Much pain in the knee comes from chronic injury to one or more of its many ligaments. Fortuantely many knee ligaments are close to the surface, and therefore are very treatable by manual medicine methods without surgery or medications.
The knee is an astonishing joint: It is able to support the entire weight of the body, even while it is flexed, can hinge innumerable times without friction or pain, and also can control the positioning of the leg and foot. Of course it is the entire system of bone, cartilage, ligament and muscle that performs these miracles. But I'm going to argue that it is the ligaments of the knee that makes the whole thing hang together.
There are the major ligaments, like the Cruciates and the Collaterals which literally keep the thigh attached to the lower leg. If you tear these in half, you have a big problem.
Then there are other ligaments whose function is more mysterious. Many of these surround the knee and resist various stresses, especially torsion. They also create a capsule that keeps the workings of the knee bathed in joint fluid. Because they surround the knee, they are not very deep and as I mentioned before, they are easy to treat by manual medicine methods.
Finally, there are some ligaments which are a bit odd. I'm thinking of the Menisco-Tibial ligaments, which as their name implies, arise from a meniscus (the main cartilage of the knee, and which disappears in advanced arthritis) and then attach to the tibia, the main bone of the lower leg. These are also known as the Coronary ligaments because they wrap circumferentially a bit of the way around the knee, like a crown goes around a head.
Technically these are not ligaments, because ligaments run from one bone to another, not from cartilage adhering to a bone, to another place on the same bone. Orthopedists call them capsular ligaments because they are part of the joint fluid retaining capsule. After that, the agreement ends. It is assumed that these ligaments stabilize the meniscus and help it resist wear and tear. (See other articles in this Blog for the importance of preventing cartilage damage.)
I have found that the Coronary Ligaments are a common source of knee pain. Since these ligaments are oriented circumferentially, I believe they are very important in resisting rotation. The knee really does not like rotation. When you're moving in one direction, and plant your foot and change direction suddenly (as when playing basketball or racquetball,) you are putting rotational force through your knee, and sometimes this damages the Coronary Ligament, causing lasting pain, even years later.
I treat the coronary ligaments with Graston Technique, an instrument-assisted soft-tissue manipulation method which stimulates the body's own healing mechanism in well-understood ways. Usually three or four treatments make a huge difference in knee pain caused by these ligaments.
If you have a question about the coronary ligaments and knee pain, or whether Graston Technique might help you, please call me.
Thursday, April 14, 2011
Wednesday, April 13, 2011
Friday, April 8, 2011
Got a craving for fast food? Skip the coffee, study says
Got a craving for fast food? Skip the coffee, study says (Study linked from Futurepundit)
Wednesday, April 6, 2011
Rotator Cuff: Tears and Treatment
I have seen many patients who suffered for years with shoulder pain from rotator cuff injuries. Some went through shoulder rehab or PT with little improvement. Now they think their only option is surgery. But for many of these patients that's just not true. The good news is that the rotator cuff muscles can heal just like any other muscles: they're close to the surface and easily accessible to treatment by manual medicine methods. Even if the rotator cuff has been sore for over a year, the non-invasive treatments offered at The Motion Doctor can help them heal quickly.
First, a little explanation to help you understand this cause of shoulder pain.
The rotator cuff is a group of muscles that live on the shoulder blade. Of these muscles, several have tendons that run under the armpit and attach to a bump on the side of the arm closest to the body. Other tendons run around the outside of the shoulder and attach to a bump on the side of the arm that's away from the body. When the body-side muscles are contracted, the front of the arm is rotated towards the body, and when the away-side muscles are contracted the front of the arm is rotated away from the body. Because of their function, these muscles are referred to as "rotators." Because the attachment bumps are almost at the top of the arm, and the tendons wrap to each side, the resulting mass of tendons looks like a cuff (at least to anatomists who apparently don't get out much.)
The bone that the rotator cuff acts on is the humerus. People usually feel the most rotator cuff pain when making larger movements that take the upper arm away from its normal position by the side of the body and at the same time reach for something beside or behind them. However, since the lower arm is attached to the upper, the forearm and hand are also positioned by this group of muscles, so people sometimes feel rotator cuff pain when making smaller movements.
Reaching overhead also commonly causes pain. This is because the supraspinatus muscle, despite being called a rotator, actually initiates raising the arm. Pain is also due to (i) reaching overhead generally involves rotation of the arm, and (ii) quirky design of the supraspinatus, which is also the most commonly injured rotator cuff muscle. This muscle originates on the top half of the back of the shoulder blade (above the "spine" of the scapula, hence "supraspinatus,") and runs over the top of the shoulder to its attachment on the "away" side of the arm. It's protected by a bony arch that you will feel if you lay your hand on the top of your shoulder.
The down side of this protective arch is that it becomes a pinch point if there's any inflammation in the tendon. To make matters worse, limited space under the arch means reduced blood supply to this portion of the tendon, increasing the chance of an "-osis" degenerative tendon condition (see explanation elsewhere in my blog,) while at the same time impeding healing. Blood trying to make its way through this pinch point is the cause of the throbbing shoulder pain many people feel, especially at night.
As with all muscles, rotator cuff muscles generally actively heal themselves. This is true to a greater or lesser degree depending on the severity of the injury, the general health and conditioning of the muscles, and the amount of reinjury during healing. As with all muscles, excessive scar tissue can accompany healing, and this is often the cause of chronic pain and decrease in function, which themselves perpetuate pain and dysfunction, in the injured muscle as well as elsewhere.
The vast majority of rotator cuff injuries are easily treatable by deep-tissue therapies that promote healing, such as Graston Technique and NMR. My best successes generally come through NMR protocols which treat every muscle in the involved area, from origin to insertion, while the patient is directed to perform the action of each muscle, from contraction to relaxation. Using these methods, I have often resolved patients' longstanding pain of several years in just a handful of visits. If you have a question about the rotator cuff and shoulder pain, or whether Graston Technique or NMR might help you, please call me.
First, a little explanation to help you understand this cause of shoulder pain.
The rotator cuff is a group of muscles that live on the shoulder blade. Of these muscles, several have tendons that run under the armpit and attach to a bump on the side of the arm closest to the body. Other tendons run around the outside of the shoulder and attach to a bump on the side of the arm that's away from the body. When the body-side muscles are contracted, the front of the arm is rotated towards the body, and when the away-side muscles are contracted the front of the arm is rotated away from the body. Because of their function, these muscles are referred to as "rotators." Because the attachment bumps are almost at the top of the arm, and the tendons wrap to each side, the resulting mass of tendons looks like a cuff (at least to anatomists who apparently don't get out much.)
The bone that the rotator cuff acts on is the humerus. People usually feel the most rotator cuff pain when making larger movements that take the upper arm away from its normal position by the side of the body and at the same time reach for something beside or behind them. However, since the lower arm is attached to the upper, the forearm and hand are also positioned by this group of muscles, so people sometimes feel rotator cuff pain when making smaller movements.
Reaching overhead also commonly causes pain. This is because the supraspinatus muscle, despite being called a rotator, actually initiates raising the arm. Pain is also due to (i) reaching overhead generally involves rotation of the arm, and (ii) quirky design of the supraspinatus, which is also the most commonly injured rotator cuff muscle. This muscle originates on the top half of the back of the shoulder blade (above the "spine" of the scapula, hence "supraspinatus,") and runs over the top of the shoulder to its attachment on the "away" side of the arm. It's protected by a bony arch that you will feel if you lay your hand on the top of your shoulder.
The down side of this protective arch is that it becomes a pinch point if there's any inflammation in the tendon. To make matters worse, limited space under the arch means reduced blood supply to this portion of the tendon, increasing the chance of an "-osis" degenerative tendon condition (see explanation elsewhere in my blog,) while at the same time impeding healing. Blood trying to make its way through this pinch point is the cause of the throbbing shoulder pain many people feel, especially at night.
As with all muscles, rotator cuff muscles generally actively heal themselves. This is true to a greater or lesser degree depending on the severity of the injury, the general health and conditioning of the muscles, and the amount of reinjury during healing. As with all muscles, excessive scar tissue can accompany healing, and this is often the cause of chronic pain and decrease in function, which themselves perpetuate pain and dysfunction, in the injured muscle as well as elsewhere.
The vast majority of rotator cuff injuries are easily treatable by deep-tissue therapies that promote healing, such as Graston Technique and NMR. My best successes generally come through NMR protocols which treat every muscle in the involved area, from origin to insertion, while the patient is directed to perform the action of each muscle, from contraction to relaxation. Using these methods, I have often resolved patients' longstanding pain of several years in just a handful of visits. If you have a question about the rotator cuff and shoulder pain, or whether Graston Technique or NMR might help you, please call me.
Wednesday, December 8, 2010
Fountain of Youth in Your Muscles? Researchers Uncover Muscle-Stem Cell Mechanism in Aging
This one is so good that I'm just going to post the link to Science Daily:
http://www.sciencedaily.com/releases/2010/12/101201105336.htm
Oh yes, and this too:
“Performance losses in middle age are mainly due to a sedentary lifestyle, rather than biological aging. "
http://www.itwire.com/science-news/health/43721-will-you-age-slower-if-you-exercise-eat-well?start=1
http://www.sciencedaily.com/releases/2010/12/101201105336.htm
Oh yes, and this too:
“Performance losses in middle age are mainly due to a sedentary lifestyle, rather than biological aging. "
http://www.itwire.com/science-news/health/43721-will-you-age-slower-if-you-exercise-eat-well?start=1
Subscribe to:
Posts (Atom)