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Knee Osteoarthritis: Is ‘Bone on Bone’ a painful life sentence?

Knee Osteoarthritis: Is ‘Bone on Bone’ a painful life sentence?

by | May 16, 2023 | Knee, Osteoarthritis, Pain, Surgery

  • Knee Osteoarthritis is a common ailment responsible for pain, loss of function and reduced quality of life
  • Rates of knee OA are set to increase
  • Whilst there is no cure, exercise therapy under the guidance of a physiotherapist is considered a front line treatment to help reduce the severity of symptoms
  • There are options before a knee replacement

Do your knees go crackle and pop? Pain with walking, stairs or getting out of a chair? Stiffness and pain first thing in the morning or after a long car ride? These are signs that you may be living with the early or even advanced symptoms of knee osteoarthritis (OA). Don’t fear though – there is plenty that can be done immediately.

What is “OA”?

Osteoarthritis (OA) is an increasingly prevalent source of musculoskeletal pain and dysfunction. OA is a disease of the joint – including cartilage, bone, capsule and other associated tissues. This disease process can cause chronic pain, reduced physical function and diminished quality of life. The ageing population and increased global prevalence of obesity are anticipated to dramatically increase the impacts of knee OA and its associated impairments [1]. Although osteoarthritis can affect any joint, OA is knee is one of the most common complaints.

Presentation

It most commonly presents in people over the age of 50, and is often described as being painful, stiff and occasionally swollen. In terms of a tissue level, knee OA describes the gradual deterioration of the supportive cartilage within the knee joint. As the cartilage wears away with time, the protective joint space between the bones decreases. With a reduced cartilage lining to protect and support the spacing of the knee joint, the Femur and Tibia (knee bones) are increasingly less likely to dissipate forces through the joint . With time, it should be expected that bone spurs (osteophytes) may form in and around the joint as the bones react to repetitive contact with each other.

Management

The management of knee OA largely consists of exercises addressing strength, range of motion, quality of movement, emphasizing joint control, pain reduction and weight management.

Strength Training

Strength training should be the cornerstone of addressing knee OA, particularly the early signs. Strengthening the muscles around the knee joint, such as the quadriceps, hamstrings, and glutes provide better support to the knee, reducing stress on the joint and helping to alleviate pain and discomfort. Movement associated with exercise has an added benefit – It increases joint lubrication. Loading of the joint stimulates the production and distribution of synovial fluid within the joint. This fluid acts as a lubricant, reducing friction and providing cushioning to the joint surfaces. Improved lubrication can help alleviate pain during movement.

Range of motion

Knee osteoarthritis often leads to stiffness and limited range of motion in the joint. Physiotherapy can include specific exercises, manual therapy and stretches to improve joint flexibility, helping to restore a more normal range of motion and enhancing mobility. The greater the restoration of range, the better the knee feels.

Pain reduction

Both strength training and physiotherapy can help reduce pain associated with knee OA. As mentioned, stronger muscles provide better support to the joint, relieving pressure and reducing pain during movement. Physiotherapy may provide education of aggravating and easing factors (eg. hot / cold packs, hydrotherapy) as well as liaise with your GP for adequate analgesic medications.

Lifestyle modifications

Adopting a healthy lifestyle can play a pivotal role in managing knee osteoarthritis. Maintaining a healthy weight reduces the stress on the knee joints. Regular low-impact exercises such as swimming, cycling and reformer pilates help improve strength, flexibility, and overall joint health. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can promote weight loss and provide essential nutrients for joint health. Quitting smoking and minimizing alcohol consumption are also beneficial.

Improved weight management

Regular exercise can assist in weight management, which is crucial for individuals with knee osteoarthritis. Excess weight puts additional strain on the knee joint, contributing to pain and progression of the condition. By maintaining a healthy weight, exercise helps to reduce the load on the joint and alleviate pain.

Surgical Interventions

When conservative measures fail to provide relief, surgical interventions may be necessary. Procedures such as arthroscopy, osteotomy, and joint replacement surgery can help repair damaged tissues, realign the joint, or replace the damaged joint with a prosthetic. These surgeries can significantly improve mobility and reduce pain, allowing individuals to resume their daily activities. Physiotherapy can aid in preparing you for the surgery, as well as rebuild your “new” knee after a knee replacement has been completed.

In conclusion, while knee osteoarthritis can be challenging, it is not a condition that should hinder individuals from leading fulfilling lives. By implementing lifestyle modifications, exploring various treatment options, and working closely with your physiotherapist, individuals can effectively manage their symptoms, alleviate pain, and enjoy an active lifestyle with a sense of well-being. If conservative options fail, there are surgical interventions that can be investigated. If you are wanting to look after your knees, or already suffering from knee pain, chat to our knowledgeable Praxis Physios to discuss your treatment options at any stage of OA’s progression.

Until next time,

Praxis what you Preach

Tibialis Anterior – The missing link to pain free legs and performance?

Tibialis Anterior – The missing link to pain free legs and performance?

by | May 16, 2023 | Ankle and Foot, Return to Sport, Running Injuries

Shin splints? Painful knee with jumping? Recurrent ankle sprains? These are the types of injuries we fix day in and day out at Praxis Physio. There are number of recommended paths for rehabilitation in theses injuries backed by the research and our clinical experience, but has the evidence been missing something? There is some social media traction in the fitness and exercise world recently around tibialis anterior (TA) loading as a ‘cure all’ for every lower limb injury. Being the physio nerds that we are, we looked in to it for you!

The tibialis anterior is located on the front (anterior) portion of the shin (tibia) – hence the name. Its role is to lift the foot (dorsiflex) the ankle as well as provide some stability for the outside of the ankle . This action is key for movements in walking and running especially in negotiating steps and hills as the foot needs to clear a certain height before landing. It is also very important in landing from a height and changing directions rapidly, as it acts as shock absorber for the knee and ankle joints (reference).

Like any muscle or joint in the body, the TA is not without its problems. Physios are regularly confronted with patients who complain of pain and stiffness around the muscles of the shin. Such conditions may include shin splints, compartment syndrome, patellofemoral pain syndrome (aka runner’s knee) and general ankle joint pain and stiffness post ankle sprain.

As mentioned, there has been a lot of discussion lately in the strength and conditioning community about whether training this muscle can prevent or treat musculoskeletal conditions, such as the ones mentioned above. Anecdotally, training of the TA has been described several benefits. Specific athletes have explained that they have seen improvements in vertical jump height, running speed, running stamina and squat depth. From a prevention and treatment point of view, it has been said that training the TA has helped improve symptoms associated with knee pain, ankle pain and shin splints. Also let us not forget, that from an aesthetics point of view, a strong and bulky looking TA does make our legs look more attractive, as bodybuilders would argue.

Unfortunately, the scientific community has not provided strong evidence that training the TA can aid in affecting the above musculoskeletal pathologies, or attain the performance benefits. So what do we know from previous scientific literature? Well, Munoz et al (2015) describes the tibialis anterior as key during an efficient gait cycle as well as being critical for balance control. Furthermore, an increase in strength of the TA helps greatly reduce the risk of falling. Maharaj et al (2019) confirms that during walking and running , TA’s tendinous tissue absorbs energy during contact and controls foot position during swing.

The proposed mechanisms to aid in athletic performance include:

  1. Increased ankle stability: Strong tibialis anterior muscles provide better stability to the ankle joint during jumping movements. This stability allows for improved force transmission from the lower leg to the foot, enabling athletes to generate greater power and maintain proper alignment during takeoff and landing.
  2. Enhanced dorsiflexion range of motion: Adequate dorsiflexion range of motion is essential for optimal jumping performance. Strengthening the tibialis anterior helps to improve flexibility and mobility in the ankle joint, allowing athletes to achieve a greater degree of dorsiflexion during the pre-jump phase. This increased range of motion enables a longer and more powerful push-off, resulting in higher jumps.
  3. Improved jump height and explosive power: The tibialis anterior plays a significant role in generating propulsive force during the takeoff phase of a jump. By strengthening this muscle, athletes can produce a more forceful and efficient push-off, leading to increased jump height and explosive power. The ability to generate greater force through dorsiflexion contributes to a more powerful and effective jump.
  4. Injury prevention: Weak tibialis anterior muscles can contribute to imbalances in the lower leg, potentially leading to various conditions such as shin splints or ankle sprains. Strengthening this muscle group helps to maintain proper muscle balance around the ankle joint, reducing the risk of injuries that could hinder jumping performance.

So if we are to believe TA holds the key to athletic performance and injury mitigation, how do we unlock it?

To strengthen the tibialis anterior, physiotherapists often prescribe specific exercises that target this muscle, such as toe raises, resisted dorsiflexion exercises, or using resistance bands to provide resistance during dorsiflexion movements. These exercises should be performed in a controlled manner and progressively increased in intensity to promote muscle strength and endurance. Below you see variations on how you can load the TA and progress and regress it respectively. Remember that we need to treat the TA like any other muscle we are wanting to train – progressively overloading it!

As Physiotherapists, we greatly value and adhere to evidence-based practice, however one could argue that this particular muscle has not received the scientific study treatment it rightly deserves. So if you are having some lower leg issues, or haven’t quite got that bounce you are wanting, come and chat to one of our friendly and knowledgeable staff. We can do a full assessment and put the spring back in your step!

Until next time, Praxis what you preach!

Prevent. Prepare. Perform

References:

Maharaj JN, Cresswell AG, Lichtwark GA. Tibialis anterior tendinous tissue plays a key role in energy absorption during human walking. J Exp Biol. 2019 Jun 4;222(Pt 11):jeb191247. doi: 10.1242/jeb.191247. PMID: 31064856.

Ruiz Muñoz, M., González-Sánchez, M. & Cuesta-Vargas, A.I. Tibialis anterior analysis from functional and architectural perspective during isometric foot dorsiflexion: a cross-sectional study of repeated measures. J Foot Ankle Res 8, 74 (2015). https://doi.org/10.1186/s13047-015-0132-3

Fact or Fiction Friday – Lower back Pain and MRI’s

Fact or Fiction Friday – Lower back Pain and MRI’s

by | Nov 8, 2022 | Lower Back, Pain

I need to get an MRI to help with the management of my lower back pain

Answer – FICTION

In a recent narrative review, Wang and colleagues (2018) concluded that MRI imaging in the early stages of lower back pain can have detrimental effects including more pain, less improvement, higher risk of surgery and worse overall health status. In fact, one study reported that patients that received an MRI within the first month had an 8x greater risk for surgery and 5x more medical costs!

If you do NOT present with severe neurological deficits, signs of a serious or specific underlying condition or have persistent pain >6 weeks which is unresponsive to conservative treatment then there likely isn’t a need for further investigation!

To get help with your long standing back pain or even that acute flare up, give us a call on (07) 3102 3337 or book online  so we can sort you out.

#praxiswhatyoupreach #praxisphysio #factorfictionfriday #physioeducation #preventprepareperform #pain #backpain #lowerbackpain #MRI #patienteducation

Wang Y, et al. Informed appropriate imaging for low back pain management: A narrative review. Journal of Orthopaedic Translation. 2018.

Blood Flow Restriction – more than just a gimmick?

Blood Flow Restriction – more than just a gimmick?

by | Oct 11, 2022 | ACL, Gym and Strength, Knee, Reformer Pilates, Return to Sport

Summary:

  • Restriction of blood flow purportedly creates an internal environment of greater stress, thus greater adaptation
  • Importantly, the greater adaptation can occur with less absolute load to damaged or painful tissues
  • Started in healthy population to build muscles but the principles are transferable to rehabilitation
  • Best suited persons who are unable to tolerate normal load
  • Post surgery, tendinopathies and people needing to arrest atrophy or build muscle fast are best candidates

Blood flow restriction (BFR) training is becoming increasingly popular in rehabilitation and conditioning settings. As the name suggests, BFR training incorporates a restriction of blood to an area paired with low resistance training (20-50% of 1 rep maximum). The principle is to achieve greater muscle strength and hypertrophy gains for healthy and load-compromised populations with the same or less load than without a cuff. Essentially – more bang for your buck in the early phases of rehabilitation!

Benefits of BFR include; prevention of muscle mass in early post-operative periods, similar benefits of muscle mass and strength as heavier resistance training in achilles tendinopathies (>70% 1RM) (Centner et al, 2019), and improvement in maximum voluntary torque.

 

Whilst research is still being developed, multiple studies have been conducted recently showing the benefits of BFR training in post-operative populations ie. ACLR, patella / achilles tendinopathies, as well as knee osteoarthritis and patellofemoral pain syndrome.

Here at Praxis Physiotherapy, we have used a BFR cuff paired with low-resistance training on the reformer pilates and in the gym to optimise the distal quadriceps strength post ACL surgery. As you can see we are putting to the distal quadriceps to fatigue under a small amount of load, thus preventing muscle loss (Prue, et al. 2022) which can be common postoperatively.

General prescription guidelines according to the Australian Institute of Sport recommend that “the application of BFR should be limited to less than 20 minutes for lower limb, and 15 minutes for upper limb, before allowing adequate time for reperfusion of tissues (3 min).” (AIS, 2022).

In summary, this is an exciting new area of research that we are investigating clinically. Anecdotally, we hear from patients that they fatigue earlier in the desired muscle groups. We as a Praxis Team are embarking on some in clinic research in the area and hoping to provide feedback on our experiences so keep your eyes peeled. In the meantime, if you are pre or post your operation and are looking to maximise your recovery, come and have a chat with us about whether BFR is suitable for you!

Until next time,

Prevent | Prepare | Perform

Team Praxis

Jumper’s Knee (Patellar Tendinopathy)

Jumper’s Knee (Patellar Tendinopathy)

by | May 17, 2022 | Knee, Return to Sport, Sports Injury, Tendon

Do you play a jumping sport such as volleyball, basketball or AFL? Have pain in the front of your knee when jumping, landing or changing direction? Have you lost some jumping power recently? Well read on friends as you may have a grumbly knee tendon.

Summary:

  • Patellar tendinopathy is summarised clinically as pain and dysfunction in the patellar tendon
  • Most commonly affects jumping athletes from adolescence to early middle age.
  • Return to sport can be slow with physio useful as a front line management tool
  • Often requires prolonged rehabilitation centred around education, strength training and load management

Jumper’s knee (or patellar tendinopathy) as its name suggest predominantly affects athletes who engage in sports which require large volumes of jumping. Jumping dynamically loads the knee and places large loads on the patellar tendons due the large and repeated requirements of the thigh muscles (quadriceps). These include sports that require repeat jump / landing efforts and/or high volumes of load during training and competition. Elite adolescent male athletes tend to be at a higher risk, especially if you play volleyball.

Mid Potion Achilles Tendinopathy Location

Like most injuries, patellar tendinopathy reflects an overload of the tissue and a failed healing response. Tendons tend to most susceptible to long periods of dynamic loading given their role in storing and releasing energy like a spring. The stiffer the spring, the more effective the spring and the more punishment it can take before the function deteriorates.

This injury is one that can be mild or moderate in nature and as such allow playing to some degree. As such, player’s tend to not to miss a lot of games like more “traditional” injuries such as ankle sprains or hamstring tears. It can typically slowly present and have a “warm up phenomena” (as in it can get better during a game), however aches after activity and the next morning. The pain is often at the very bottom of the knee cap, and on the space between the kneecap and the top of the shin bone where the tendon lies.

Key management strategies include ensuring the correct diagnosis and an understanding of tendon pathology (for more on tendon pathology, check out this blog). From there, pain management strategies and workload management is a key tenant to rehabilitation. Above and beyond workload management and good patient education, we at Praxis Physio also test the strength and range of the hip, knee and ankle musculature as well as jumping / landing biomechanics to understand where the likely reasons are for your knee pain.

After a comprehensive assessment, targeted and graduated strengthening is provided. The premise of these early phases are to reduce pain, improve strength, improve function, increase power (specifically the energy storage potential of the tendon) then finally sports specific training and management on symptoms.

As someone who has had an 18 month history of patellar tendinopathy, I personally can attest to the frustration this injury provides. I made many mistakes along my rehabilitation journey – though this was before I was a physiotherapist and took a clinical interest in tendinopathies. Thankfully, the research has come a long way in the last decade, so if you are having ongoing knee pain that you suspect is jumper’s knee, book in with us so we can get you jumping back to your best.

Until next time, Praxis What You Preach…

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