Is Your Knee Pain Caused by a Mechanical Problem in Your Foot?

knee pain caused by foot pain

Your knee aches everytime you go down the stairs, it flares up after a long run, maybe you’ve even iced and foam rolled and gotten treatment of the knee itself, but the pain continues. What’s going on?

Many of my patients are surprised when they find out that a mechanical dysfunction in their foot was the cause of their knee or hip pain. Especially because they never had any foot pain!

When you push off the ground, your big toe (hallux) dorsiflexes, the rearfoot and midfoot supinate, the forefoot pronates on the midfoot, and the tibia externally rotates. This mechanism is called the Windlass effect.

If the Windlass effect is not working well or if the big toe is limited in its ability to dorsiflex, then we have a mechanical problem known as functional hallux limitus (FHL). When the foot is unable to move properly, something else will move more than it is supposed to in order for us to get from point A to point B. The forces get transferred abnormally into the soft tissues in the lower leg and around the knee, causing knee pain. If the issue continues upwards, hip or gluteal pain will often result as well.

 

There is a movement test that we do in the office to find out whether a patient has FHL. If the Windlass effect is not working correctly, we adjust the joints of the foot/ankle that are preventing this mechanism from occurring, and we strip the adhesions out of the overly tight muscles that go along with these joint fixations.

Book your appointment now to find out whether you have a mechanical problem in your foot. Call 510-465-2342.

Photo credit:wiki commons

Posted in Conditions, running, Uncategorized

Graston Technique Explained aka “How Do Those Metal Torture Bars Fix My Injury?”

oakland chiropractor graston tools

If you’ve ever seen the set of stainless steel Graston tools in our office, you may have wondered what those scary-looking devices are good for!  You may have even experienced a Graston treatment on your knee or shoulder, but not really understood what the tools do.  Today’s article will explain the theory behind Graston, aka “Why This Torture is Really Effective”

*Since this is the internet, it should be noted that we use the word “torture” in a tongue and cheek way.  Of course we’re always working within patient tolerance and encouraging our patients to use breathing techniques to keep the muscles relaxed and their mind distracted from the pain.  And some people report that it doesn’t feel like torture at all, and that they even prefer the Graston technique to manual therapy.  But for most people, it’s worth the temporary discomfort during treatment to arrive at a pain-free place after treatment.
Oakland sports chiropractor uses Graston Technique to treat shoulder pain

Graston falls under the umbrella of Instrument Assisted Soft Tissue Mobilization (IASTM).  This is a form of therapy that uses specialized stainless steel instruments to assist the clinician in the mobilization or poorly organized scar tissue in and around muscles, tendons, and fascia.  The instruments are solid and have angled edges, and are guided with the help of a lubricant such as coconut oil.  Longitudinal strokes are applied parallel to the fiber alignment in a stroking motion along the skin to mobilize the underlying soft tissues.

As the instruments move over an area with underlying fibrotic adhesion, a change in texture is palpable.  The initial strokes, which are used for screening purposes, are smooth and flowing, but become shorter and more concentrated to increase the pressure per unit area once the fibrosis is located.  The pressure needs to be firm enough to locate the fibrosis and cause microtrauma, but not so hard that macrotrauma occurs.  The microvascular trauma and capillary hemorrhage induces a localized inflammatory response and stimulates the body’s healing cascade and immune-reparative system.  (We need to stir up a little bit of inflammation to get rid of a larger inflammatory problem).

Usually upon completion of treatment, there is immediate erythema and the potential for some transient ecchymosis.  (This means there are some tiny red dots that show up as the tiny microcapillaries burst open, and there can be some possible short-term bruising.)

Treatments can be one-time only, or performed over a course of 6-8 sessions, depending on the severity and duration of the injury.

Have you experienced Graston treatments?  What do you like or dislike about it?  Let us know in the comments below.

Source: Orthopaedic Examination, Evaluation, and Intervention.  Dutton, Mark.

Photos: Wiki commons

Posted in Uncategorized Tagged with: ,

Sciatica – 5 Things You Didn’t Know

sciatica

Posted in Conditions, running, Sports Tagged with: , ,

Why Do I Get Calf Cramps at Night?

Do you experience uncomfortable cramps in your legs at night?  Do your calf muscles cramp up when you’re least expecting it?  Calf cramps and other leg muscle cramps can have various causes.  This article will examine some of the most common reasons for getting calf cramps, and then discuss some options for prevention and treatment.

 

What Are Calf Cramps?

A cramp, also known as a charley horse is a sudden spasm or tightness in a muscle.  They can last anywhere from one second to several minutes.  On a microscopic level, the actin-myosin fiber segments that are involved in shortening and lengthening a muscle, to put it technically, “go totally wonky”.  When the myosin fibers are unable to break free from the actin filaments during muscle contraction, a prolonged contraction occurs and the person may experience a cramp.

Actin_myosin_filaments pic

Sodium (Na), Magnesium (Mg), and Potassium (K) are necessary to drive this process, so if we are deficient in either of these minerals, we are leaving our muscles susceptible to cramps.

There is one other mineral we need to think about with respect to this process, and that is calcium (Ca). Keep in mind for now that potassium can inhibit calcium (not let poor calcium do it’s job).

There is also one other microscopic miracle we need to know about, so let’s go back to microbiology class!  Our cell membranes contain little pumps called Sodium-Potassium pumps (Na-K pumps) that shuttle those two minerals in and out of cells as necessary to maintain proper mineral balance.  As that “put on the brakes” potassium flows out of the cell, it eventually wipes out all the calcium in the cell, which is a trigger to closes the Na-K pump.  When we don’t have enough potassium in the body, the calcium builds and builds and builds and basically the muscle contraction builds up and never shuts off, thus a cramp!

na-k pump pic

So in summary, we need:

Calcium, to drive the actin-myosin contraction process.

Magnesium, to allow for muscle relaxation in the actin-myosin process.

Sodium, to maintain mineral balance with respect to the Na-K pump.

Potassium, to assure that we don’t use too much calcium.

 

Why Do I Get Calf Cramps?

Cramps may occur due to various causes, such as:

  • Repetitive motion or overuse injuries to the calves (running or even standing for too long).
  • Exposure to cold temperatures, especially to cold water.
  • Specific medical conditions, such as blood flow problems, MS, or kidney or thyroid dysfunction.
  • Pregnancy (in late stages of pregnancy the mother’s calcium and magnesium stores may be low).
  • Mineral imbalance in the blood (lack of sodium, calcium, potassium, or magnesium).
  • Dehydration (not enough fluid in the body).
  • Exposure to cold water.
  • Taking certain medications such as steroids, diuretics, and birth control pills

Calf cramps, and other leg and foot muscle cramps tend to happen at night because that is when your muscles are resting.

 

How To Prevent Calf Cramps?

Cramps may be prevented or decreased if you can take in adequate Na, Ca, K, and Mg and drink enough water throughout the day to stay hydrated.  Whole foods sources of these minerals are as follows:

leafy greens chard pic

Calcium: Leafy greens, legumes, seafood, and fruit.

Magnesium: Leafy greens, nuts and seeds, fish, beans, avocados, yogurt, bananas, dried fruit, dark chocolate,

Potassium, Leafy greens, fish, squash, yogurt, white beans, avocados, mushrooms.

Sodium:  Many foods contain sodium and most americans get enough sodium.  It’s important to note however, that clean eaters who exercise frequently may need to add sea salt into their diet to make sure not too much sodium is lost through sweat.

To prevent calf cramps at night, you can take a warm bath, do some gentle exercise, and drink some fluids before bedtime.

 

Treatment of Calf Cramps

Once a cramp is happening, there are two ways to break it.  The first way is to gently stretch the muscle.  If it’s a calf cramp, stretch the calf muscle by pulling your toes towards your shin.  One easy way to do this is to stand facing a wall with one foot behind you, and then do a basic runner’s calf stretch.

If this method doesn’t work, the second, slightly more aggressive method, is to manually affect the actin-myosin bridging.  No, you don’t need to pull out a microscope for that.  All you need to know is in which direction the muscle fibers run.  In the example of the calf muscle, the fibers run vertically from the knee to the foot.  You are basically going to quickly pinch the middle of the muscle.  Place your hands in the center of the muscle, fingers facing each other and about two inches apart.  Then perform a quick pinch motion, going deep into the muscle and bringing your hands towards each other.  It doesn’t feel great, but it is effective!

Posted in Uncategorized

The Nine Most Common Running Injuries and How to Avoid Them

running berkeley half goes near campus

Whether you’re running Berkeley fire-trails behind the stadium just for fun, or stepping it up for the more serious undertaking that is the Berkeley Half Marathon, you will want to learn about the most common running injuries. Furthermore, there are some simple steps you can take to prevent these injuries!  As it turns out, preventing these running injuries is quite similar to treating them, so you will save yourself some agony if you can identify them early.

 

View of Berkeley Half

When we talk about running injuries in Berkeley or Oakland, we’re not talking about mountain lion attacks on the fire-trails, tripping over unavoidable political posters, or even getting into fights with people wearing red shirts (go Bears!). The most common running injuries are insidious, meaning that they develop slowly and steadily, in the most tricky and dastardly way. You could train all throughout the summer months, only to have a repetitive use running injury sneak up on you in the middle of November, right before your first attempt at running the Berkeley Half!

Avoiding Running Injuries

The most interesting thing about most of the following running injuries is that the PREVENTION is the SAME as the TREATMENT! Yes you read that correctly! If you click on an individual link below, you will be taken to an article we’ve written that specifically address the symptoms, causes, prevention, and treatment of that particular injury.

You may start to notice patterns. For instance, plantar fasciitis (pain on the bottom of your foot near your heel) is best TREATED by a sports chiropractor performing Active Release Techniques to the muscles and fascia on the bottom of the foot, as well as to the tight, overworked muscles in the calf, hamstrings, and glutes. In order to PREVENT plantar fasciitis, you will need to stand on a tennis ball to breakup the adhesions that are starting to form (due to overuse) on the bottom of the foot. You will also need to foam roll your calf, hamstring, and glute muscles to alleviate the tightness in those structures that is causing the problem downstream at the foot. To TREAT plantar fasciitis, you stretch the calf muscles.  To PREVENT it, you also…you guessed it…stretch the calf muscles! Additional TREATMENT includes strengthening the glute muscles, because this improves lower extremity biomechanics. In terms of PREVENTING the issue, starting a glute strengthening program early in the running season goes a long way!

Oakland/ Berkeley sports chiropractor treats a running injuryAdjusting the foot is a great TREATMENT to make sure the talus (top foot bone) is gliding smoothly in it’s ankle mortise, and that all the other foot bones are able to move in all desired directions. A great PREVENTION measure for plantar fasciitis is to have your Oakland or Berkeley sports chiropractor check your feet to make sure there are no fixations and that everything is moving properly.

 
Oakland/ Berkeley sports chiropractor treats a running injuryThe parallels between treatment and prevention can be similarly drawn for each of the other running injuries in this article. Generally speaking, if you’re not sure where you need to be focusing your efforts (where do you need to stretch, what should you be mobilizing, what is moving too much, what is weak, etc.) preventative visits to your Active Release Techniques chiropractor can get you pointed in the right direction in terms of self care, and will keep your body as tuned-up as possible. Like regular maintenance visits on your vehicle will keep it running longer and more efficiently, regular prevention checkups at the sports chiropractor will keep you functioning at your highest potential.

 
Outside of the doctor’s office, you can take general wellness measures to fuel your body properly. Fuel can take the form of proper nutrition, adequate sleep, reducing stress, adopting a mind-body practice, and simply getting enough vitamin D through sunshine or supplements.

Follow the links below for specific injuries:

1.  Plantar fasciitis

2.  Shin splints (medial tibial stress syndrome)

3.  Runner’s knee (knee pain)

4.  Piriformis syndrome

5.  Hip pain (VIDEO)

6.  Achilles tendonitis

7.  Hamstring pull

8.  Iliotibial band syndrome

9.  Calf strain

We are here to help support you in your running and fitness endeavors. If you have any questions about running injuries, would like to be evaluated for a specific injury, or would like to schedule a preventative tune-up, please give us a call! We can be reached at (510)465-2342.

Image credit: Berkeley pictures via wiki cc

Posted in running, Uncategorized

Deadlifting with Osgood Schlatter

franco columbo deadlift osgood schlatter

Franco Columbo via Wikipedia

Despite what the name sounds like, Osgood Schlatter isn’t the name of a professional weightlifter from Germany. Osgood Schlatter (aka osteocondritis) is a condition of the knee wherein repeated stress from contraction of the quad muscles pulls on the immature tibial tuberosity (bony area at the top of the shin), causing pain, inflammation, and the formation of a bony bump at the front of the knee.  This condition usually occurs in children ages 9-16, coinciding with a growth spurt and athletic activity such as soccer or basketball.

osgood schlatter but you can still deadlift

Osgood Schlatter knee bump

While many cases of Osgood Schlatter resolve in an athlete’s teenage years, there may be a resulting bump on the tibial tuberosity that never disappears. For most adults, the bump is merely an aesthetic nuisance or a minor irritation when kneeling. Unfortunately for several others, the bump is a constant source of discomfort during kneeling or whenever it receives an impact. If you are one of these adults, you have had the bump long enough to know your limits in terms of what you are comfortable kneeling on and for how long, and have developed shortcuts in many of your daily movements; from twisting a certain way to enter your car, to sitting on the appropriate side of an aisle opposite your knee bump in order to avoid an accidental impact. But there is one exercise in which, if you lose focus or if your form wavers, you risk a painful steel on bone impact: the DEADLIFT!

deadlifting with osgood schlatter

Deadlifting with Osgood Schlatter via Wikimedia

The deadlift is an amazing exercise for developing full body strength, and it would be a shame to throw it out if you can find a work-around. The most common workaround that people do (holding the bar a mile away from the shins to avoid potential contact), however, is dangerous for the low back, so the purpose of this article is to describe some alternate ways to do the deadlift with Osgood Schlatters.

Hex bar deadlifts

Deadlifts with the hex bar (aka trap bar) will draw focus from the glutes and hamstrings, to be shared by the quads. It’s not inherently bad to strengthen your quads, we just have to make sure we’re doing another exercise to focus directly on the glutes and hamstrings (barbell glut bridges, straight leg deadlifts, hamstring eccentrics on the Valslides, etc) so that we don’t become quad dominant.

The deadlift with the hex bar allows you to stand within the borders of the apparatus, so that your knees and shins are totally clear of the bar. You will need to pay special attention to your form at the top of the lift, to assure that you aren’t hyperextending your lower back. With a traditional deadlift, the barbell provides your hips a natural stopping point, whereas with the hex bar, your hips are free to swing way forward (if you let them).

Specific alternate hand grip

When most people try the the mixed hand (alternate hand) grip, they will naturally take an overhand grip with their dominant hand and an underhand grip with their weaker side. Is this appropriate for deadlifting with OS? It depends which side your bump is on. If the bump is on your left knee, selecting an overhand grip with your left hand will allow you to guide the bar slightly out in front of your knee to clear your bump on the way up and again on the way down. If you’ve been deadlifting for a long time with the opposite grip, it may take some time to get used to. Remember you aren’t bicep curling the bar up, you are deadlifting it. Keep your elbows locked with your arms straight to help you use your lower body and avoid temptation to assist with your arms (and risk bicep injury).

Neoprene knee sleeve

 For lifters with just a small (or less tender) Osgood Schlatter bump, a knee sleeve may be all you need to prevent accidental contact with the bar. Most of the time you won’t actually hit your shin with the bar, it’s more often the fear of hitting your shin that interferes with successful deadlifting. A neoprene knee sleeve can assist you mentally so that you can get rid of the fear that bumping your “bump” will be excessively painful.

Get your form checked

For lifters who do not have Osgood Schlatter, there is a bit of wiggle room in terms of correct form. As long as you aren’t rounding your low back and you lock your elbows, you can generally pick up a fair amount of weight without the thought of injury crossing your mind. When you have Osgood Schlatter, you will need to really dial in your form. Bending your knees a split second early on the lowering phase or failing to push your hips back that extra half inch can result in a painful smash against your tibial tuberosity. Once you are familiar with basic form (one good resources is the book “Starting Strength” by Mark Rippetoe), consider hiring a trainer or CSCS coach to check your form and help you perfect your alignment and biomechanics so that the lift feels comfortable (to the extent possible) for you!. It is possible to deadlift safely and also allow the bar to clear your bump!

Start light when practicing your new form. Even if you think you should be able to deadlift 225, a 45-lb bar isn’t too light to practice with until you develop the muscle memory to confidently deadlift without your Osgood Schlatter bump getting in the way.

Some general tips that can help with your deadlifting form:

*Chest forward (show off your cool shirt!)
*Look straight ahead
*Big inhale on the way down, exhale on your way up
*Lean back into your heels to get the lift started
*As soon as the bar clears your bump (not your kneecaps), straighten your knees
*Push your hips forward against the bar at the top
*Bend your knees as soon as the bar clears your bump on the lowering phase

You CAN deadlift even if you have a bump remaining from Osgood Schlatter in your teen years. Try these tips and be confident that it is possible! Increase the weight slowly, and make sure your form is 100% perfect before adding more weight. Please let us know if you have any questions about deadlifting or other strength exercises; we are here to help you stay active and feel balanced!

Posted in Fitness, Lifting, Sports, Uncategorized Tagged with: ,

Why Am I Salty After a Marathon?

 Why am I so salty after running a marathon?

Have you ever completed a long run and wondered: “what is all that dried crusty white powder covering my face, neck, and running shirt? Am I salty? Why am I salty after a long run?”

Is it my sunscreen dripping? Did I run through ocean air? If this is salt, does that mean that my diet is too salty? Why isn’t my friend covered in dried salt if we ran the same distance?

These are all good questions, and ones that I hear frequently from runners when I provide ART services at the finish line of local races. The short answer to these questions is: Yes, that is salt! The longer answer is still, yes, that is salt. But this phenomenon doesn’t happen to everyone, so here’s the deal about being salty after a marathon:

Dublin marathon, Oakland Running Festival, any long run can leave you salty afterwards

Nearly everyone loses fluids when they sweat, but some people are saltier sweaters that other. Thanks to the clever scientific properties of osmolarity, we can state in basic terms that sodium and water travel together. When we eat a handful of salty pretzels, our body retains water in an amount appropriate to match that salt increase. (People with chronically low blood pressure often need to add sodium to their diet so that their bodies hold onto more fluid, which prevents a decrease in fluid volume. When there is a larger volume of fluid in the blood vessels, there is a corresponding higher pressure.) When we sweat (either caused by exercise or by sauna), we lose water, and the sodium in our blood stream is drawn out with that water.

It may make sense at first thought, that if you are seeing a lot of salt on your running cap, that maybe your diet is too salty and therefore you shouldn’t eat anything salty after a long run. Quite the opposite is true in most cases however; the salts on your face indicate that you have lost sodium, and thus need to replace it with a salty beverage or food. Remember, sodium and water are travel companions, so if you are running a marathon and only hydrating with water (no salt tabs or sodium containing sports drink or salty snacks at water stops) and you are still sweating, you are still losing salt and water, but you’re only replacing the water! This dilutes the sodium:water ratio, leaving you prone to hyponatremia.

Let’s look at some numbers:

numbers for why am i salty after a marathon

 

The average RDA sodium is 1,500mg  to 2,300 mg depending on your source (1).

2,300 mg sodium = approx. 1 teaspoon of salt.

The average sweater loses the equivalent of 500mg sodium in one hour of exercise (assuming they lose one pound of sweat per hour)(2).

If you’ve ever tracked what you eat for an entire day, you may have noticed that it’s actually quite difficult to meet the 2,300mg sodium goal on a whole foods based healthy diet. Eating fast food and processed foods daily can get you there quickly, but many nutritious foods don’t naturally contain a lot of salt.

Let’s look at an example. Betty tracks her diet for a week and learns that she naturally consumes about 1,000mg sodium on an average day. She doesn’t eat anything out of the ordinary on the Friday before the Oakland Running Festival so we can assume she has eaten 1,000mg sodium. She runs for four hours on Saturday, which means she’s lost 2,000mg sodium. (4 x 500mg). She takes one salt tab (200mg sodium), some salty peanuts (100mg sodium), and some electrolyte drink (200mg sodium) during the course of the marathon for an additional 500mg sodium). Unfortunately, that leaves sweaty Betty with a sodium deficit of 500mg!

Some people’s sweat will contain more sodium than others, so depending on Betty’s constitution, she may feel just fine at the end of the day, or she could suffer from headaches, nausea, and fatigue (greater than that of an average marathoner).

Should Betty care to rectify the situation, she could intake an additional 500mg sodium. This translates roughly to ¼ tsp of sea salt. The following is an easy to make sports drink that will replace sodium as well as hydrate you during your long run. It’s free of added chemicals and colorings.

 Oakland chiropractor offers a healthy sports drink recipe for runners

*Squeeze one orange into a container with a lid (Or pour in ¼ orange juice).

*Squeeze one lemon into the container.

*Stir in ¼ to ½ tsp. sea salt.

*Fill the container up with cool water to dilute as desired.

A regular sized “Nalgene” bottle seems to hold the proper volume such that the drink doesn’t taste too diluted. Unless you are very sensitive, you won’t even taste the salt! As with any nutritional or medical advice, please check with your primary care doctor to rule out any underlying health issues (such as sodium-sensitive-hypertension) that might contraindicate sodium intake.

Picture credits: (1) Kara Goucher Flikr cc (2) Flikr cc (3) Flikr cc via Natashi Jay (4) O.J. wikimedia

(1) American Heart Association (AHA) RDA of sodium: 1500 mg

(1) Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Sodium Fact Sheet: http://www.cdc.gov/salt/pdfs/Sodium_Fact_Sheet.pdf: 2,300 mg

(2) http://www.active.com/nutrition/articles/salt-and-athletes-shake-it-or-leave-it

Posted in Conditions, Nutrition/Recipes, running, Uncategorized Tagged with: , , ,

How Do I Know if I’m Overtraining?

fatigued runner

Feelings of depression, fatigue, sluggishness, irritability, and not wanting to start the day’s workout are all symptoms of overtraining. You need to be honest with yourself if you are just tired, say, from not sleeping well last night, or if the tired feeling seems to be coming out of thin air. The cumulative fatiguing effect of strength and conditioning workouts can surprise even the most dedicated athlete. If you haven’t had a rest day in awhile, ask yourself whether you’re experiencing one or more of the above symptoms. There is no hard and fast science about how many days per exercise cycle an athlete needs to rest. Furthermore, the frequency of your rest days may differ by month or with other circumstances in your life. Last month maybe you felt great and only took one or two rest days, despite many heavy workouts. This month could be a totally different story, maybe you’re feeling like you need to take two rest days a week, regardless of your activity level.

Taking steps to avoid overtraining is important for everyone, and it’s easy to try to compare your situation to your workout buddy’s. Honor how you are feeling, and don’t just rest because your workout program says so. Likewise, don’t push through a workout that’s on your “schedule” if you are feeling extremely overtired or irritable.

lazy dog on couch

It’s important to note that taking a rest day doesn’t mean that you have to sit on the couch and not move at all. Sure, an hour or two of just relaxing can be nice, but many athletes feel restless on days when they don’t get to partake in any exercise. A short walk, easy hike or bike ride, gentle yoga class, or friendly tennis game (only if you aren’t the competitive type!) can still allow you to engage your mind and body, while allowing your muscles a chance to recover.

When will you take YOUR next rest day?

Image credits:
Top picture: http://pixabay.com/static/uploads/photo/2014/04/27/16/12/marathon-333185_640.jpg
Dog on couch: Flikr creative commons

Posted in Fitness, running, Sports, Uncategorized Tagged with: , , ,

Meniscus Injuries After 40

 

Prevention of meniscus injuries

A soccer injury is just one possible cause of meniscus injury

 

The purpose of this article is to discuss the mechanism of meniscus tears (which usually occur in females over the age of forty).  We will discuss the prevention of meniscus injuries and the treatment of meniscus injuries.

Anatomy

Let’s review meniscus anatomy before we discuss injury. The meniscus of the knee consists of two rings of cartilage that seal the gap between the rounded ends of the femur and the flat ends of the tibia. The seal is fairly tight, similar to the way that a washer forms a seal between a bolt and a nut. The menisci are wedge-shaped along their outer edge. The lateral meniscal ring is circle-shaped, and the medial ring is crescent-shaped. They each consist of three layers of collagen fibers that allow them to be tough and flexible. The outermost fibrous layer runs along the outer curve, tying together all the layers, and resisting shear force at the knee. The middle layer fibers are attached around the edge to resist the stress of weight bearing. The deepest layer runs parallel to the outer edge of the meniscus.

 

Meniscus Injury

 

The outer borders of the meniscus are attached to the tibia by coronary ligaments, while the medial borders are free to move within the joint. The medial meniscus also attaches to the medial collateral ligament (MCL). The blood flow properties of the menisci influence the healing process after injury and the potential for an athlete’s return to play.

The only part of the meniscus that receives a direct blood supply is the outer layers (the red zone), which makeup about 10-30% of each meniscus. The remaining layers (the white zone) are nourished only by the synovial fluid, which diffuses from the joint.

Menisci are designed to transfer load across the knee joint by increasing the contact surface area. Joint contact pressure increases by 50-200% when a meniscus has been removed from the knee1. The other functions of the meniscus include absorbing shock, lubricating the joint, and facilitating bone-on-bone gliding as the knee flexes and extends. They are displaced towards the rear of the joint when the knee extends, and towards the front of the joint when the knee flexes. The lateral meniscus moves a bit more than the medial meniscus, due to the connections between the medial meniscus and the MCL, and its firmer attachment of the medial meniscus to the tibia.

Why Meniscus Injuries Occur

There are two types of meniscus injuries, traumatic and degenerative. Degenerative injuries happen slowly over time, and do not require an acute trauma for a tear to develop. Traumatic injuries usually occur in athletes. The most common injury mechanisms are hyper flexion of the knee, lateral trauma, and hyperextension of the knee. When the knee is rapidly hyperextended, the femur can press into a piece of the meniscus that hasn’t had time to glide back out of the way. The resulting stress can result in a tear along the outer part of the meniscus (longitudinal or “bucket-handle” tear).

When the knee sustains impact from the lateral side, the leg is forced into a “valgus” position with rotation. This can happen either from a collision to the outside of the knee, or from a “plant and cut” maneuver. In this position, the MCL is under stress, and the medial meniscus may pull away from its attachment to this ligament. The MCL may also sustain a tear in this position. If the anterior cruciate ligament (ACL) is torn as well, it is known as the “terrible triad” of knee injuries.

If the knee gets flexed beyond its normal range, the back of the lateral meniscus may get torn. There are several types of tears that may occur due to this injury mechanism, a radial tear being the most serious, as it disrupts the outer fibers and affects the ability of the meniscus to bear circumferential stress.

A traumatic meniscus injury may result in a sudden feeling of “giving way,” and the athlete may feel or hear a “pop.” Pain and swelling may come on rapidly, even though they may feel like they are able to continue play. The knee may “lock up” with a small ROM if a torn piece of the meniscus “floats” into the joint space. 73% of tears occur in soccer, basketball, and skiing2.

Treatment of meniscus injuries

At-home treatment for a meniscus injury includes rest, ice, compression, and elevation of the knee. Clinical tests can predict whether a meniscus tear has occurred, and an MRI will confirm a tear. If there is a small tear in the red zone, it is recommended that the athlete rest from sports, immobilize the knee, and consider using crutches for a few weeks until the meniscus can heal. If a larger tear is present, arthroscopic surgery is generally recommended. Most athletes can return to sport at or near their previous level of competition following the surgery. In one study, the mean time between injury and return to play was 5.6 months3.

When surgical repairs do fail, it is usually due to performing the same activity that caused the initial injury. The most important factor in determining success of the surgery was the location of the tear. Tears further from the red zone/white zone junction are more likely to fail, as are complex tears.

When the tear is in the white zone, a surgical removal (partial or complete) may be needed. There are benefits and risks to meniscus removal surgery. On the positive side, aggressive rehab can begin quickly and the athlete can get back to training as quickly as two weeks after surgery. The risk is that osteoarthritis may develop. According to a study in the American Journal of Sports Medicine, patients who underwent the meniscus removal surgery were ten times more likely than patients who didn’t have a knee injury to develop osteoarthritis twenty years after the surgery4. Repairing the tear didn’t necessarily guarantee that osteoarthritis wouldn’t occur.

Some risk factors that would make it more difficult for an athlete to return to play after meniscus removal surgery include being female, over forty years of age, BMI>30, more than one-third of the meniscus removed, and abnormal alignment of the hip, knee, and foot.

Non-surgical treatment

Another thing to think about is how we can best take pressure off the meniscus. A knee that is out-of-alignment, or has imbalanced or tight muscles pulling on it is more prone to developing meniscus issues. The IT band has an attachment into the lateral meniscus. Often the IT band needs to be foam-rolled, or treated with a soft tissue technique such as Active Release Techniques (ART). Additionally, the foot and hip need to be addressed, as tightness or fixations in either area can impact the integrity of the knee. Anytime muscles and tissues are overworked or shortened, the body lays down scar tissue to protect the area. Scar tissue is your body’s self-defense mechanism to try to hold a damaged area together, but it also negatively affects the functioning of your tissues. ART is an efficient technique to break up this scar tissue, to allow your muscles and connective tissues to return to normal function. There are also ART protocols for the meniscus area itself. It can sometimes get caught at the front or the back of the knee joint, and it is possible to manually release the meniscus through this technique.

Oakland chiropractor examines meniscus injury

Prevention of meniscus injuries

If we can reduce the pressure on the meniscus in the first place, the likelihood of injury will be lower. The hip, knee, and ankle need to be in proper alignment during running and throughout the gait cycle. If the knee is varus or valgus, it can put pressure on the meniscus

It has been demonstrated that core proprioception, that is, the body’s sense of where it is in space, can predict knee injury in women5.   A decrease in proprioception and control in the core can decrease stability and control at the knee. Following are some exercises that can increase core strength and balance.

For balance:

Stand on a wobble board or a balance mat. Pass a ball to your partner while you both stand on two legs. Then stand on one leg each and pass the ball. If you want to make it harder, throw with your non-dominant hand. Try dribbling the ball with one hand, and then close your eyes and see how long you can continue dribbling. Do a set of double-leg squats, and then a set of single-leg squats. Try to pull or push your partner off balance (keep it clean if you’re the competitive type).

wobble board for meniscus

For strength:

Squat Progressions:

Double-leg: Feet hip width apart, toes pointing forward or slightly outward. Arms overhead or out in front for balance. Push your butt back as if you were going to sit in a chair. Squat down until your upper and lower leg forms a 90-degree angle. Push back up to standing.

Single-leg: Same stance as above. Hold a chair for balance if needed, squat down on one leg, holding the other leg in front of you or behind you.

Single-leg decline: Stand on a decline block or a surface that is slanted downward at about 45 degrees. On one leg, lower down in a squat position until your upper and lower leg form a 90-degree angle. Push up to standing with both legs. All the work here is done in the lowering phase.

Isometric VMO hold: Stand with feet hip width apart, toes pointed outwards. Without lifting your feet off the ground, isometrically contract your leg muscles as if you were going to rotate your feet so they were pointing straight ahead. Don’t actually move your feet!

strength exercises for meniscus injury

Nordic hamstring exercise: From a kneeling position with a partner holding your feet, tighten your core, and then let your body fall towards the floor, catching yourself with your hands just before you hit the floor. Push up to kneeling position and repeat.

For Explosive Power:

Plyometrics are exercises done to increase your power, that is, your strength at quick movements. Examples of plyometrics include box jumps, forward and back jumps, tuck jumps, and hurdle jumps.box jumps for meniscus injury prevention

Running Drills:

Any running drills that approximate the movements of sport are good for injury prevention. Examples include running with high knees, kicking feet to butt, side-stepping, side-running with legs crossing alternately in front and behind, and skips.

Please feel free to contact us if you have any questions about meniscus tears or other knee injuries.

References:

1. Am J Sports Med. 2009; 37:124-129.

2. Am J Sports Med. 2006;34:1170-1175.

3. Am J Sports Med. 2009;37:1131-1134.

4. Am J Sports Med. 2007; 35:1756-1769.

5. Am J Sports Med. 2007;35(3):368-373.

6. http://www.pponline.co.uk/encyc/knee-injuries-the-prevention-and-treatment-of-cartilage-damage-41839

Image credits: all images are wiki commons or flikr creative commons files

 

Posted in Conditions, Sports, Uncategorized Tagged with: , , ,

10 Reasons Why You Should Squat

oakland chiropractor tells 10 reasons to squat like this
1. Prevent injuries

Whether you play soccer, basketball, or football on the weekends, research has proven over and over that athletes who squat injure themselves less frequently than athletes who do not squat.1 Full range of motion squats strengthen the gluts, hamstrings, and hip musculature that controls the motion of the knee. Knees that are properly controlled are better protected when jumping, landing, changing direction, and decelerating.

2. Save time

Why waste precious time in the gym cranking out reps on machines? Whether you’re standing, lying, or sitting on these machines, calf raises, hamstring curls, and knee extensions give you a smaller bang for your buck than a compound exercise like the squat.

3. Perform better

You can run faster if you can drive with stronger hip extension. You can jump higher if you can generate stronger power from your gluteal muscles. You can cut faster on a turf field if the musculature covering the sides of your hips is strong and firing properly.

4. Heal knee pain

Squatting through knee pain is not advised without obtaining a proper diagnosis from a healthcare professional. For a small percentage of knee injuries, squatting is contraindicated (at least for a certain period of time). Once you rule out that category of knee pain, squatting can help restore gluteal strength and quad strength. It’s interesting to note that healing knee pain often entails the same program as preventing knee pain…strengthen the surrounding and controlling musculature.

5. Balance your body

We live in the modern world of crunched-up computer posture and prolonged chair sitting. Unfortunately these positions leave us with chronically shortened hip-flexors. Tight muscles are one thing, but the situation is made worse by a tricky little principal called reciprocal inhibition.   Similarly to how your triceps muscles automatically relax when you attempt a bicep curl, the muscle on the opposite side of the hip joint “turns off” when the hip flexors are held in that contracted position. This can create a condition called Dead Butt Syndrome, in which the fibers of the gluteus maximus muscle can’t contract properly. These gluteal muscles are the largest in the body, they are our prime movers, and the squat is one exercise that can get them fired up again and create balance in the body.

6. Free your breath

Studies have shown that connecting your movement with your breath helps reduce anxiety and lowers blood pressure. Many people find this true with yoga, but the deliberate breathing required during the squat exercise is another way to find this connection.

7. Feel your power

How accomplished do you feel when you increase the weight by 5 pounds on the calf raise machine? Maybe a little bit, if you can even remember which resistance setting you chose last time! Admit it, like most of us, you haphazardly place the pin in the weight stack at about the same location every time. Compare that to how awesome and powerful you feel when you hit a new PR on your squat!

8. Monitor your progress

It’s easy to track where your overall strength stands. Performing heavy squats will tell you pretty quickly when you have one rep left in the tank, and when you don’t!

9. No more sit-ups

Raise your hand if you actually enjoy performing sit-ups! When you start squatting heavy weights, you will engage your entire core to keep yourself in a stable position. This bracing is far more effective than training the rectus muscle (the “front” abs) with crunches or sit-ups. Furthermore, studies from Professor Stuart McGill, director of spine biomechanics at the University of Waterloo in Canada, have indicated that repeated flexion of the spine can damage spinal discs (the cushioning between each vertebrae) over time.

10. Improve everyday movements

Squats very much train your body in a functional movement. An example of a non-functional movement would be doing knee extensions on a machine. With the possible exception of kicking a soccer ball, you wouldn’t fire your quadriceps to straighten your knee with your feet up in the air! Why, then, would you train in a non-functional manner? Squatting is a closed-chain exercise that preps us for performing the daily actions of squatting to grab something from the floor, pick up your tired child, or harvest tomatoes from your garden.

 

References:

1. Clin J Sport Med. 2013 Sep;23(5):407-8. doi: 10.1097/01.jsm.0000433153.51313.6b.

Neuromuscular training to prevent knee injuries in adolescent female soccer players. Wingfield K.

Picture: Everkinetic [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Posted in Fitness, Lifting, Sports Tagged with: , , , , , , ,
Riverstone Chiropractic is conveniently located on Grand Avenue in Oakland CA. We serve patients from Oakland, Berkeley, Albany, Richmond, Walnut Creek, El Cerrito, Emeryville, San Leandro, Alameda, and surrounding cities in the bay area. Riverstone sports chiropractor Dr. Sandy Baird uses her background in athletics and massage therapy to provide her patients with effective and personalized sports medicine treatments, which include Active Release Techniques, chiropractic treatment, deep tissue massage, and rehabilitation exercises. Riverstone Chiropractic - 3409 Grand Ave #5 Oakland California 94610 - (510) 465-2342
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