the body.

7. Pain in the leg or arm that increases or decreases in severity with exercise?

8. Inability to balance on one leg for the same duration from Right to Left?

9. Tightness or strength differences for the same muscle group from Right to Left?

10. Repeated hamstring or groin pulls or repeated incidents of the same problem without complete recovery? (ie treating the symptoms not the cause)

11. Inability to perform a single leg squat without the knee traveling in toward the center.

Shoulder impingement

Shoulder impingement is a common musculoskeletal complaint which involves the inability of the scapula (shoulder blade) and humerus (upper arm bone) to move appropriately secondary to either joint alignment or muscular balance. Common complaints involve shoulder pain or "pinching" while reaching overhead either for work or recreational reasons. For example, while swimming freestyle, a tennis serve, or painting a ceiling. Pain is often felt across the shoulder or upper arm.

As physical therapists we often find restrictions of movement across the thoracic spine and the scapula, as well as, the inability of specific muscle groups to contract appropriately across the shoulder joint. Specifically, the lower trapezius and serratus anterior weaken with this problem.

New research has shown appropriate repositioning of the scapula both passively by your physical therapists (Tate et al, Journal of Orthopedic and Sports Physical Therapy, 2008; 38:1) and actively through appropriate exercise can reduce symptoms and improve sports and work performance.

The key is identifying the cause of your symptoms and weakness instead of only treating your symptoms. Contact us or schedule a complimentary physical therapy consultation to discuss your individual physical therapy needs.