Knee Injury Prevention

Exercises to Keep You From Getting Sidelined

The evidence strongly supports the implementation by clinicians, and athletes. Programs effective in preventing injuries include a combination of dynamic stretches (flexibility), running drills, strength training, core strength, and plyometrics.

Athletes should complete these programs several times each week, and they should exercise a minimum of 30 minutes weekly. These prevention programs should start during the sport’s preseason and continue through the regular season.

Clinicians, coaches and athletes should all help ensure that the programs are routinely performed before and during the season. Because most of the research studies they examined included high school and collegiate athletes. Researchers strongly recommend these programs for athletes between the ages of 12 and 25 years. However, these programs may also benefit older athletes. Your physiotherapist can work with you and your coaches to help design the right program for you.


Exercise Is Essential for Osteoarthritis

The Benefits of Physical Activity

The authors offer 7 key recommendations. (1) Exercise and physical activity should be tailored to your needs and preferences. (2) Consider water exercises if it is too painful to exercise on land. (3) Supervised exercise therapy over a 6-week period is often helpful to get you started. (4) Some people may need 12 weeks of supervised therapy (GLA:D)to begin. (5) After you complete supervised therapy, you may need periodic “booster sessions” . (6) Home exercises should be performed to optimize your outcomes. (7) You should be sure you understand how to manage flare-ups in pain and how to modify your exercises.

The benefits of exercise are numerous: they help fight cancer, heart disease, diabetes, and osteoporosis, and improve your mental health. Your physiotherapist can help design the right program for you. JOSPT

Optimizing Recovery After Achilles Tendon Pain

Guidelines Help Deliver Quality Care

You may recover quickly or over several months from pain in your Achilles tendon. Although you have pain, you should continue your daily activities within your pain tolerance.

Your physical therapist will likely prescribe strength training to aid your recovery. Strength training exercises and additional weight may be added to help make your calf muscles stronger. These exercises are typically performed slowly for the best results.

If your pain began recently, your physical therapist may use a treatment called iontophoresis, which delivers a medicine (dexamethasone) to the painful area to reduce soreness and improve function. Your physiotherapist can help guide your recovery from Achilles tendinopathy, decreasing pain, improving mobility, and restoring muscle power. JOSPT

Optimizing Recovery After Knee Meniscal or Cartilage Injury

Guidelines Help Deliver Quality Care

Protected weight bearing, early movement, and supervised rehabilitation—including therapeutic exercise and neuromuscular stimulation—offer the strongest evidence for patient improvement. Your recovery should include in-clinic treatment and exercises at home. You will use crutches to allow you to walk while enabling the injury or surgical site to heal. You may need crutches for up to 8 weeks.

Early in your recovery, you will be guided to improve your range of motion to reduce joint pain and fully straighten your knee. Ice may help decrease swelling and pain. Exercises to increase knee and hip muscle strength will be added over time.

The evidence suggests that neuromuscular stimulation may also help improve strength and function. These exercises improve coordination, confidence in movement, stability, power, and function to help you return to activities and sport. A conversation between you and your therapist and surgeon will determine how soon you may return to full activity. JOSPT

Knee Ligament Sprains and Tears

Ensuring Best Care

Knee ligament injuries can result from contact or faulty movement when playing sports, but may also happen during leisure and work activities. Overall, the revised guidelines indicate that early movement, cryotherapy (ice), and supervised rehabilitation that includes therapeutic exercise and neuromuscular stimulation offer the strongest evidence for treating these injuries.

What does this mean for you? Your recovery should include both in-clinic treatment and at-home exercises. Early on, your therapist will show you how to improve your range of motion to reduce joint pain and fully straighten your knee. Ice and other types of cryotherapy may help decrease swelling and pain. Your therapist will prescribe exercises to activate and strengthen the muscles that support the knee and will progress these exercises for 6 to 10 months after injury, and particularly following knee surgery. The therapist also may add neuromuscular stimulation for 6 to 8 weeks to improve strength and function. Exercises that improve coordination and confidence in movement, stability, power, and function (often called neuromuscular re-education) can also help you return to activities and sport. The findings further support the use of early weight bearing. However, the evidence for bracing is uncertain; the guidelines recommend that you speak with your surgeon and therapist to determine whether a functional knee brace will help you. JOSPT


An Underdiagnosed Problem for Athletes?

Always wear properly fitted protective equipment when playing sports. However, if you are concerned you may have had a concussion, get it checked out! The symptoms of a concussion can vary among athletes and be hard to recognize. You should think about the potential of having a concussion whenever you have sustained an impact to your head or neck. Watch for symptoms such as headaches, confusion, dizziness, tiredness, trouble concentrating, forgetfulness, getting easily frustrated/irritated, trouble sleeping, trouble paying attention, balance problems, vomiting, being bothered by light or noise, blurred vision, ringing in the ears, vision changes, or a loss of consciousness.

Because so many athletes have trouble recognizing that they have had a brain injury, some sports teams are using these preseason screening tools to make it easier to find out if athletes have had any changes in function that might indicate a problem. These tests can also be used after a head injury to help determine whether further medical tests are needed or how much rest is required before the athlete returns to sport. Only a healthcare provider can tell if an athlete has had a concussion and when it is safe to return to play. JOSPT

Knee Pain

A Holistic Approach to Treatment

For people with anterior knee pain, the good news is that there are many potentially effective treatments. If you have altered tracking of the kneecap, taping or a brace may temporarily decrease the pain. Strengthening your quadriceps and hip muscles can help decrease the load and pressure on your knee, and thus the pain under your kneecap. Training to improve how you move and run may also decrease the pain. Finally, orthotic devices or changing your shoe type may aid in lessening the pressure under your kneecap. After a thorough evaluation, your physiotherapist can help customize a treatment program for you. For more information on the treatment of patellofemoral pain, contact your physiotherapist specializing in musculoskeletal disorders. JOSPT

Low Back Pain

How Does Your Physical Therapist Treat Low Back Pain?

For people with low back pain, the good news is that your back will likely feel better, even though the pain may be severe. Staying active is important, and bed rest should be avoided. If you are worried that your pain may not subside, your physical therapist can teach you ways to help you move better and recover faster. Based on your examination, the best treatment for acute low back pain may be manual therapy (mobilization/ manipulation) or exercises that restore motion and decrease pain in the leg that is linked to your low back pain. Exercises that improve coordination, strength, and endurance are best added to treatment once the pain lessens. However, if your pain becomes chronic, moderate- to high-intensity exercises and progressive exercises that focus on fitness and endurance are helpful in pain management. Your physiotherapist can help customize an exercise program for you. For more information on the treatment of low back pain, contact your physiotherapist specializing in musculoskeletal disorders. JOSPT

Heel Pain

Hands-on Physical Therapy and Stretching Prove Effective for Treating Heel Pain

Although stretching the calf and foot can reduce heel pain, the addition of hands-on physical therapy resulted in better pain relief and greater improvements in function during the first month of treatment. If you have heel pain, you may wish to seek the help of a physical therapist who can instruct you on the proper stretching techniques to perform. The physical therapist can also determine if you are a candidate for trigger point soft tissue techniques applied to your calf muscles. For more information on the management of heel pain, contact your physiotherapist specializing in musculoskeletal disorders. JOSPT

Total Hip Replacement

How Long Does It Take to Recover?

Improvements in strength, balance, and coordination after a hip replacement are needed to help patients return to their daily activities and decrease their risk for falls. Researchers have previously shown that hip strength and muscle weakness persist up to 2 years after surgery. Based on the rapid recovery in the first 3 to 4 months, some patients may stop doing their exercises, which may limit their recovery and place them at risk for falls. On the flip side, some patients may be frustrated if they are not getting better faster, set goals for your recovery, and begin to answer the question “How am I doing compared to others?” For more information on rehabilitation following a hip replacement, contact your physiotherapist specializing in musculoskeletal disorders. JOSPT

Baseball Pitching

Understanding the Mechanics of Throwing a Baseball May Help Protect the Shoulder and Elbow

Short distance throws from flat ground are similar to fastball pitches. Thus, flat-ground throws of 120 to 180 ft can be used as warm-up or conditioning exercises for college-level pitchers, and appear to be safe for recovering pitchers. Maximum-distance throws create the most force, speed, and motion at the shoulder and elbow. These greater distance throws should be used carefully, because they can cause injury if used too often or too soon after injury. Supervised retraining may help pitchers recovering from a shoulder or elbow injury. For more information on rehabilitation following a pitching related injury, contact your physical therapist specializing in musculoskeletal disorders. JOSPT

Return to Sport After an ACL Surgery

When Should an Athlete Return to Sport After an ACL Surgery?

Strength and power deficits after surgery may be a risk factor for future injuries and may set athletes up for failure when they try to return to their prior performance levels. Of the 9 tests they used, the researchers found only 3 tests that were sensitive enough to measure side-to-side differences. These 3 tests can be used during more advanced recovery phases after surgery to help ensure that the athlete’s exercise program is successful in returning the injured leg at least to the level of the uninjured leg. The researchers suggest that the surgically repaired leg should perform at least 90% as well as the uninjured leg before you return to sport. The bottom line is that these 3 hopping tests can be used as part of a comprehensive physical and functional examination to help ensure not just a speedy, but a safe return to sport after ACL reconstruction. For more information on rehabilitation following ACL surgery, contact your physiotherapist specializing in musculoskeletal disorders. JOSPT

Knee Pain

Strengthen My Hips? But It’s My Kneed That Hurts!

Patients with knee pain may benefit from starting with hip strengthening exercises. Potential benefits include faster pain relief and better hip strength. You may be curious why the patients in the hip group got better quicker. This may be because the knee strengthening exercises actually irritated the knee, or perhaps because the exercises that focused on hip strengthening helped improve the mechanics of the entire leg and so reduced stress on the knee. Although starting off with hip strengthening exercises may decrease the pain sooner, it is important to follow hip exercises with specific functional exercises that target the muscles of the entire leg. You also need to consider the physical activities you perform and your response to this exercise approach to ensure your best outcome. Your physiotherapist can help customize this approach for you. JOSPT

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