Doing many quad sets and hamstring stretches helps, but I still have knee pain. Is there anything new I can try?

February 2nd — admin

I’ve had knee pain since I was 13 (I’m now 18). The doctor calls it patellofemoral pain syndrome. I’ve done a million quad sets and hamstring stretches. It helps but I still have pain when I try to increase my training schedule for track and field events. Is there anything new I can try?

Treatment for patellofemoral pain syndrome (PFPS) has traditionally relied on quadriceps strength training. Some patients also benefit from neuromuscular training, which focuses more on motor control than improving strength.

So far no one has found a “one size fits all” kind of program. Some people seem to get better with one type of exercise while others have less pain and more function with other types of training.

Some time ago researchers saw that hip strength may be an important key to PFPS. One by one studies have been done to confirm this suspicion. Most recently physical therapists at the Nicholas Institute of Sports and Medicine and Athletic Trauma in New York City studied hip strength and flexibility as it relates to PFPS.

They found that 60 percent of patients with PFPS got better after a six-week training program. Exercises to improve hip flexor strength and flexibility resulted in decreased pain and improved function.

The goal was to prevent inward rotation of the thighbone (femoral rotation). Maintaining good alignment of the patella as it moves up and down over the knee reduces the tension on the soft tissues around the knee. This new treatment approach may help you as well!

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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My teammate thinks my knee pain may be as a result of tight hip flexors. How do I check for this myself?

January 31st — admin

I’ve been having knee pain whenever I do running or squatting drills during football training. One of my other teammates says tight hip flexors can cause this problem. How do I check myself for this?

There are several tests used to measure hip flexor flexibility. An athletic trainer, physical therapist, or orthopedic surgeon can test you.

One test is called the Thomas flexion test. You lie down on your back on a table with a firm surface. The crease of your buttock should be at the edge of the table. Bring both knees up to your chest. Keeping your back flat on the table, lower one leg until it is straight out. Lower that leg toward the tabletop as much as you can without arching your low back or letting your pelvic bone tilt.

A tight hip flexor muscle will keep you from lowering your leg all the way down to the table. A flexible person will be able to get to a horizontal (normal) or beyond horizontal position (hyperflexible). The physical therapist uses a tool called a goniometer to measure the hip angle during this test.

Another test is the Ober test used to measure flexibility of the iliotibial band (ITB). This band of fascial tissue comes down along the side of the leg from hip to knee. For this test, you lie on your side with the leg in question on top. The lower leg can be bent to help support you on the table.

The upper leg is bent 90 degrees at the knee. The therapist lifts the leg away from the body to a horizontal position and then extends it backwards slightly. The leg is then lowered toward the table until it starts to rotate or can’t go any further.

A normal amount of motion allows the leg to be placed in the horizontal position. With a tight ITB, the leg stays up and won’t drop down towards the table. The extra flexible person can touch the knee to the table.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What is spontaneous ostenonecrosis and what causes it?

January 19th — admin

What is spontaneous ostenonecrosis and what causes it? My husband has been diagnosed with this problem in his left knee. We can’t figure it out.

You’re not alone in your questions. We know that osteonecrosis is the death of bone tissue. But spontaneous osteonecrosis (SON) is sudden, unexpected, and without known cause.

Some recent reports point to a possible increase in this condition in adults over age 60. At first doctors thought it was linked with arthroscopic surgery to remove a torn meniscus. But then five new cases were reported in patients who had meniscus degeneration but no surgery.

It appears that age-related wear and tear on the meniscus may be the start of the problem. But there are still many questions about what’s going on. For example, in one study of five patients, symptoms of knee pain were identified as medial meniscal degeneration.

At the time of the diagnosis, there were no changes in the bone seen on an MRI. The patients were all treated with physical therapy, exercise, and noninflammatory drugs. Two months later the symptoms increased. A second MRI showed osteonecrosis of the knee.

What happened in those two months between MRIs? Doctors just aren’t sure yet but further studies may offer some insight into SON.

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Our son had knee pain. Doctors used an X-ray and an MRI. I thought they used bone scans. Why not?

November 30th — admin

Our son had knee pain every time he tried to run or work out. We finally took him to the doctor’s. An X-ray was negative but the MRI was positive for a stress fracture. I thought they used bone scans to find things like this. Why not?

Diagnosing stress fractures isn’t easy. As you know they don’t show up on X-rays in the early stages. This is called a false negative. In other words, the X-ray was read as normal when there really was a problem.

Bone scans have the opposite problem. They often indicate there is a problem when there isn’t one. This is called a false positive. False positives are more common with children and teenagers who are still growing or remodeling bone.

MRIs seem to offer the best results when looking for bone stress injuries. In a recent study of military trainees with exercise-induced knee pain, two separate radiologists read the patients’ MRIs. They did this without knowing the patient’s symptoms or history. They didn’t consult with each other. There was good agreement between the two physicians and an accurate result with the MRI.

MRIs can’t show the difference between bone bruises and bone stress injuries because bone marrow edema is present in both. In such cases the physician must rely on the history.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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After a bout with Rocky Mountain Spotted Fever, I have knee pain when I run. Are they related?

November 23rd — admin

I’ve been training for my third triathlon but I got sideswiped by a bout of Rocky Mountain Spotted Fever. I was down and out for three full months. Now that I’m starting back I notice a lot of knee pain I didn’t have before. Every time I try to bump up my training schedule the knee pain comes on. Is this left over from the fever?

There probably isn’t a direct link between the Rocky Mountain Spotted Fever and your new knee pain. A doctor would need to tell you for sure. Sometimes there is a residual arthritis that crops up after RMSF or Lyme disease. Both conditions are infectious diseases spread by the bite of a tick.

There are two other possible factors. One is weight loss. If you lost a major portion of body weight during your illness, you may have lost muscle bulk and strength as well. Bones are at increased risk of fracture without the protection of strong muscles around the joints.

The second is your training schedule. Many athletes jump right back into training where they left off instead of building up gradually. Many stress injuries occur when training frequency and intensity are too much too soon.

See a medical doctor before continuing your training program. If you’re cleared to go ahead, then step back a few notches and build up your strength first then endurance for the triathlon. If you were off for three months, you can expect it to take three months to regain your former training level.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What causes knee to buckle?

October 28th — admin

Sometimes my knee clicks and then gives out from underneath me. What causes this kind of buckling?

Some doctors would say your knee is unstable. The true definition of instability is when the kneecap called the patella dislocates or shifts too far to one side.

Symptoms of buckling, collapsing, or giving way are more often caused by weakness. The quadriceps muscle along the front of the thigh helps hold the knee straight. Flexion or bending the knee without warning is a sign of quadriceps insufficiency.

Such giving way or insufficiency occurs as a result of pain, deconditioning, or swelling inside the joint. When the doctor examines you he or she will try and decide if your symptoms are coming from outside or inside the joint. If the problem is outside the knee joint then is it caused by the patella or something else?

A complete diagnosis may require exam, X-rays, and even arthroscopic surgery.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Pain in arthritic knee not necessarily from arthritis!

October 26th — admin

My doctor told me that just because there are arthritic changes on my knee X-ray doesn’t mean the pain in my knee is coming from those changes. Why not? Doesn’t it make sense that the damage seen would be causing the problems?

It does make sense and that’s what’s got doctors and scientists scratching their heads. Many studies of the spine and joints show changes where there is no pain and pain where there are no changes. They don’t know how to explain it.

It may be a little like that old question: if a tree falls in the forest but no one is there to hear it, does it make any sound? Are X-ray findings pathologic if the patient doesn’t have any symptoms?

It’s possible the changes will eventually cause symptoms. But it might take an injury or repetitive load to bring on any pain.

Doctors also suggest the joint’s ability to hold up under heavy or repetitive loads may be based on more than just joint alignment. Maybe if the patient doesn’t stress the joint past a certain point, there are no symptoms no matter what shape it’s in.

More study is needed to end the debate of when to treat a joint. Should we apply medical treatment any time there are symptoms (with or without X-ray changes)? Or should we apply treatment anytime there are X-ray changes with or without symptoms.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Donor tissue for ACL repair – which leg?

September 9th — admin

Should I have my ACL repair done using donor tissue from the same leg or the other leg? Which is better?

There may not be an easy, straightforward answer to this question. Let’s go over some of the considerations.

If the tendon graft is taken from the same leg, then only one leg is affected. The patient can shift the weight off that leg during the early days after the surgery.

Repairing the knee with donor tissue from the other leg means both sides are affected. There have been a few cases reported of problems developing from overload of the donor side.

This is more likely during the first 24-hours when the patient is still under the influence of anesthesia and drugs to limit pain. Without complete sensation, the patient can put too much load on the donor leg. The result can be an avulsion fracture. The remaining (weakened) patellar tendon pulls away from the bone.

On the plus side, taking donor tissue from the other leg leaves less trauma to the reconstructed knee. Rehab can progress along much faster.

Most surgeons use donor tissue from the same side. Talk to your surgeon about his or her preferences and reasons for choosing one over the other.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Torn ACL still causing pain two years after repair

September 7th — admin

I tore my right ACL two years ago. It’s still not right. I have continued pain and swelling that’s keeping me from enjoying the things I like to do. Will I ever be able to ride a bike again?

Knee pain, swelling, and giving way two years after ACL repair are signs and symptoms that the joint is unstable. If you haven’t gone back to your orthopedic surgeon, now would be a good time to make an appointment.

It may be a simple case of muscular weakness or imbalance. Sometimes such problems can be taken care of with a rehab program. In other cases there may be other (unknown) damage to the joint. Perhaps there’s a torn meniscus or some osteoarthritis developing.

Worst-case scenario: the repaired ACL may have failed. Further testing is needed to find out what’s wrong. The chances are good that treatment is available that can get you back to the activities you like.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Why does kneecap pain come and go?

August 9th — admin

I have a painful knee problem called patellofemoral pain syndrome. Sometimes it hurts like crazy. Other times I have no pain at all. Why is that?

People with patellofemoral pain syndrome (PFPS) often have knee pain and stiffness when climbing, going down stairs, or while squatting. Popping or stiffness after sitting with the knee bent is called the movie theatre sign.

Most of the symptoms of PFPS depend on the up and down movement of the kneecap and the pressure it places on the cartilage and bone underneath. Scientists aren’t sure what causes the stiffness. Symptoms go away when the person avoids any of these activities.

Changes in the joint, ligaments, and joint capsule may occur after a long period of pain. Messages of pain and stiffness may be sent to the brain sooner or more often than in the normal knee.

A recent study at the University of Illinois found that subjects with PFPS may be misinterpreting their pain as stiffness. Future treatment of PFPS may be centered on pain relief in order to decrease the sensation of stiffness.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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