A meniscus is a cushion type of structure that sits between the femur head and the tibia, on the medial side of the knee and the femur and the fibula on the lateral side of the knee. Its role is to protect any friction between the femur head and the other bonds. In sports activities where there is a lot of stop-and-go or stop-and-twist type of motion, such as basketball or netball, the meniscus is put under intense stress, and the chance of injuries can increase. Meniscus tear classification? A meniscus tear is a type of injury that can be classified based on its severity and size. There are different types of classifications, but the most used and accepted is Laprade’s classification (LaPrade et al., 2014). Laprade classification of Meniscus root tears (MRTs) is based on the morphology during arthroscopic assessment. The classification includes five distinct lesions: Type 1 tears represent partial root tears that are stable (7% of all meniscus root tears). Type 2 tears represent complete radial tears within 9 mm of the root attachment centre (67.6%). This type of tear is then subdivided in three other sub-group based on the distance of the tear from the center of the root attachment (2A 0–3 mm, 2B 3–6 mm and 2C 6–9 mm). Type 3 tear was defined as bucket-handle tear with complete root detachment (5.6%). Type 4 tears are complex oblique tears with complete root detachment (10%) and bony avulsion of the root attachment (9.9%). Meniscus tear symptoms In order to diagnose a meniscus tear, the gold standard method is an MRI scan. That said, nowadays, the only time you would get an MRI scan to your knee for a meniscus injury, is for surgery purposes, as we now know, that live with a meniscus tear is possible, as long as the muscle that across the knee joint are well looked after. That said, in the early stage, the symptoms of meniscus tear can include: Joint swelling Tenderness in the knee on the medial or lateral portion of the knee A feeling of catch in the knee as is moving Limited range of motion A feeling of the knee not able to hold the weight. Localised pain To alleviate the discomfort, the aid of a crutch, especially in the early stage, is recommended, and as per all acute phase injuries, the first few days, rest and movement with pain-free range of motion are extremely important. In addition to this, heat can be applied for intervals of 15 minutes once or twice a day. How do we rehabilitate a meniscus tear? As with all injuries, there is not one rehabilitation process that works for everyone, but there are guidelines that can be used to lead a recovery process. Let’s start with the acute phase (first phase), which is the first 72 hours. In this time frame, we would avoid putting direct weight on the affected side and, where possible, do simple knee flex/ext pain-free movements. Placing a pillow under the knee could help avoid locking the knee, which may not feel comfortable. Second phase: In this phase, which would be somewhere after the initial 72 hours, if it feels comfortable, we can start placing some gentle weight on the knee, even though using a crutch can still be acceptable, especially in the early stage of this phase. The second phase can last up to 5 or 6 weeks. An active range of motion, where the knee flexion is always greater, and the knee extension is getting closer to full extension, would keep increasing daily. In this phase, we can introduce Isometric exercises for knee flexion and extension. Those types of exercises can be done with a bench curl machine or an elastic band or ankle weight. What is most important is to start with lightweight or resistance, hold the weight for 40 seconds, and release for 40 seconds. The time frame can be adapted to the patient’s comfort. Halfway through this phase, we can start to introduce eccentric and concentric loads with weights and potential assisted sit and stands type of movement, with a chair that is higher than average and something in front of the patient where they can hold on to (like the back of another chair). As the patients’ confidence and muscles start responding more and more to these exercises, we can move to the third phase, and here we are in week 7 or 8. The chair for sitting and standing is now at average height; we may not need anterior assistance anymore. It is now essential to ensure the patient is walking and confident about placing weight on the affected side. Single-leg squats can be initiated, maybe even with the aid of a stick initially, and day by day without. The load on the anterior and posterior chain muscles of the thigh is increased, and as we move forward from week 10 to week 12, plyometric exercises can be introduced. Along those exercises, we look into explosive lunge, squatting, skipping the rope and running. A great test would be the hopping test, which consists of single-leg hopping, side to side. One minute of oping should not reproduce any pain. All these progressions are approximations of a natural healing process, and based on the individual presentation, this protocol can be modified and enriched as needed. Meniscus tear and surgery. In their meta-analysis of 6 randomised control trials, Meng et al., 2024, concluded that data favour exercise therapy over surgery as a first intervention for meniscus tears. These conclusions come from the fact that the pain reduction, estimated with the knee Knee Injury and Osteoarthritis Outcome Score (KOOS), does not show any difference between the arthroscopic partial meniscectomy (APM) and exercise therapy. That said, it doesn’t mean that surgery is never an option. What Meng et al., 2024 prove is that before heading for an invasive procedure, it is worth it to look into exercise therapy on its own. If the conservative method does […]
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Patellar tracking disorder is a condition that occurs when the patella, also known as the kneecap, moves out of its original place when the leg straightens or bends. What causes Patella Tracking Disorder? In most cases, the kneecap shifts towards the outside of your leg, called “Lateral Patella tracking”. Occasionally in some cases, it may shift toward the medial side too. Why this shift happens due to the force applied to the kneecap itself. It was said that the knee joint is a hinge joint, which connects the tibia and fibula of your leg with the femur. The kneecap is held in its natural position by ligaments on the medial and lateral sides and by tendons on the top side. Below the patella is a cartilage layer that helps the patella glide along the femur’s groove. When the cartilage below the patella does wear out, it can create pain and discomfort in the knee. The misalignment of the patella results from tendons, muscles or ligaments that are either too tight or too loose. Lateral patella tracking VS Medial patella Tracking In the case of Lateral Patella Tracking, the Vastus Lateralist is over-developed compared to the Vastus Medialis or the IT Band (Iliotibial Band) pulling too much. Vastus L. can overtake Vastus M’s strengthening due to the muscle size. Indeed the V.L. is visibly bigger than the V. M. On the other hand, tension along Gluteus Max and or tensions in the TFL can play a role in the pulling of the IT band. Are you in Pain, and you suspect to have a Patella Tracking disorder? Get in touch with Giovanni now. Risk factors for Patella Tracking Disorder Here is a list of reasons that can lead to Patella Tracking Disorder: Footwear Running Weakness in the quads muscle Unbalance of muscle between the inner and outer regions of your tight Sports that require excessive knee bending, jumping or squatting Improper form or techniques while working out or during sports activities Overweight Genetics (structural reasons) Incidents or trauma to the knees Malformation within the femur bond Damaged cartilage Symptoms Pain is the most symptom of Patella tracking disorder. The pain caused by this condition can occur during regular activity such as standing up, walking and or sitting down. Any knee movement can recreate the pain. In the case of arthritis, the pain can be more intense, and swelling is present at the knee joint. Treatment Options At Melbourne Massage and Treatment, the services available for Patella tracking are multiple. Depending on the severity of the condition, Myotherapy treatment and or MLD are the most recommended. Thanks to Dry Needling and/or Joint Mobilisation therapy, Myotherapy treatment can help rebalance the muscle forces surrounding the knee cap. On the other hand, MLD can help in reducing the inflammation and the swelling present eventually on the knee joint. What then Giovanni would look in, too, is also the mobility of ankles and hips. The correct mobility of these two joints would ensure that the knee is not compensating for the poor joint quality of movement, which can be part of why the patella tracking disorder is in the first place.
Arthritis can be described as the swelling and tenderness of one or more joints. Arthritis symptoms and types Symptoms include: joint pain stiffness reduce Range of Motion (ROM) Major Types: Osteoarthritis Rheumatoid-Arthritis Said so, Arthritis can be a consequence of another type of disease, like: Ankylosing spondylitis Gout Juvenile idiopathic Psoriatic A. Reactive A. Septic A. Thumb A. Those types of Arthritis manifest in different body areas and can display simultaneously. Symptoms can worsen with the ageing process. What is Osteoarthritis, and what causes it? We refer to osteoarthritis when the cartilage between the bonds that form a joint does wear out. Cartilage is a hard, slippery tissue that sits between 2 bonds, like the knee cap and femur, or between the bond of your fingers and toes. When this protective layer that keeps the two bonds separate does work out, the joint starts swelling due to an inflammatory process, and pain is consequently reproduced. The cause can be joint overloading due to chronic injuries or imbalance within the musculoskeletal system. For example, wearing high heels, or having a high foot arch, can lead to wear in the cartilage of the big toes. There is no cure for this type of arthritis, and pain management, through manual therapy and or medications is what so far can be done. What is Rheumatoid Arthritis, and what causes it? Rheumatoid A. is a disease type where the immune system attacks the joints. For rheumatoid arthritis, there are fewer known reasons why it can happen, but there are some factors that can play a role, such as: Family history Gender Obesity Joint injury Age Diagnoses To diagnose arthritis, you would have to see your GP and go for further investigations such as an X-ray, blood test or other medical investigations process. Massage and Treatment for Arthritis. For this type of condition, massage can be a useful therapeutic tool to reduce the pain sensation and manage the presentation. No massage technique can cure the presentation itself, but techniques like MLD are probably the most effective in pain management and symptom relief. Thanks to the direct stimulation of the Lymphatic System, MLD can inhibit the pain signal and relieve the person. As arthritis is often present in older people, we must check for any other condition or presentation that is an absolute contraindication to this type of treatment before commencing treatment. If this post is talking to you, and you need a massage, book your next session by clicking here.
Apr
Knee pain is a common presentation for clients of any range of age and gender. Knee pain indeed is a vast topic. So in this post, we are going to go through how to identify the reason why we can experience knee pain. For doing so we are going to look at some special testing, that we use for the knee joints. Next, in a further post, we may analyse individual conditions. What about the Knee Joint? The knee is the strongest joint in the body. It takes a lot of pressure from the upper body and still has to handle the shock coming from the lower leg session, shock as walking, running and jumping. Indeed, whenever we do one of these actions, the knee plays a big role. Knee Anatomy Bond: Above: Femur Below: Medially the Tibia, laterally the Fibula. Patellar is the front “floating bond” Ligaments: Anterior Crucial Ligament Posterior Crucial Ligament Posterior Menisco-Femoral Ligament Fibular Collateral Ligament Tibial Collateral Ligament Transverse Ligament (this one is visible only from the front side of the knee, below the patella). In between the bonds we have: Medial Meniscus Lateral Meniscus If this post is talking to you, book your next massage session by clicking here. So, the knee joint can be divided into two parts: Tibiofemoral joint Connects through the collateral ligaments, cruciate ligaments and menisci; Patellofemoral joint Gives stability to the medial and lateral retinaculum and allows the extension mechanism through the tendons of the quadriceps f.. Now that we have a better idea of what the knee anatomy is, we can look into his functionality. Knee ROM are: Extension: 0° Flexion: 140° Internal Rotation: 30° External Rotation: 40° Abduction/Adduction: 15° Said so, we can see that the major movement that the knee can accomplish is, flexion. Even if the Internal and External rotation since to be a big move for the knee, in the reality, that’s not always the case. The older we get, easily this motion actively gets tighter. Indeed, one of the main reason for meniscus injury is the twisting of the knee, when the feet is holding the ground and the body rotates. But as previously mentioned in this post we would look into the knee special test. What knee functional test have to tell us? As we already mentioned in another post, a generic active, passive or resisted ROM tell us about muscle functionality. On the other hand, a special test for the knee can show us if a ligament or a meniscus is loose, in the case of ligament or injured. Furthermore, special tests, on the knee are essential to prevent further injury and reduce joint degeneration. To start with we have the drawer test: Anterior Draw test and Posterior Draw test. The Anterior one is to test the anterior crucial ligament, and the posterior, obviously, is for the crucial posterior ligament. Both these tests are done with the client lying supine on the table, with a hip and knee flexed, and foot on the table. The therapist will ensure that the foot doesn’t move and will place its hands around the knee, with the fingers (except the thumb) seating at the top of the calf and the thumbs seating on the patella. For the A.D. test, the therapist will lightly pull the knee joint away from the patient body. On the other hand, for the P.D. test, the therapist will push the knee towards the patient’s body. These tests are positive if there is a loose movement within the knee, in the direction of pull or push. If the client has a history of injuries, to the ACL or PCL the therapist wants to make sure not to push or pull with great effort, or injury could occur. Vagus and varus test. Those tests analyse the status of the medial and lateral ligaments. For the valgus test, the therapist places one hand above the knee laterally, and the other hand above the ankle on the medial side. By applying opposite pressure in the 2 directions we put the medial ligament under stress. If pain is reproduced, or there is a loose movement the test is positive. The same action is for the Varus test. In this case, the hands are placed still above the knee and ankle, but the bottom hand is placed laterally and the top one, is placed medially. Apleys Test This test is used to evaluate the state of the meniscus. The client, in this case, would be lying in a prone position, with the knee flexed. The therapist will be standing next to the client, on the side of the knee flexed and will apply pressure to the knee. If no pain is reproduced with pressure only, the therapist can gently apply a rotation movement to the flexed knee. The test is positive if the pain is reproduced. McMurray test. This is luckily the most efficient and most used knee test used by therapists in case of meniscus injury Here is how it works: The patient lies in the supine position with the knee completely flexed (heel to glute). Lateral Meniscus: the examiner then medially rotates the tibia and extends the knee. Medial Meniscus: the examiner then laterally rotates the tibia and extends the knee. McMurray is a positive test if the pain is reproduced. There are still a couple of tests that can be done for the knee, but so far we did cover the most important. About the therapy that I can offer for releasing knee pain, MLD is what I would suggest the most. Especially for acute pain and swelling or oedema reduction. Whereas, Myotherapy or Remedial Massage and Thai Massage can be used too but more to facilitate and or strengthen the muscle surrounding the area.