FitSugar

Injury Prevention: Strong Hips = Strong Knees

FitSugar — Fri, 09 May 2008 05:30:00 -0700

We all know that men and women are different, even in how we exercise. Add to those differences the fact that women are more likely to suffer knee injuries. The difference is structural; the width of our child bearing hips angles the thigh bone (femur) in such a way that it creates some laxity and instability in the knee joint. Not to mention the ebb and flow of hormones women experience monthly can affect knee stability too.

One way to protect your knees is to strengthen your hips, or anatomically speaking your glute med – the muscle that fills in the side of your pelvis (see an image of the muscle here). Having strong glute meds helps to control the thigh bone, which then helps to stabilize the knee joint. Sounds like a win/win situation to me.

To see how to strengthen your hips, just read more.

Side Squats with Theraband

Tie a resistance band around your ankles. Start with red/medium band and work your way up to green/heavy.
Begin standing with feet directly underneath your hips.
Squat halfway down and side step to the right as far as you can manage.
Bring left leg toward right, returning to your starting position.
Step to the right 10 times, then reverse stepping to the left 10 times. Repeat for 3 sets.

Fit's Tips: This is a great exercise for runners and can help prevent patellofemoral pain, aka pain on the outside of the knee. Couple this with rolling out your IT band and you will be good to go. Preventing injuries means you log more miles and stay on the road!

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Tendinitis

FitSugar — Wed, 08 Oct 2008 17:34:54 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Tendinitis is the painful inflammation of a tendon and its ligaments, which attach it to the bone. It often results from the stress of repetitive movements. Acute tendinitis may become chronic if it is not treated. The areas most commonly affected are the shoulder (rotator cuff tendinitis), elbow (tennis elbow or golfer's elbow), wrist and thumb (de Quervain's disease), knee (jumper's knee), ankle (Achilles tendinitis), and hip. Calcific tendinitis, which occurs when calcium deposits build up in a joint, often appears in people with a chronic disease, such as diabetes.

Signs and Symptoms

Swelling
Tenderness
Pain that worsens when you move the affected limb
Warmth and redness
Crepitus (crackling)

What Causes It?

Tendinitis can result from overuse, undertraining, or poor technique in sports, repetitive movement in certain occupations (such as typing), falling, lifting or carrying heavy objects, and extreme or repeated trauma. It may also be seen with certain inflammatory conditions (for example, Reiter's syndrome, ankylosing spondylitis), autoimmune disorders (for example, diabetes), and some infections.

What to Expect at Your Provider's Office

Your health care provider will give you a thorough physical examination and may take x-rays and other diagnostic tests.

Treatment Options

Your health care provider may prescribe pain relievers or steroid injections. Treatment also may include ice, rest, or temporary immobilization. Massage, strengthening exercises, or physical therapy help improve tendon use. Ultrasound and use of electricity help to control pain. Surgery is used only for severe tendinitis that is not healing from other treatments.

Drug Therapies

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as indocin (by prescription) and ibuprofen (over the counter), reduce pain and inflammation. NSAIDs have various side effects.
Lidocaine or corticosteroid injections into the tendon -- cannot be used for weight-bearing tendons because of risk of rupture.
Colchicine -- for calcific tendinitis (when calcium builds up in the joint).

Complementary and Alternative Therapies

Ice, especially after the initial injury
Rest
Massage
Temporary immobilization of the affected limb (slings, splints)
Flexibility and strengthening exercises after acute phase has passed
Physical therapy (such as range-of-motion exercises)
Ultrasonography (phonophoresis) -- high-frequency sound used to heat an area and increase the blood supply
Transcutaneous electrical nerve stimulation (TENS) -- electricity used to control pain

Nutrition and Supplements

Vitamin C (250 - 500 mg two times a day) to aid in healing, increase immune function, and reduce inflammation
Calcium (1,500 mg a day) and magnesium (750 mg a day) to aid healing of connective tissues and muscles
Vitamin A (15,000 IU a day) for immune function and healing
Vitamin E (400 - 800 mg a day) and essential fatty acids, such as fish oil or evening primrose oil (1,000 - 1,500 IU one to three times a day) to reduce inflammation

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Bromelain (250 - 750 mg three times a day between meals), an enzyme derived from pineapple, to reduce swelling and inflammation.
Curcumin (Curcuma longa), yellow pigment of turmeric, (200 - 400 mg three times a day between meals) to reduce inflammation.
White willow (Salix alba) bark contains salicin, which acts similar to aspirin in reducing inflammation and pain. Make a tea with 1 - 2 g of bark boiled in a cup of water. Strain and cool. Or use 2 - 3 tsps. powder in 1 cup of boiling water. Drink three times a day. Do not use if you are allergic to aspirin or take blood-thinning medication.
Licorice (Glycyrrhiza glabra) (3 cups of tea a day) to reduce inflammation. Do not use if you have high blood pressure or congestive heart failure.

The following herbs may also help with inflammation, although they have not been tested for tendinitis.

Cat's claw (Uncaria tomentosa ), one 20 mg capsule per day.
Devil's claw (Harpagophytum procumbens ), 750 mg three times per day. Do not use if you take blood-thinning medication.
Boswellia (Boswellia serrata ), 300 - 400 mg three times per day.

Homeopathy

Homeopathic remedies for tendinitis include creams or gels. Arnica cream by itself or in combination with Calendula officinalis, Hamamelis virginiana, Aconitum napellus, and Belladonna, applied three to six times a day, speeds healing and decreases discomfort. For acute injuries, always start with Arnica.

Internally, the dose is usually 3 - 5 pellets of a 12X to 30C remedy every 1 -4 hours until the symptoms get better.

Bryonia for pains that are worse with the slightest motion or when jarred. The pain feels worse with cold and better with heat.
Phytolacca for tendinitis where the pain is focused at the insertion of the tendons and feels worse with heat.
Rhus toxicodendron for tendinitis that is worse in the morning.
Rhododendron for tendinitis that gets worse with barometric changes.

Many naturally oriented physicians use injectable homeopathic medications, including Traumeel, which has shown promise in reducing inflammation in some studies.

Physical Medicine

Orthotics or heel lifts and shoe correction (Achilles tendinitis).
Elbow strap and small (2 lb.) weights (tennis elbow).
Contrast hydrotherapy, or alternating hot and cold applications. After the first 24 - 48 hours, soak affected part for 3 minutes in hot water, then 30 seconds in cold water.
Castor oil pack: Apply oil to a clean, soft cloth, cover in plastic wrap, and apply to the affected area. Place a heat source over the pack, and let sit for 30 - 60 minutes.

Acupuncture

In 1997, the National Institutes of Health reported that acupuncture may be an effective therapy for tennis elbow. In addition, two studies examining the effect of acupuncture on this and other types of tendinitis have found that acupuncture provides better pain relief than placebo.

Acupuncturists report that patients with tendinitis frequently exhibit a primary deficiency in the liver meridian, with a relative excess in the gallbladder meridian. In addition to needling treatment on the liver meridian and the supporting kidney meridian, treatments using moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) may also be included. Needling and moxibustion may also be directly applied to painful areas and related sore points.

A technique known as Balance Method acupuncture can be effective in treating many musculoskeletal problems, including tendinitis.

Chiropractic

Although no well-designed studies have examined the effectiveness of chiropractic treatment for tendinitis, chiropractors commonly treat this condition with ultrasound, electrical muscle stimulation, manual trigger point therapy (applying firm pressure by hand on a trigger point for several seconds and then stretching the muscle afterwards), and massage. Joint manipulation may also be performed on individuals with diminished joint mobility.

Following Up

Tendinitis often has three stages: Stage 1 is characterized by a dull ache following activity, which improves with rest. In stage 2, there is pain with minor movements (for example, dressing). Stage 3 is when you have constant pain.

Special Considerations

Recurrences are common, particularly for athletes and people whose work requires repetitive motions.

Supporting Research

Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park, NY: Avery Publishing; 197:174-175.

Blonstein JL. Control of swelling in boxing injuries. Practitioner. 1969;203:206.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 2000;109:9–14.

Duke JA. The Green Pharmacy. Emmaus, Pa: Rodale Press; 1997:106-109.

Gimblett PA, Saville J, Ebrall P. A conservative management protocol for calcific tendonitis of the shoulder. J Manipulative Physiol Ther. 1999;22(9):622-627.

Gobel H, Heinze A, Ingwersen M, et al. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain. Schmerz. 2001;15:10–18.

Jensen R, Gothesen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med. 1999;5(6):521-527.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kelly WN, Harris ED Jr, Ruddy S, Sledge CB. Textbook of Rheumatology. 5th ed. Philadelphia, Pa: WB Saunders Co; 1997:372-373, 386, 422-429, 462-463, 486, 558-559, 598-599, 603-606, 642.

Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee-a randomized double blind, placebo controlled trial. Phytomedicine. 2003;10:3–7.

Kleinhenz J, Streitberger K, Windeler J, Gubbacher A, Mavridis G, Martin E. Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain. 1999;83:235-241.

Koopman WJ. Arthritis and Allied Conditions: A Textbook of Rheumatology. 13th ed. Baltimore, Md:Williams & Wilkins; 1997:44, 1769-1771, 1795, 1894-1896.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Millar AP. Sports Injuries and Their Management. Sydney, Australia: Maclennan & Petty; 1994:10-14, 84-85, 101-103, 111-112, 118-119, 8830-8831.

Molsberger A, Hille E. The analgesic effect of acupuncture in chronic tennis elbow pain. Br J Rheumatol. 1994;33:1162-1165.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:805-809.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed on September 24, 2001.

Vinger PF, Hoener EF, eds. Sports Injuries: The Unthwarted Epidemic. Boston, Mass: John Wright; 1982:227, 255.

Review Date:
6/30/2006
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Anterior knee pain

admin — Wed, 03 Sep 2008 17:55:27 -0700

Overview

Definition
Alternative Names
Considerations
Causes
Symptoms
First Aid
Do Not
Call immediately for emergency medical assistance if
Prevention
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Anterior knee pain is pain that occurs at the front of the knee.

Alternative Names

Runner's knee

Considerations

The health care provider will perform a physical examination of the knee to confirm and assess the pain.

Tests that may be performed to rule out possible structural damage to the knee or connective tissue include the following:

Joint CT scan
Joint x-ray
MRI scan of the knee

Causes

Common causes of runner's knee include rotation (pronation) and lateral (away from the middle) pulling of the kneecap. This causes the kneecap to become misaligned with the connective tissues and muscles involved with knee movement.

Anterior knee pain may also be caused by:

Arthritis
Cartilage injury
Pinching of the inner lining of the knee with knee motion (synovial impingement, or plica syndrome)
Poor alignment of the patellofemeral joint (where the kneecap rubs against the lower portion of the thigh bone)
Softening of the cartilage under the kneecap (chondromalacia patellae)
Tendinitis of the quadriceps tendon (where the thigh muscles attach to the top of the kneecap) or patellar tendon (where the kneecap attaches to the shin bone)

Symptoms

Symptoms include knee pain below the kneecap and on the sides of the kneecap, particularly with deep knee bends or prolonged sitting.

In cases of runner's knee, pain occurs first when running downhill then gets worse and occurs with all running. Finally, pain is present even when you do not run.

First Aid

Treatment of anterior knee pain involves resting the knee and not running until you can do it without pain.

A sports medicine specialist or physical therapist may prescribe stretching exercises for the hamstrings and quadriceps, and strengthening exercises for the muscle that pulls the kneecap toward the center of the body. You can substitute bicycling for other exercise if you can do it without pain.

Special shoe inserts and orthotics (support devices) may help prevent further injury after healing.

Do Not

Do not perform deep knee bends or overuse the knee until your symptoms improve.

Call immediately for emergency medical assistance if

Call your health care provider if knee pain persists in spite of resting the joint.

Prevention

To help prevent sports injuries:

Warm up properly before exercise
Stretch after warm-up or exercise
Cool down after exercise

References

Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;75:194-202.

May TJ. Persistent anterior knee pain. Am Fam Physician. 2007;76:277-278.

Review Date: 5/5/2008

Reviewed By: Andrew L. Chen, MD, MS, Orthopedic Surgery and Sports Medicine, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

adam.com

Source Doc: 1_001259

Chondromalacia patella

admin — Wed, 03 Sep 2008 17:49:52 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention
References

Illustrations

Chondromalacia of the patella

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Chondromalacia patella is the softening and degeneration of the tissue (cartilage) underneath the kneecap (patella).

Alternative Names

Patellofemoral syndrome

Causes, incidence, and risk factors

Chondromalacia patella that occurs in adolescents and young adults is thought to be related to overuse, injury, or too much force on the knee. It is more common in females. Many young people have a a slight problem with the position of the kneecap.

Chondromalacia patella may also be a sign of arthritis of the kneecap, which is usually seen in older individuals.

People who have previously had a dislocation, fracture, or other injury to the kneecap may be more likely to get chondromalacia.

Symptoms

A grating or grinding sensation when the knee is extended
Knee pain in the front of the knee that worsens after sitting for a long period of time
Knee pain that worsens with using stairs or getting out of a chair
Knee tenderness

Signs and tests

The doctor will perform a physical examination. The knee may be tender and mildly swollen, and the kneecap may not be perfectly lined up with the femur (thigh bone).

When you straighten your knee, a grinding sensation may be felt below the kneecap. Pressing the kneecap when the knee is straight may be painful.

X-rays are usually normal, although a special x-ray view of the kneecap may show signs of arthritis or tilting.

Treatment

Temporarily resting the knee and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may help relieve pain. Physical therapy, especially quadriceps strengthening and hamstring stretching, may be helpful.

Limit participation in sports or strenuous activity until the pain has gone away. Avoid activities that increase the knee pain, such as deep knee bends, until the pain improves.

If the alignment of the patella cannot be corrected with therapy, surgery may be an option. Depending on the type of misalignment, the surgery may be arthroscopic (using a camera, which allows a smaller incision) or open.

Expectations (prognosis)

Chondromalacia patella usually improves with therapy and use of NSAIDs. For the few people who need it, surgery is successful most of the time.

Complications

The main complication is failure of treatment to relieve pain.

When surgery is necessary, surgical complications may include:

Failure to relieve pain
Infection
Worsening pain

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of this disorder.

Prevention

Avoid trauma or abnormal stress on the knee. Keep the leg muscles strong and flexible, especially the quadriceps and the hamstrings.

References

May TJ. Persistent anterior knee pain. Am Fam Physician. 2007;76:277-278.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000452

DrSugar on Chronic and Nagging Knee Pain

DrSugar — Wed, 16 Jul 2008 03:30:00 -0700

DrSugar is keyed up about the knee and the nagging pain in that joint that can frustrate your fitness drive. Here's what he has to say.

Let's begin with a brief anatomy lesson for the knee is a complicated structure with multiple moving parts and a variety of connective tissues holding everything together. For a dedicated athlete or even the average weekend warrior, the knee joint is a minefield of potential sites of injury. Commonly injured areas prone to inflammation include: the prepatellar bursa (in front of the knee cap), patellar tendon (holds the knee cap in place), anterior cruciate ligament (criss-crosses inside the knee), meniscus (lines the bottom of the knee joint), as well as the bones and muscles making up the knee joint.

Now that you know a little more about the structure of the knee, to see how it can break down read more.

Chronic knee pain is usually due to inflammation of tendons or bursa around the knee, however sometimes more serious injuries such as stress fractures of the tibia (shin bone) can also start as a nagging pain. Two of the most common chronic knee problems are patellofemoral syndrome (aka runner's knee), which affects the anterior knee, and iliotibial band syndrome, which affects the lateral knee and thigh. Both are very common and usually occur as a result of overuse or poor exercise habits. To prevent these syndromes it is important to minimize high impact activities when possible. This includes always using proper running shoes that fit well, avoiding downhill running, and minimizing jumping or running on hard surfaces, such as concrete. Other ways to decrease stress on the knee include mixing exercises such as running, swimming, and biking. The idea is to avoid producing only one type or repetitive motion at the knee joint.

If it is too late for prevention, then there are a number of ways you can help treat your soft tissue knee injury. The most important first step is to slow down and avoid the activity that is causing the pain. The most common culprit is running because it is such a common high impact activity. If you are an avid runner plagued with knee pain, you might have to switch to biking or swimming until the inflammation subsides. Ice, heat, and anti-inflammatory medications can also help with pain in an acute setting, but are unlikely to provide any long term benefit. For long term results, it is important to strengthen the muscles around the knee. This can be accomplished through physical therapy or core strength training with an experienced trainer. Another important solution is to have your feet evaluated for orthotics or other shoe inserts if you suspect that you have low arches or any other foot abnormality. It is also important to see your doctor for any severe knee pain or prolonged pain that is not relieved with methods described above to rule out more significant damage to ligaments or bones.

If you have a question for DrSugar, send me a private message here and I will forward it to the good doctor.

DrSugar's posts are for informational purposes only and should not be considered medical advice, diagnosis, or treatment recommendations. Click here for more details.

Avoid Runner's Knee

FitSugar — Fri, 02 May 2008 05:30:00 -0700

If you are new to running you definitely want to be wary of developing runner's knee, an overuse injury that is twice as likely to occur in women than men. Known in the medical world as patellofemoral pain syndrome (PPFS), runner's knee causes pain in and around the knee cap (or patella). The pain is caused by tracking issues with the knee cap that irritate the bony groove the knee cap actually sits in. While there can be many reasons for this annoying and common problem that most often strikes newbies, it is most often caused by tight hamstrings and calves (the muscles in the back of the leg) coupled with weak quads (the muscle at the front of the thigh).

You don't need to avoid running to prevent runner's knee, but you should try to run on accommodating surfaces like dirt paths and asphalt, not concrete. Uneven terrain and hills can aggravate knee tracking problems, so be wary of hills if you are experiencing tenderness around your knee caps. Be proactive and strengthen your quads. And to see how, just read more.

Wall sits are an easy exercise that target the quads.

Stand with your back against a wall, placing your feet about two feet out in front of you. Feet should be hips distance apart.
Bending your knees, slide your back down the wall until your knees are at 90 degree angles. Your knee joints should be over your ankle joints, so you may need to inch your feet further from the wall to create proper alignment. Don't let your knees fall in on the midline of your body, or sway outwards.
Hold for one minute, do three reps.

Don't forget to stretch your hamstrings and your calves too.

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