Arthroscopic Knee Surgery – Does it Even Work?

While researching for my latest article in the Portsmouth Herald, I came across an interesting study titled: “Arthroscopy for degenerative knees – a difficult habit to break.”

The title of this study is telling.

Arthroscopic knee surgery is still one of the most common surgeries performed, despite research telling us that it’s not nearly as effective as most people are led to believe.

Furthermore, studies now indicate that people who get arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that could have been avoided.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint if you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee.

Sounds pretty simple and harmless – right?

But over the years, research has shown that this procedure is really not necessary in most cases.

Most people can get pain relief and restore function in their knees without ever getting surgery.

One of the earliest studies from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have shown similar results. Even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment like physical therapy.

Despite all this research, surgeons are still performing these procedures more than ever.

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management and not giving therapy enough time to work.

In our office, we often see people after they’ve tried regular physical therapy first. Since we have a more specialized approach, and we’re able to spend more time with our clients, we tend to get better results and can help clients avoid surgery all together.

But not all physical therapy clinics are afforded that luxury. In those cases, people are led to believe that the physical therapy “didn’t work,” and they get scheduled for surgery.

But what’s the big deal really?

If outcomes are the same regardless of whether you get surgery or not – why not just get it? It’s quicker, and far more convenient than going to weekly therapy appointments…

But despite the term “minimally invasive,” it’s still surgery.

You will have bleeding, swelling, and recovery time. There is trauma that is caused to the soft tissue in and around your knee that has to heal. There’s also the risk of infection, which comes with a whole set of different complications.

And then of course there’s the elephant in the room that nobody likes to talk about…

I’ve seen many of these arthroscopic surgeries performed that had clients feeling WORSE than before surgery. Because it turns out the procedure wasn’t even necessary. Luckily, we’re still able to rehabilitate them. But it’s completely demoralizing and discouraging for our clients.

In general, despite how small the procedure may seem, you want to avoid surgery whenever possible.

Although small, the risks that can happen with surgery simply aren’t worth it – especially when you can get the same results from natural, conservative treatment.

We’ll be talking about this whole topic and more during our next Online Zoom workshop for Knee Pain sufferers, happening Tuesday, April 27th from 6-7 pm.

For some, arthroscopic knee surgery really is necessary. But for most, it can be avoided.

If you’re currently suffering from knee pain and want to learn more about what you can do to not only avoid surgery – but help get rid of knee pain naturally and on your own – be sure to attend our workshop! It’s free to attend. CLICK HERE to reserve your seat.

 

Carrie working on a knee

Three Causes of Knee Pain and What to Do

Knee pain has been the hot topic around our office this week!

With the nicer weather we’ve been having – more people are outside – and their knees are “talking” to them.

Knee pain is the second most common complaint of musculoskeletal pain (back pain is number one) and it impacts one-third of all Americans at one time or another.

Most of our clients are in their 50’s and 60’s and love to ski, run, hike and bike. They worry that knee pain could bring an end to their active lifestyles.

The good news is that eighty percent of ALL knee problems can be resolved without procedures or surgery – but it starts with accurately identifying the root cause.

Here are three of the most common causes of knee pain and what you can do to resolve it.

1. Patellofemoral Knee syndrome

Also known as “runner’s knee”, patellofemoral knee syndrome (PFS) is characterized by pain in the front of your knee – usually just below or behind your knee cap. With PFS, the source of the problem typically has to do with unwanted pressure in the front of your knee… that eventually results in pain.

It’s very tempting to just get a cortisone shot – or take pain pills – to reduce the inflammation caused by this wear and tear. But then you’re only addressing the symptoms…

If you truly want to put an end to PFS, you’ll need to find the cause of this problem.

Typically, it’s poor form and movement habits that are the result of an imbalance somewhere between your hips, quads (front of the thigh), and hamstrings (back of the thigh). When you figure that out, you’ll restore healthy, balanced movement in your knee again – and reduce the aggravation at your knee cap.

2. Iliotibial band syndrome

This is a very common problem that is similar to PFS except that you’ll experience pain on the side of your knee instead of the front. Your iliotibial band (ITB) is a large, thick band of tissue that runs along the side of your thigh to the bottom of your knee. Your ITB is formed from a muscle in your hip called tensor fascia latae (TFL).

When your TFL gets overworked – your ITB suffers – and will result in what often feels like stabbing pain at the side of your knee.

The most common treatment I see for this is foam rolling and massage – and while these are great modalities to relieve your symptoms – they do NOT address the root problem.

You must figure out why your TFL is being stressed and overworked if you really want to get rid of your pain. Typically, it’s due to weak glute muscles, the deep ones designed to stabilize your pelvis. Your TFL is neighbor to your glutes so when they decide to be lazy – your TFL loves to help out – and eventually overdoes it.

When you can get these two groups of muscles working properly together – you’ll put an end to ITB syndrome 🙂

3. Osteoarthritis

Many people find out they have osteoarthritis in their knees and think there’s nothing that can be done. They either have to “live with it” or get surgery to replace their knees.

Not true!

First of all… arthritis is normal and it happens to everyone as they age. What is NOT normal is for you to think you’re helpless because of it.

Arthritis occurs when the protective cartilage that cushions the ends of your bones wears down over time. While there isn’t anything you can do to reverse this process – there is plenty you can do to minimize the symptoms you get because of this condition.

It all comes down to balanced joints and movement.

The more mobility you have – and the more stability you have around your knees – the less symptomatic your arthritis will be.

Some key areas to focus on when you’ve got arthritis in your knees is good core strength, and good flexibility in your hips and ankles. If anything is off in these areas – your knees will want to compensate – which could result in aggravation of arthritic symptoms.

“Motion is lotion” is not just a saying – it works! Especially when it comes to arthritis.

If you’re currently suffering from knee pain, remember that there is a very good chance you fall into the eighty percent of people who can successfully get rid of it completely on their own.

There is no need to rely on pain pills – or think that procedures and surgery are your only options!

If you’re curious about what might be causing your knee pain and you’re looking for expert help so that you can avoid injections and surgery – Request a Discovery Session with one of our specialists!

You can do it over Zoom or in person – and our specialists will let you know if you’re a good fit for what we do and if we can help you with your knee pain. 🙂

CLICK HERE to Request a Free Discovery Session.

Tips to Combat Arthritis this Winter

People tell me all the time: “I don’t need to check the weather anymore, my joints tell me what’s coming.” And as winter approaches, I know I’m going to be hearing more and more of this.

So why is it that arthritis sufferers tend to be impacted more during the colder, wetter months?

The actual science on this is inconclusive. Some studies have completely debunked the myth that weather can affect your joint pain, while others have shown that arthritis sufferers do indeed have what we call “weather sensitivity” — and they feel worse in the cold, especially when it’s about to rain or snow. The working theory behind this is related to barometric pressure. As a storm system develops, barometric pressure (atmospheric pressure) begins to drop. Some scientists believe that this results in expansion and contraction of tissue in and around your joints (tendons, muscles, bones, and even scar tissue). If those tissues are already sensitive due to arthritis, this could irritate them further. Additionally, the lower temperatures of winter are thought to increase the thickness of fluid inside your joints, making them stiffer and perhaps more sensitive to pain during movement.

Regardless of whether this phenomenon is myth or fact, it doesn’t make your pain any less real! The good news is there are things you can do to minimize pain related to arthritis as winter gets closer. 

There are two types of arthritis, inflammatory and non-inflammatory. Rheumatoid arthritis is the most common form of inflammatory arthritis, and osteoarthritis is the most common form of non-inflammatory arthritis. Although they have very different causes, weather changes can still have an impact, and there are still things you can do to minimize that impact.

Both forms of arthritis are characterized by one or more of your joints being inflamed.

Inflamed joints do not like to be compressed or irritated. It’s often why people will tend to rest and decrease their activity when they have pain. Add cold winter temps and weather to the mix (along with a pandemic), people just naturally do less this time of year. They think if they take the weight off their joints, or move less, they are protecting their joints. That’s actually not true. What protects your joints is strength and flexibility. The more mobile you are, the less likely your joints will get irritated, even arthritic ones. Have you ever worn a piece of clothing that’s too tight? You get irritated. Same with your joints! If they aren’t free to move, they get angry. The muscles around your joints and how strong they are also play a huge role in minimizing irritation.

In the absence of strength and stability, your body will do what it needs to compensate. The structures around your joint will contract to make your joints stiff and tighter in an attempt to give your joints the stability they are lacking. But arthritic joints don’t want to be stiff and tight, they want to be free and mobile! So if you suffer from arthritis, it’s critical that you have good mobility and good strength — period.

In general, the most important thing you can do for your arthritis any time of year, not just in winter, is to keep moving.

And you will move better when you’re strong and flexible. Movement gets blood flowing, which is our best and most natural form of anti-inflammation. Walking is the easiest and most practical way to get healthy movement daily, but biking and swimming are great choices too. You’ll also want to engage in some form of activity, such as Yoga, Pilates, or Tai Chi, that allows you to move your limbs, body and joints in a full range of movement. Cardiovascular activities like walking and biking won’t do that. Pilates is great because it emphasizes both full body strength (which helps balance out your joints) and it promotes flexibility at the same time. It’s why we like to use it in our office. Although it’s easy to just stretch and get more flexible, it’s important that you incorporate strength training into your routine also. Achieving good mobility AND strength is the secret to combating arthritis. Folks tend to only focus on the flexibility part, which is one of the common mistakes I see. 

I hope this helps you better understand why your arthritis might feel worse in winter, and what you can do about it! If you’re suffering from any kind of back or knee pain that is preventing you from being more active and mobile and therefore worsening your arthritis, check out our FREE Back Pain and Knee Pain guides. Just click to have the guide sent straight to your inbox with no obligations or strings attached!

Knee Pain while Running? Don’t Blame Arthritis

Is running bad for your knees? Does it cause arthritis?

We get asked these questions a lot, especially by clients who are in their 50s and 60’s and wondering if it’s safe to keep running.

The short answer is no — running is NOT bad for your knees! If you experience knee pain when you run, it’s not that you’ve “aged out” of the sport or that it’s causing arthritis in your knees. This is a very common misconception. In fact, research supports that running may actually be GOOD for your knees!

Staying strong, active, and mobile is your best defense always against osteoarthritis.

Therefore runners, because they are typically active and healthy individuals, often have healthier knees compared to non-runners.

Ok then — so if not arthritis — what really causes knee pain in runners?

In most cases, it’s simply a biomechanical issue that goes unaddressed over time. But the GOOD news is that once identified, these issues can actually be fixed with proper education and strengthening (best offered by movement specialists like us!).

Here are three of the most common factors we see that are often the true culprit of knee pain when you run (not arthritis):

1) Poor ankle mobility

Ankle mobility affects the way force hits your foot, which can impact your knee. If your ankle doesn’t move fully, freely, and adequately, excess forces will be shifted up to your knee. The knee may be forced to flex, rotate, and/or tilt more than it needs to. This, in turn, may result in unwanted loads that the tissues of the knee can’t handle. An expert in biomechanics and movement can not only help you identify if this is the true root of your “knee problem,” but can also help you improve your ankle mobility in order to prevent long term damage to the joints, tendons, and ligaments of your knees. We actually see this as a very common problem in those that have sprained or twisted their ankles in the past. If that’s you, this could be a reason why you’re suffering from knee pain while you run.

2) Weakness in your hips and thighs

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing good, balanced strength in your hips and thighs is critical. The hamstring and quadriceps muscles play a crucial role in stabilizing the patella, otherwise known as your kneecap. Since running is extremely repetitive on your joints, especially your knees, it requires they have good durability and endurance — something that is lost quickly when you neglect proper strength training. Often “wear and tear” in your knees (otherwise known as arthritis) will get blamed for your knee pain when in actuality, the loss of strength around your knees is what’s causing that wear and tear to feel worse than it needs to.

3) Unstable core

It may seem like running is all in the legs, but the stability of your pelvis and trunk have a huge influence on how your legs perform. You derive the majority of your power, speed, and stamina from your core muscles and glutes. Much like with ankle mobility, if your core is not performing adequately or efficiently – your legs will have to work harder. A stable core is key for developing and maintaining good balance and rhythm with any activity – but especially running. With a repetitive activity like running, efficiency and form is everything. Without a strong core, it’s impossible for your leg muscles and knee joints to work as efficiently as they were designed to, and it will be really difficult for you to maintain good and proper running form mile after mile. When your core strength is weak, and doesn’t have enough endurance to sustain the amount of miles you want to run, your knees will suffer.

What’s important for you to remember is that arthritis is NORMAL — everyone gets it as they age. 

What doesn’t have to be “normal” is for arthritis to stop you from running, or doing any other activity that you love. You can get surgery to fix the “wear and tear” in your knees, or injections to decrease the inflammation, but if you don’t check and address any underlying biomechanical issues, these fixes will be temporary and your knee pain will keep coming back. And worse… they could force you to stop running all together!

If you’re suffering from knee pain and it’s starting to impact your ability to run or do any other activity that you love, you might want to join us for our next live Zoom workshop: Preventing and Overcoming Knee Pain so you don’t have to stop activities you love! 

It’s FREE and happening on Tuesday, Aug 25th, from 6-7pm. Just follow this link to reserve your virtual seat.

people walking with face masks

Beyond the Mask: Five Ways to Build Immunity and Stay Healthy

The COVID-19 pandemic has changed so much of how we live, work, communicate, and think about our health. While precautions like face masks can be helpful, the best way to avoid getting seriously ill is to have a strong, healthy immune system. In our office, we’re helping people’s immune systems by making sure they stay active, healthy, and mobile. We’ve been helping people with back and knee pain recover quickly and manage their conditions from home, so they can get back outside and keep moving and exercising.

Exercising regularly is just one way to keep your immune system strong. Here are five more ways to make sure you’re building immunity during  these strange times!

 

1. Hydrate

 

Staying hydrated is one of the best things you can do for your health in general, but it’s especially important when you’re trying to fight disease. Each individual cell in your body that works for your immune system needs to be fully hydrated to perform its job optimally — and that all depends on how much water you drink!

 

2. Stay Moving

 

In the era of working from home and passing time with friends or family on Zoom, it can be hard to get up from your computer and make sure you’re staying active. But it is so important that we interrupt our sitting and make time to exercise! Keeping your blood flowing allows pathogens to be filtered out more efficiently — plus, sweat can even kill pathogens on the surface of your skin. 

 

3. Get Good Sleep

 

Sleep deprivation has been proven to increase the risk of illness, as well as increasing the risk of more serious long term effects. Sleep is when your body’s cells get to repair themselves — including those immune cells! Plus, getting enough sleep at night can help lower your overall stress. 

 

4. Eat Well

 

Nutrition is key for building and maintaining immunity. You should try to avoid processed foods and integrate more clean alternatives like nuts, berries, eggs, and fish. 

 

5. Get Outside 

 

Scientists are telling us that the novel coronavirus thrives best indoors, and out of UV light. All the more reason to get outside! Soaking up that Vitamin D will boost your immune system and just make you feel better in general. Not to mention that going outside is the one of the best ways to get exercise right now with gyms being closed! 

If you’re currently suffering from back, knee, or any other kind of pain that is preventing you from moving and exercising, give us a call.

We’re currently offering free consultations, both in-person and virtually, to help you figure out what’s going on and give you all the information you need to make the best decision about what to do next.

 

Noticing More Knee Pain during Quarantine?

Aside from back pain, the second most common complaint bringing people into our office these days is knee pain, and lately, I’ve seen a little surge.

Here’s why…

People are sitting a lot more, which leads to increased stiffness in your knees. And a lot of us are doing different kinds of activities than we did 6 weeks ago, which for some, is exposing knee problems they never knew they had.

I spoke to one gentleman last week (we’ll call him “Jack”) who had started walking every day, and running a little bit, because his gym had closed. After about 4 weeks of this, he began experiencing pain in the front of his knee. He put some ice on it, took a break from his daily walks and running, and also resumed some stretches that a former physical therapist had told him to do. This seemed to help, so he resumed his walks and running again. Three days into it… bam… his knee pain returned.

Our specialist team has opened up our schedules to answer people’s questions about what they can do at home right now to take care of any aches or pains.

So Jack took us up on that, because he wanted to know if his knee pain was something to worry about. Did he need to see a doctor? Did he need to let it rest some more? Were there specific exercises he could do?

He did NOT want to stop his walking and running routine, but he definitely didn’t want his knee to get so bad that it would keep him from returning to the gym when it opened back up. He’s 55 years old and staying active and mobile is VERY important to him. We spoke for about 20 minutes and I knew immediately that rest wasn’t going to work, and that X-rays or medication from a doctor wouldn’t do anything either. Those things would only mask the problem. They would take care of the pain in his knee – but wouldn’t correct the source of his problem.

Ironically, the truth about knee problems is that they’re often not actually knee problems!  

With most knee pain, we can trace the underlying issues to a locality directly below the knee (the ankle or foot) or directly above it (the pelvis, hips, core, and low back). If you don’t engage your core throughout your daily movement, it actually puts a huge amount of strain on your knees. As your legs swing and rotate, the torque that should be occurring through your pelvis and hips gets overloaded onto your knees. So as we age, we may start feeling a sense of wear and tear or weakness in our knees that actually comes from a lifetime of improper movement.

The mainstream medical model is focused largely on treating symptoms rather than identifying the root cause of WHY the problem is occuring in the first place.

Pain pills, injections, and even surgery are often recommended before more conservative and natural treatments! And because these quick fixes are merely addressing the symptoms, the physical problems return for the majority of affected individuals. That’s because those knee issues actually stemmed from a different part of the body, and the knee will continue to be overloaded until those biomechanical problems are addressed directly!

Yes – we were able to figure ALL of this out from a FREE phone session.

The next step for Jack was an evaluation with our knee specialist. We scheduled a virtual session over Zoom, she was able to confirm the source of the problem. Turns out the muscles in his hips weren’t firing like they should and it was causing his knees to compensate and work harder than they needed to, which resulted in pain. So we got him doing the correct stretches and specific exercises that would train his hip and pelvis to work like they are supposed to.

In no time, Jack will be back to his walking and running routine, but he will ALSO be in better shape to return to the gym. One of his frustrations before was not being able to do as many squats as he wanted – because they hurt his knees. He had no idea that the problem was actually coming from his hips! So he is pretty excited to try his squats again once his gym opens back up.

If Jack’s story sounds familiar to you, schedule a call with us.

There is no point in sitting at home worrying, or scouring Google for what you should do to fix your pain. We can figure out what’s going on with you over the phone and I’ll let you know if you need to schedule a session with us, see a doctor, or if it’s something you can take care of on your own.

You could also join us for our FREE Virtual Knee Pain Webinar on Thur May 14th from 6-7p!

How to Tell Good Pain from Bad Pain

Over the last few weeks, we’ve been inundated with people asking for help.  And we’re so thankful for everyone who is reaching out! 

Since being quarantined at home and off their routines, people are noticing more knee pain and back pain (these are the two biggies) because they are either sitting more — or because they are DOING more.

The folks who have been sitting more have been complaining about more back pain and stiffness, tightness in their hip flexors and knees, and more tension in their necks.

However, the people who have been doing more are noticing increased or NEW aches and pains in their knees, muscles, and joints – and are wondering if this is “normal” or if it’s something to be concerned about.

For some, the aches and pains are quite harmless – and it’s easy enough to stretch out on your own at home. If you’ve been more active lately because you’ve been bored or suddenly have more time, these could be symptoms of “good” pain. It’s not unusual to have more soreness in your muscles and joints with increased activity or exercise.

But for others – these symptoms could be a sign of an underlying problem that was already there – and just now surfacing. And if that’s the case – simple home stretches that you look up online are not going to be enough – and could actually make you worse.

So how do you know?

One way is to look at how your pain behaves. Does it get worse? Or does it get worse, but not until later? Does your pain move around? Or does it come and go? Does it get better and STAY better the more you stretch? Or does the stretch only provide temporary relief — like a bandaid — and your pain just keeps coming back?

Understanding how your pain behaves is how you know whether or not you’re doing the right thing or the wrong thing.

And how your pain behaves is not as simple as “getting better” or “getting worse.” 

There is so much grey area when it comes to pain, and it’s where people get really confused.

For example, pain might seem like it’s going away, but then it comes back again. Does that mean you’re better? Or is the problem still there? Sometimes pain will move, and you think it’s a sign of improvement. We see this all the time with back problems. Pain starts in your back and is really painful, but then it moves to your butt, hip, or thigh and is more achy and not as sharp. You think you’re getting better — but most of the time this means your back problem is actually getting worse!

The truth is, you’ve got a 50% chance of getting it right and a 50% chance of getting it wrong. And if you fall on the side of getting it wrong, it can lead to a lot more problems down the line that you won’t be able to fix on your own from home.

The BEST way to figure out if your pain is normal — or if it’s something more — is to talk to an expert.

That’s what we’ve been doing ALL month here. As specialized physical therapists, we have been getting on the phone — or hopping on Zoom — to help you figure out what’s going on in your back, knees, or somewhere else.

It’s totally free to talk to us! We’ll let you know if what you’re experiencing is normal… and if what you’re doing is safe or not.

If you want to get on our schedule — and talk to one of us for free — just fill out this form.

You can talk to us in-person if you’re comfortable leaving your home, or virtually if you’re nervous about leaving. Both methods are equally as effective!

Whatever you do, don’t try to figure out your pain on your own — and don’t just throw pills, ice, or heat at it. This could lead to more problems down the line. Plus, if you let it get bad enough, you may be forced to go to Urgent Care or the ER — two places you DON’T want to be right now.

Instead, get on top of your pain and learn how to treat it properly so that you can be healthy and pain-free for the rest of quarantine! 

 

syringe

Steroid injections may do more harm than good, research shows

Have you been told you need to get a cortisone injection? Have you already tried them more than once? 

Research is now showing that cortisone injections may hurt more than help in the long run! 

The results of a recent study from Radiology has raised concerns in the medical community about potentially adverse effects on joints following corticosteroid injections. These injections are commonly used to treat arthritis, especially osteoarthritis of the hip and knee. The researchers in this study observed patients who had previously received steroid injections and found that some of the patients exhibited further joint damage on medical imaging tests. According to the original article, these patients presented with “accelerated OA [osteoarthritis] progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss.” 

The joint issues that can be triggered by cortisone injections don’t just show up right after the procedure — which makes it easy to see the steroid shot as a quick fix with no drawbacks.

And it’s true that there are usually no short-term side effects. However, when it comes to your joints, it’s all about the long game. And it’s worth noting that an analysis from the Cochrane Review in 2015 found that the benefits of steroid injections usually wear off after about six months…  meaning it’s a temporary “band-aid” solution to a bigger problem — a band-aid with the potential to result in permanent degradation of your joints!  

Arthritis is an issue we see all the time in our physical therapy practice, and that’s why patient and physician concerns with steroid injections are so relevant to us. Many of our clients have had injections suggested to them or have gone through with the procedure but not experienced any long-term healing. In many cases, this can be an overly simplified answer to the very complicated question of individual pain. Physical therapy, on the other hand, isn’t a one-size-fits-all solution. Our treatment model is entirely based around addressing the root cause of your pain instead of just providing temporary relief. Plus, we’re all about keeping your treatment non-invasive, movement-based, and entirely customized to YOU. 

If you’ve been told that you need a cortisone injection in your back, knee, or shoulder, think twice and get informed about other options!

If you’d like a NATURAL route to pain relief — and one that will make you more mobile and active at the same time — come talk with us! You can even schedule a FREE 30 minute Discovery Session with our specialists right now — no strings attached. 

knees

Happy Halloween! Spooky Noises coming from your Knees?

“What are those cracks and noises coming from my knees? Is there something wrong??”

Our clients come in with this question all the time. They usually feel nervous and fearful that the noises they hear may indicate something more serious is going on within the joint. Is there damage occurring whenever they hear this sound? Do they need to avoid activities that provoke these symptoms? Will they need to rely on pain pills and surgeries in order to maintain their mobility if their joints deteriorate? 

Crepitus refers to these clicking, popping, and creaking sounds that a large portion of the population experience on a regular basis.  This phenomenon can occur at any joint, but is most commonly reported in the knees, shoulders, ankles, hips, and spine. 

Although these noises often don’t produce any pain, they can cause anxiety. Individuals start to develop their own beliefs about what is going on, and ultimately alter their behavior to avoid these cracking or popping sensations.

What causes these noises?

Many structural factors can contribute to joint noises.  Some of the most common are:

  • Tendons rubbing along bony prominences (bumps on bones)
  • Nitrogen bubbles popping due to pressure changes within the joint
  • Small labral or meniscus tears that get caught or pinched as we move

However, we don’t have the luxury of utilizing x-ray goggles during our examinations.  This means that we often cannot be certain of exactly which structures are creating these sounds.  What we do know is they aren’t a reason to be highly concerned as long as they aren’t associated with pain or swelling in the affected joint.  

How can I prevent it from getting worse?

The best way  to prevent these symptoms is to keep moving!! Motion is lotion. Regular movement throughout the day allows our joints to lubricate themselves, kind of like applying WD-40 to a creaky door hinge.  Additionally, it’s important to keep the muscles surrounding your knees strong and balanced. This helps to offload the forces through the joint, which limits “typical” wear and tear on cartilage and bony structures.

What if I’m noticing pain or inflammation in the joint that’s making these noises?

If you have a specifically noisy joint that’s also painful or swollen, it’s best to come in for a formal examination with a physical therapist – ideally someone who specializes in movement mechanics.  We train you in correct, healthy movement that both relieves your body of pain in the short term and protects it from further damage in the long term.

If finding the solution to your problem is something you’re interested in, you can come in for a free Discovery Session at our practice in Portsmouth, NH! All you have to do is fill out this brief form here and we’ll contact you. Discovery Sessions are great for people who want to talk with a specialist about what might be causing their problem, and we’ll help you figure out what the next best steps are.  Our goal is to give you all the information you need so that you can make the best decision for your health – without any obligation or commitment.

We also know not everyone is ready to commit to regular physical therapy appointments, and that’s why we offer free health and posture classes!  These events are for people in our community who want really valuable, expert information about movement, pain, and overall wellness. We know it’s confusing out there with all of the information floating around on Google and Facebook, and this is a valuable first step towards getting some answers for your problem.

Hopefully you found this information helpful, and the only thing scaring you this Halloween will be haunted houses instead of the noises coming from your joints!

PS – If you found this information helpful, please share this with a friend or on your Facebook feed.

Knee pain? Top three causes and what to do about it.

Knee pain is one of the most common complaints that brings people into our office.

Since most of our clients are in their 40’s, 50’s and 60’s, they start to really worry that knee pain could bring an end to their active lifestyle. But that doesn’t have to be the case! The good news is that unless you’ve had some serious trauma (like a major accident or fall), 80% of all knee problems can be resolved without any kind of procedure or surgery – and most importantly – you can learn how to continue managing them on your own so that they never get in the way of your favorite activities again.

Sound too good to be true?

It’s not – I promise – but the first step is figuring out where your knee pain is coming from. Once you know that, you can get on the right path to resolve it.

Here are three of the most common causes I see that make people suffer from knee pain and what you can do about them:

1. Iliotibial band syndrome

This is a very common problem that typically affects runners, avid walkers, and hikers. It is often misdiagnosed and confused with patellofemoral syndrome (see below). Your iliotibial band (IT band) is a very large thick band on the side of your knee that will often get overworked due to a muscular imbalance elsewhere in your body (usually your hips and core). When this happens, you’ll feel pain that is on the side of your knee that is usually very sore and tender to touch, and typically sharp and stabbing versus achy. It will impact you most when you’re going downhill or down the stairs.

It’s important to note that even though a tight, and painful IT band is the structure causing you to have pain – it is typically a symptom of an underlying problem. Like I said before, IT band problems are usually the result of your core and hips not stabilizing your pelvis properly – which ultimately results in your knee not receiving the support it needs when you’re running, walking, or hiking.

Getting rid of the actual pain is the easy part… in our office we use things like dry needling, soft tissue work, and sometimes even some taping. But if you want to keep the pain gone – you MUST address the underlying causes as well. This is what a lot of people miss. We love using Pilates-based exercises in our office because they not only target your core, but also get your muscles working in a coordinated, symmetrical fashion, helping to keep things balanced as you get back to your favorite activities.

2. Patellofemoral Knee syndrome

This problem is very similar to IT band syndrome, with just a few key differences. This first is that it can impact almost anyone – not just runners, hikers, and walkers. You’ll also experience the pain in the front of your knee – typically under your kneecap – and it will tend to be more achy than sharp. This problem will often come on very slowly and can be more chronic than its IT band cousin. You’ll feel this more when you’re going up stairs, up hills, and with squatting. You’ll also notice stiffness and pain in the front of your knee after sitting awhile – that usually will go away once you start moving.

Much like IT band syndrome – these are all symptoms of an underlying cause. A weak core and hips can cause this problem too, but I usually see more weaknesses in glutes and hamstrings with this one. When the backs of your hips and legs aren’t kicking in like they should, it can result in tight hip flexors or quads. This is a super common culprit for patellofemoral syndrome. So once again, you can get rid of the pain quite easily in most cases, but you must make sure to determine – and address – the root cause so that you can keep this pain gone for good.

3. Osteoarthritis

Many people hear that they have osteoarthritis in their knee and think there isn’t anything they can do about it. Not true!! Arthritis is often blamed for knee problems but it isn’t always the cause of what you’re feeling… Let me explain….

When arthritis is the true cause and culprit for your knee problem, it will be painful and stiff all the time. You’ll lack significant mobility and it will be almost impossible to walk and bear weight without support or a cane. When this is truly your problem – you are a great candidate for total knee replacement surgery. Now here’s the catch… sometimes your X-ray or MRI will show that you have terrible arthritis or that you have “bone-on-bone”… but that doesn’t mean you need to rush to surgery! Your symptoms should really decide that.

If your pain comes and goes (meaning you have good days and bad days), if you can walk around most days and go up and down the stairs and your knee just “catches”, or maybe you feel stiff a lot but this eases up with movement – you might have arthritis in your knee but it is not the root cause of your knee problem. Because here’s a hint – arthritis does NOT come and go – but other common musculoskeletal problems can. When your pain comes and goes, you know it can’t be entirely from arthritis.

So what should you do?

With arthritis, whether it’s partially to blame, or whether it’s just something that shows up on the X-ray and gets blamed… we still need to look at the surrounding structures and root cause of the problem.

If your quads are really tight, and the muscles around your knee are imbalanced, this can create compressive forces in your knee joint which will exacerbate what might normally just be “mild” arthritis (compression will aggravate arthritis). You could also have weakness or problems in your ankles, feet, or core that are causing your knee to work harder than it needs to. This can cause pain all on its own, OR aggravate your arthritis. The point is, get checked by a musculoskeletal expert – people trained like us – so that instead of just fishing for the problem or only treating symptoms, you are getting to the root cause of your problem and setting yourself up for success!

If any of this sounds familiar to you, you may benefit from working with a specialist physical therapist who can help you get back to the activities you love – without pain pills or unnecessary procedures. You can click right here to request a FREE Discovery session with one of our specialists. We’d love to help you figure out the root cause of your knee problem so that you can get back to doing everything you love – instead of spending time in the doctor’s office 🙂

Not quite ready for a solution yet but looking for more information? Request a seat at our next Health and Posture class! It’s totally free and the next topic just happens to be all about hip and knee problems! Figure out if your problem is arthritis, IT band syndrome, patellofemoral syndrome, or something else entirely… with other folks just like you.