If a patient has knee complaints - and I rule out the spine as the source - I assess (and usually treat) the knee with repeated movements. Usually the movement is to address the joint position itself, though sometimes the movement addresses a tendon or muscle. Here McKenzie diplomat Joel Laing demonstrates the movement: knee extension with overpressure in partial weightbearing. I used this with a patient last week in fact! There are many ways to move a knee, but this is one of the most commonly used movements. Please remember, even in the presence of arthritis, meniscus, ligament, tendon, or cartilage damage, in most cases joint pain can be rapidly fixed with repeated movements. The typical exercise prescription for home for the knee is 10 repetitions every 3-4 hours. McKenzie clinicians are trained to examine whether your problem falls into the 80% of cases which will respond to repeated movements, and to find which movement is best for you. --Laura
Last night was a great night! Runner's Depot in Davie hosted my presentation on the spine and how it relates to running injuries. Runners have a reputation for having a lot of injuries and, worse, a lot of recurrent or persistent injuries. The crux of my talk is that a lot of injuries in the lower extremities are misdiagnosed as local injuries and not correctly as injuries originating from the nerves in the lumbar spine. For example, plantar fasciits is commonly misdiagnosed. Yes, it exists, but not as frequently as it is diagnosed. The hallmark sign of plantar fasciitis is extreme foot pain with first steps in the morning. That usually eases throughout the day, but returns each morning since the plantar fascia is on slack all night as you sleep and is then stretched with your first steps out of bed. If that sign is present, I still investigate the spine to rule it out. But when that hallmark sign is absent (for example, the pain is variable throughout the day or week), the diagnosis of a lumbar spine injury is more likely (or another diagnosis). More specifically, a nerve may be being hit or pinched in the lumbar spine and producing pain along the part of that nerve in the foot. IT band issues, patellar tendonitis, hip labral tears, and meniscal damage are a few other pathologies that come to mind when I think about regularly misdiagnosed injuries. Irritated nerves from the spine can produce pain in any area of the lower extremities and must be ruled out in the decision-making process. And remember, just because something is on an x-ray or MRI does not mean it is causing your symptoms. Images are full of problems in people without symptoms so a clinical diagnosis, in which structures and tissues are individually stressed, is needed.
I don't think that spine injuries are more prevalent in runners; nearly everyone will have a spine injury at some point. We just need to be able to diagnose them correctly when they do exist. That way, runners, like everyone else, can get back to doing what they love to do as soon as possible! --Laura
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
This study comes from the BMJ, formerly known as the British Medical Journal. I've included the conclusions here and a link to the entire study. This shows once again that surgery for orthopedic issues should be a last resort. -- Laura
BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3740 (Published 20 July 2016)Cite this as: BMJ 2016;354:i3740
Conclusions and policy implications
The observed difference in treatment effect was minute after two years’ follow-up, and the trial’s inferential uncertainty, as shown by the 95% confidence limits, was sufficiently small to exclude clinically relevant differences. Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Nineteen per cent of participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. No serious adverse events occurred in either group during the two year follow-up. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.
Find the entire article here: http://www.bmj.com/content/354/bmj.i3740?utm_content=buffer795ae&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer
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