A study on when surgery will or won’t be needed for medial knee problems

knee_pain
June 2015 – Volume 23 – Issue 2 – p e15–e22
A Review of Surgical and Nonsurgical Outcomes of Medial Knee Injuries
Smyth, Mark P. MD*; Koh, Jason L. MD†

Abstract
Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported. In this paper we report on the injuries by extent and type of anatomic structures damaged including partial medial-sided injuries, completed isolated medial-sided knee injuries, and combined injuries. In general, most authors concur that isolated partial or complete medial collateral ligament (MCL) injuries can be treated nonoperatively with a brace and early motion with good clinical outcomes. Prospective, randomized trials support nonoperative treatment of the MCL in combined anterior cruciate ligament-MCL injuries. Knee dislocations and posterior medial corner injuries appear to have better results with surgical management including reconstruction. Multiple reconstructive techniques have been described for chronic injuries but it is difficult to compare their results.

Crossfit and Lowerback pain.

Compliments of Ryno van den Berg – Stretch therapist Faerie Glen

Crossfit and Lower Back Pain

“How can it be that my lower back hurt when I’m doing crossfit?”
“Does it mean I’m doing something wrong? Or is it a much more likely answer that my body might lack range of motion (ROM)?”
Range of motion (ROM) is a term commonly used to refer to the movement of a joint from full flexion to full extension. Extension is a physical position that decreases the angle between the bones of the limb at a joint. It occurs when muscles contract and bones move the joint into a bent position. The opposite movement, flexion, bends the joint so that the joint angle shortens. Each joint has a normal range of motion. However, the amount of movement in a joint varies greatly between individuals. Joints maintain a balanced range of motion by regular use and stretching of the surrounding soft tissues (muscles, tendons and ligaments).Injuries to the soft tissues surrounding a joint often reduce range of motion due to swelling and tissue damage. Regaining range of motion in a joint is one of the first phases of injury rehabilitation, and physical therapists often prescribe specific ROM exercises for each joint.

Flexing the lumbar spine under great load e.g. doing dead lifts, places stress on the inter vertebral discs and greatly increases our risk of a disc herniation.

When it comes to picking up weights we need two basic things to complete this properly.
1. Hip ROM
2. Spinal Stability

Hip ROM is mostly from the hamstrings and gluteal muscles. If these muscles are tight we won’t be able to tilt our pelvis into the correct position to set up a neutral and stable spine. An athlete will be able to lower the bar from a deadlift with a neutral spine until they get to about midshin, then they lose the natural lumbar curve of the spine. You can cue this athlete until you’re blue in the face but it won’t change the lift until you address those flexibility limitations.

There are certain physiological factors to consider when it comes to lower back health:

•Lower back flexibility is necessary to encourage normal curvature of the spine. Without this flexibility, forward and lateral movements are disrupted, which can cause strain on the hamstrings, leading to lower back and hamstring pain.

•Hamstring flexibility allows for anterior rotation (tilt) of the pelvis in forward flexion and posterior rotation in a sitting position. Without this, the pelvis is restricted, which can cause disc compression.

•Hip flexor flexibility can achieve a neutral pelvic position. Those with tight hip flexors have an exaggerated anterior pelvic tilt, which can cause compression.

•Abdominal strength and muscular endurance will maintain proper position of the pelvis and reinforce the back extensor fascia. Weak abdominals exaggerate anterior pelvic tilt causing strain on the back extensor muscles.

•Back extensor strength and endurance provide stability for the spine, maintain posture, and control forward flexion. Weak back muscles increase stress on the spine and can cause compression.

Lower back pain can be irritating and debilitating, but it can be improved. Proper stretch therapy, preventative measures and exercising will help athletes to have a healthy lower back again. Being pain free is always the goal and if you know you have these issues take the necessary precautions to insure your back is safe.