Charlotte Area Clinic Making Strides in Knee Pain Treatment

Knee Pain affects 18-20% of US population and many are frustrated with treatment and feel that surgery is the only option. Recent treatment breakthroughs at a local physical therapy clinic are helping patients who feel they have run out of options.

PRLog (Press Release) – May 11, 2012 – Knee Pain is a very common condition that is reported by 18-20% of the U.S. population. It affects the way one walks, works and lives. It can make hobbies and leisure activities such as going for a walk with your husband or wife, playing with your kids, and fitness activities very difficult.

Any pain or dysfunction at the knee can result in back, hip or foot and ankle pain. There are many common causes to knee pain, most of which are as a result of overuse or improper mechanics.

“During our evaluations, we often find that pain is the symptom of dysfunction elsewhere. Treating it without looking at the entire kinetic chain may offer some short term relief, but it does not address the cause of the problem and often leads to a more chronic condition,” says Chris Stulginsky, PT who is the owner of Ayrsley Town Rehabilitation.

Cortez Curtis has had pain in the front of his knee for three years. “I have been to 4 different doctors. They all took x-rays and told me I needed to exercise and lose weight. I was frustrated because I was never told what specifically to do and exercise made my knee worse.”

The knee pain located in the front of the knee was indicative of a problem elsewhere. “During the initial evaluation, Cortez was not getting much hip extension at all. Decreased hip extension typically results in increased bending of the knee, rotating the hip to the outside or positioning the foot and ankle outward while walking. In Cortez’s case he had compensated with external rotation at the hip, the knee followed suit and we had our issue.”

For the most part the primary motion of the knee is bending or straightening, which is called flexion and extension respectively; however, there is mild rotation at the knee joint which often goes unnoticed and can easily cause a great deal of dysfunction and pain throughout the joint.  The popliteus is a muscle that crosses from the outside of the knee to the inside of the knee at a 40 to 45 degree downward angle and is primarily responsible for this movement. The muscle also attaches to the lateral meniscus and often mimics meniscal derangement.

“Many knee exams are performed in sitting or while lying down. Traditional knee tests were negative. After watching Cortez walk just a few feet I had some clarity on what was going on, and confirmed it with further examination”, added Stulginsky.“When he started pressing on my knee, he was right on it,” says Curtis, who explained that for 3 years he has had difficulty playing with his kids, putting his feet on the ground when getting out of bed, and making it through his shift without intense discomfort.

Stulginsky says, “After seeing this presentation a number of times in the last few years, we have developed a protocol for this issue, which includes a simple, 2 step, self-care program. Everyone is built a little differently, it is not the same exact thing for every individual, but the themes are similar.

“I felt an instant difference,” said Curtis. “After two treatments, my pain is down 75%. Playing with my kids is easier, shifts at work are better.”

This dysfunction can cause a great deal of pain in many people, including competitive runners and weekend warriors. Stulginsky states that if this is the primary cause, it can be addressed relatively quickly in a very conservative, non-invasive fashion without medication or injections.

Mr. Curtis concludes, “I am happy that someone can finally tell me what was going on with my knee, and I have a solution that is fast, effective and easy enough that I can do it on my own.”

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Clinic Draws from Experience in Preventing Injuries & Reducing Factors Leading to Concussions

 

Jun. 6, 2012 – Hillary Neal started playing soccer at the age of 8 and played at Olympic High School from 2004 to 2008.  During that time, it was unfortunate injuries to her ankles and knees that introduced her to her career in physical therapy. “I hated being injured on the sidelines, but it showed me how I can help others that were,” says Neal.

Recent media coverage has brought attention to the situation in girls’ soccer; female soccer players are second to football players in the occurrence of concussions. “Hillary brought up the importance of neck stability which has been added to our Prehab for Soccer Program,” says Chris Stulginsky, PT who is managing partner at Ayrsley Town Rehabilitation in Southwest Charlotte. “Our injury prevention programs are grounded in research but they have really taken shape with our clinical team’s athletic and professional experience. Not only are we looking at it from a biomechanical standpoint, but from the athlete’s perspective as well.”

Neal’s experience in high school soccer helped to guide program development. “Many think that doing traditional neck strengthening will help. Though it can, it is often uncomfortable and may not be the best way to address this issue.”

She explains that a specific type of strengthening best simulates the sport specific demands placed on the body in soccer. “Our program focuses on neck stability. Many of the injuries are occurring because the athlete cannot stabilize their neck when the contact occurs.” Neal continued to explain that stability is important for many aspects of the game. “There has been a lot of focus on heading the ball, but if the stability is lacking, issues can occur without any contact to the head.  Even without direct contact, an attempt and a miss could result in whiplash like movement which could also lead to a non-contact concussion.”

Stulginsky states that people are often surprised to hear about the different processes in which concussions can happen. “Many feel that concussions require a direct blow to the head, and always result in loss of consciousness, ninety percent of concussed athletes never lose consciousness.  A great deal are a result of quick rotation or movement that results from contact to areas other than the head. Those numbers go up, the younger the athlete.”

Other aspects of the program focus on injuries in which many have more knowledge. “Thirty percent of the injuries at the collegiate level are due to overuse. Our program addresses many of the structures that commonly fail in ACL injuries and with ankle sprains,” says Stulginsky.

But for now, the focus of many parents and athletes is on concussions. “Between neck stability and offering the same baseline concussion testing utilized by the NFL, we really feel we can help a lot of young people be as safe as possible,” concluded Stulginsky.

Pregnancy and Physical Therapy

ImagePhysical therapy during pregnancy can prove to be useful for remedying common discomforts like back pain or for enhancing your body’s ability to have an easier and smoother pregnancy and birth.

Physical therapy is not just for recovery. Talk to your health care provider about incorporating physical therapy into your prenatal care.

Pregnancy and Physical Therapy: Back Pain

The number of pregnant women who experience back pain is somewhere between 50 to 70 percent. The reasons for back pain vary from person to person, but the majority of back pain concerns can be accounted for by one of the following reasons:

  • an increase in hormones
  • a change of the body’s center of gravity
  • gaining additional weight
  • a decline in posture
  • added stress

Over the last 40 years, the average age of women having their first child has risen from 21.4 to 25 years of age. Due to the fact that many women are juggling both the demands of pursuing higher education and the competitive nature of today’s workforce, more and more women are having their first child after the age of thirty five. As a result, many women becoming pregnant are less physically active in their daily lives. This decreased activity, along with the increasing national prevalence of a sedentary lifestyle, leaves an alarming number of women less prepared for the strenuous journey of carrying and delivering a baby.

Pregnancy and Physical Therapy: Relieving Pain

Women searching for ways to cope with this reality may be surprised to know that four of the above factors can be directly addressed with a proper physical therapy program.

Physical therapy is a medically based profession specializing in pain relief. Physical therapists (PTs) work with individuals to develop a treatment plan to decrease pain by identifying and addressing its causes.

Though it varies from state to state, many don’t require a doctor’s referral or prescription to see a physical therapist. PT’s can begin treating your pain on the first visit, so you walk out the door feeling better than when you walked in.

Additionally, since physical therapy is a medically based profession, the services are covered by most medical insurance plans with limited out of pocket cost. Treatment plans take a comprehensive approach by working on pain’s typical triggers:

  • posture
  • joint alignment
  • muscle strength
  • flexibility
  • nerve involvement.

Additional weight, decreased posture, stress and control of the center of gravity are not independent from one another.

A change in your center of gravity affects your posture which causes the muscles to work harder. Increased exertion creates fatigue which leads to decreased motivation to be active. The absence of an athletic release often results in increased stress. Though it is difficult, the domino effect can be slowed greatly with the help of physical therapy.

Lower back pain is an all too common reality for many expecting mothers. As the uterus and baby grow, the mother’s center of gravity moves forward. This shift increases the amount of force the muscles must generate for everyday support causing women to slump forward. Over time this poor alignment creates muscle tightness in the pectoral muscles, rolling the shoulders forward and creating increased stress on the muscles of the neck, shoulders and mid-back. If these muscular factors are not addressed, these forces will ultimately be translated down to the low back, an area which is already under a great deal of stress because it is supporting the increased center of gravity.

Additionally, exercise increases physical endurance and muscle strength, especially in the hips, back and abdomen. Improving these areas can prepare the body for the physically demanding event of delivering a baby, positioning oneself for a better labor experience. Finally, therapeutic exercise during pregnancy can assist the recovery after the delivery. It tones muscle which will improve metabolism, decrease the severity of fatigue, and assist in reclaiming your pre-pregnant weight.

I thought physical therapy was limited to recovery after surgery?

There is a general impression that physical therapists are similar to personal trainers or only work with people after surgery or catastrophic injury. While that is a component of what physical therapists do, it does not entirely encompass the scope of the profession. As stated previously, physical therapy is a medically based profession specializing in pain relief by identifying and treating the causes of pain in each individual.

A good program will take both an active, exercise based approach, as well as a passive one. The ultimate goal is to educate the client so that they can be independent in their program and continue to treat themselves at their own convenience.

Physical therapy and home exercises during pregnancy

There are no guarantees, but it is fair to expect your pregnancy and labor to go easier and possibly even quicker following any strength and flexibility enhancements. Although a few visits with your physical therapist is a good start, it is essential to incorporate home exercises into your physical therapy program. Your physical therapist is going to provide you with specific exercises that target what you need to make your pregnancy easier and even healthier. You can also rest assured that your physical therapist will guide you through proper usage of these exercises so that you can reap the most benefits.

Tips for choosing the right program

Today’s expectant mothers have a wide variety of options to consider for pre-natal care. The key is finding the appropriate program. Be wary of treatment programs that are passive, place increased stress on the joints and do not address muscle strength and flexibility with exercise. Here is what you should look for in a physical therapy program:

  • Managed by a certified professional
  • Focused on building strength, increasing flexibility and improving posture
  • Encompasses home based elements for you to do yourself
  • Proactively looks for any weakness which may become a problem later

Pregnancy is the ultimate strain on one’s body, and is a condition that physical therapy can intervene to lessen this strain. A proactive strength, flexibility and stabilization program can be very beneficial to preventing or decreasing the intensity of painful symptoms, thus making your pregnancy experience a more positive one.

 

Christopher Stulginsky, PT is the managing partner of Ayrsley Town Rehabilitation, in Charlotte, NC. He is a Prehab Network Specialist, an 830 Cold Laser Certified Premier Provider and certified by the prestigious Titleist Performance Institute.  Christopher has provided injury coverage to numerous websites most notably Deadspin, Redskins.com and NFLSportchannel.