Do you wake up in the middle of the night with pins and needles or pain in one or both of your hands? This is a common experience for many. Physiotherapists can assist you getting the restful, pain free sleep you desire.
What can cause your hands to go numb at night?
Numbness, pins and needles, or a burning, prickling sensation (also referred to as paresthesia) are symptoms of sustained pressure on a nerve and usually disappears when that pressure is relieved.1 Most people have experienced temporary pins and needles when they have sat on their foot for too long or fallen asleep with their head resting on their arm. The symptoms can also occur when there is a narrowing of the space through which a nerve or blood vessel travels, causing pressure on the structure.1 Some examples of this include carpal tunnel syndrome (pressure on the median nerve as it passes across the wrist), arthritic changes in the neck (creating pressure on the nerves where they exit the spine) and thoracic outlet syndrome (pressure on the bundle of nerves traveling into the arm from the spine).
The remainder of this article will discuss the causes, diagnosis, and physiotherapy treatment of thoracic outlet syndrome (TOS) specifically.
What is TOS?
The thoracic outlet refers to the space created between the first rib, collar bone, and a group of muscles crossing the front of the shoulder. The blood vessels and nerves that supply the arm must pass through the outlet and under or through the muscles before they enter the arm. (See Diagram #1) At any point in this journey, pressure can be placed on the vessels or nerves causing the sensation of pins and needles or pain. Holding the arm overhead, sleeping with an arm under the head or extreme rotation or bending of the neck can narrow the outlet and cause pressure on the structures. TOS is characterized by pain, paresthesia, weakness, and discomfort in the upper limb.1 It is reported that approximately 8% of the population will experience a form of TOS.2
Click to see full size.
Diagram #1
TOS is classified as vascular (vTOS) or neurological (nTOS) depending on whether the blood vessels (artery or vein) or nerves are compressed. nTOS can be further divided into true neurological TOS which happens when a bone or muscle compresses the nerve, or symptomatic (sTOS) when sleeping positions, work postures or activities, or sporting activities create temporary compression of the structures involved.2 Evidence identifies that over 90% of TOS cases are neurological with the majority of those classified as sTOS in nature.2,3
How is TOS diagnosed?
It is very important that the true cause of the symptoms be identified to determine the best treatment plan. As noted earlier, there are several causes for pins/needles or pain and numbness in the hand or arm. Each of these must be ruled out as each will be addressed differently to successfully reduce or eliminate the symptoms. There is no one test or investigation that will consistently diagnose TOS, so the diagnosis is based on a collection of symptoms.1 To obtain a clear picture of the source of the problem, a thorough exam must be completed and may include:1
A history of symptoms including:
The location(s) where the pins/needles or painful symptoms occur
The presence of stiffness, swelling or loss of muscle control or size in the hand or arm
Any postures or activities that aggravate or initiate the symptoms such as overhead activities, sleep positions, prolonged postures (sitting or lying), carrying a backpack or other items, sustained elevation of shoulder(s), or repetitive use of the hand or arm
Any history of previous injuries involving the neck, shoulder or arm or chronic diseases such as heart problems or diabetes which can also lead to paresthesia in the hand or arm1
A physical exam looking for:
Changes in skin color, temperature, or hair growth
Pain or symptoms reproduced with pressure on the muscles around the neck, shoulder, or shoulder blade
The posture of the neck, shoulder, and shoulder blade at rest and during activity
The flexibility of the neck, shoulder, shoulder blade, elbow, wrist, or hand
The strength of the muscles that move the neck, arm, or shoulder blade or pain when testing muscle strength
Instability of the shoulder joint
Abnormal or absent reflexes or sensation in the arm or hand
Tests designed to provoke symptoms by positioning or moving the neck, shoulder, arm, or hand in specific patterns or postures
Physiotherapists are well trained to complete these assessments and design a treatment plan. They also have the skills and knowledge to identify situations where a referral to a medical doctor may be appropriate. Conservative treatment, including physiotherapy, is the universally accepted first step in treatment for TOS.2,3,4 Surgery may be indicated when conservative treatment is unsuccessful,2,3,4 and may be the first option in the presence of vascular TOS due to the presence of a structural abnormality such as a cervical rib; however, the success and appropriateness of surgical intervention is controversial.
How can physiotherapy help?
Based on the assessment findings, a physiotherapist will design a rehabilitation program that focuses on reducing symptoms and correcting muscle or postural imbalances and misalignments.
Many individuals experiencing TOS have had symptoms for a long period of time and require assistance to understand TOS, become aware of what aggravates or relieves their symptoms, and strategies to reduce these symptoms allowing them to manage or prevent issues in the future.3 An individualized rehabilitation plan may include:3
Posture re-education and exercises to improve both resting and active postures
A home program of strengthening and stretching exercises to improve the strength and movement at the shoulder and shoulder blade muscles focusing on improving the control and efficiency of the shoulder girdle3,4
Hands-on therapy to the neck, thoracic spine, shoulder, and other associated structures to address any misalignments or stiffness may be performed by the physiotherapist, with self-mobilization techniques taught as part of a home program3,4
Recommendations for modification of workplace ergonomics, resting positions and sleep postures and education about strategies to address postures and activities that may bring on symptoms or make them worse.3,4
If you are experiencing frequent episodes of pins/needles, numbness, and/or pain in your arm, hand, obtaining a physiotherapy assessment is a great place to start your journey to manage your symptoms.
Watson LA., Pizzari T., Balster S., Thoracic outlet syndrome part 1: Clinical manifestations, differentiation, and treatment pathways. Manual Therapy. Volume 14, Issue 6, 2009. Pages 586-595 ISSN 1356-689X. Available at https://doi.org/10.1016/j.math.2009.08.007
Watson LA., Pizzari T., Balster S.. Thoracic outlet syndrome Part 2: Conservative management of thoracic outlet. Manual Therapy, Volume 15, Issue 4, 2010, Pages 305-314, ISSN 1356-689X. Available at https://doi.org/10.1016/j.math.2010.03.002 .
Peek J, Vos CG, Unlu C, van de Pavoordt HDWM, van den Akker PJ, de Vries JPM. Outcome of surgical treatment for thoracic outlet syndrome: systematic review and meta-analysis. Annals of Vascular Surgery, 2017-04-01, Volume 40, Pages 303-326.
Preserving the health and strength of bones as individuals age is an important issue that is not overlooked in the medical community. However, statistics show that osteoporosis and osteopenia are major health problems for over 50 million women and men aged 50 and over in the United States (US). Both conditions are characterized by low bone density, or low bone mass, but osteoporosis occurs due to the progression of osteopenia.
Osteoporosis is defined as the loss of bone mass and the deterioration of bone tissue that leads to increased bone fragility as well as enhanced fracture risk. Approximately half of the women and one-fourth of the men who are diagnosed with osteoporosis suffer from broken bones due to this condition. In addition, osteoporosis is associated with about 19 billion dollars in medical costs annually, and it is estimated that the costs will rise to at least 25 billion annually by 2025.
Osteopenia is a distinct condition that is defined as a decrease in bone mineral density (bone mass) that is lower than normal but not low enough to meet the criteria for an osteoporosis diagnosis. A specialized test called a dual-energy x-ray absorptiometry (DEXA) scan helps determine whether an individual has osteopenia or osteoporosis.
A DEXA scan provides a number called a T-score that represents how much a patient’s bone mass differs from the bone mass of the average healthy adult. A T-score within one standard deviation (SD) reflects normal bone mass. A T-score that is 1 to 2.5 SDs below the average indicates that an individual may have osteopenia — a mild form of osteoporosis. A T-score that is more than 2.5 SDs below the average T-score indicates the potential presence of moderate to severe osteoporosis.
One of the main risk factors for osteopenia and osteoporosis is aging.
Additional factors that increase the risk of developing osteoporosis include:
A lack of exercise
Dramatic weight loss
Tobacco and alcohol abuse
A family history of fractures
Gender (higher prevalence in women)
Eating disorders (anorexia or bulimia )
Low body weight or a thin and slender build
Long-term use of certain medications (e.g., corticosteroids, thyroid medication, anticonvulsants)
However, people with osteoporosis or those who are at risk of developing this condition due to osteopenia often benefit from physiotherapy. During the consultation, a physiotherapist will discuss medical history in detail to assess factors that may contribute to the progression of osteopenia or osteoporosis. If osteoporosis is suspected or a patient has an increased risk of bone fracture due to low bone density, which reflects osteopenia, the physiotherapist may also recommend more precise testing.
The main goals of physiotherapy include demonstrating safe ways to move the body, lift items, and maintain proper posture. The therapeutic plan also entails learning exercises that help slow the loss of bone mass. Bone problems may lead to physical inactivity, but this can worsen bone tissue deterioration, accelerate osteopenia or osteoporosis, and increase the risk of falling and fracturing bones. Although both of these conditions are associated with reduced bone mass, diagnosing and treating osteopenia early on is an important factor that can help prevent the occurrence of osteoporosis and future health issues.
3. Consensus Development Conference V, 1993. Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1994;90:646-650.
4. Varacallo MA, Fox EJ. Osteoporosis and its complications. Med Clin North Am. 2014;98(4):817-831.
5. Hartely GW, Roach KE, Nithman RW, et al. Physical therapist management of patients with suspected or confirmed osteoporosis: A clinical practice guideline from the Academy of Geriatric Physical Therapy. J Geriatr Phys Ther. 2022;44(2):E106-E119.
According to research, many people, including adults and children, wear the wrong type of footwear. In particular, children with certain neurodevelopmental disorders, people with diabetes, and older individuals are more likely to wear shoes that are too tight.
This problem is associated with foot pain, foot disorders, and abnormalities, such as corns, calluses, and lesser toe deformities. One of the main reasons that people wear improper shoes is because they may not realize that different types of shoes are made for specific activities. Let’s take a closer look at shoes that are designed for various purposes.
Walking Shoes
Walking shoes are one of the most commonly purchased types of footwear. Whether people walk for relaxation or physical fitness, this is an ideal form of exercise. In addition, walking is a low-impact activity that is easy on the joints, but it is still important to wear appropriate shoes for walking.
Walking shoes are usually lightweight and offer ideal support for the feet due to special soles that help people roll their feet as they walk. The rolling motion while walking is more efficient than stepping heel to toe, and walking in this manner minimizes the impact on the joints. Individuals who walk regularly for fitness need to invest in a quality pair of walking shoes. Choosing the right type of shoe helps people walk faster, further, and with a lower risk of injury. However, walking shoes that fit properly, are not too narrow or too long, and offer sufficient arch support. Proper arch support is essential to maintaining good posture and balance.
Running Shoes
Running shoes are different from walking shoes as they are designed to protect the ankles and feet from the impact of running through specialized cushioning and arch support. This type of shoe also provides traction while running on uneven surfaces, which makes it easier to run on challenging terrains, such as trails. A good pair of running shoes is an important investment, particularly for avid runners.
An important point to remember is that walking shoes are not a substitute for running shoes. Therefore, it is vital to wear shoes that accommodate a specific activity to avoid unexpected injuries.
Sports Shoes
High-impact sports, such as football, basketball, tennis, etc., require rapid movements and quick direction changes. Due to these factors, athletes may experience foot and ankle injuries. The risk of injury further increases when incorrect shoes are worn during sports activities. Wearing shoes that are designed for a particular sport helps minimize the incidence of injuries by providing high-intensity cushioning as well as foot and ankle support.
Most sports shoes have reinforced side panels and additional padding that provide extra protection from quick movements. The specific design also promotes a more balanced distribution of the arch, sole, heel, and toe to reduce the risk of sports injuries. Sports shoes may also have special grips, such as cleats that are often worn by football players, to help prevent slipping. Special grips also improve traction and performance.
Gym-Athletic Shoes
Gym or athletic shoes provide optimal stability and support for high-intensity interval training (HIIT) programs. They are particularly helpful at protecting the feet from the impact of hard surfaces while running and jumping. Furthermore, for people who are lifting weights, performing aerobics, doing box jumps, or engaging in other types of vigorous exercises, athletic (gym) shoes can help lower the risk of foot injuries by offering optimal traction. These types of shoes typically have hard soles that distribute weight during exercise, evenly disperse the force of lifting a heavy object, and prevent the feet from sliding forward.
Shoes for Rock Climbing
Shoes that are designed for rock climbing provide extra foot support, flexibility, and traction while climbing. These types of shoes usually have a flat base and a stiff, rubber sole that helps the foot grip the rock’s surface. Rock-climbing shoes are also usually made from mesh that creates a snug fit around the ankle area to help prevent the foot from moving around inside of the shoe while scaling the rocks.
Consider Speaking With a Physiotherapist
If you’re experiencing ongoing foot pain or you need assistance in choosing the appropriate pair of shoes, a physiotherapist at Crowfoot NW can provide a comprehensive evaluation and professional guidance. Understanding when to wear certain shoes is one of the keys to preventing foot problems, maintaining ideal health, and getting the most out of the activities you enjoy. Schedule a consultation today with one of our expert physiotherapists who can access your current footwear and offer useful suggestions for your next pair.
References
1. Buldt AK, Menz HB. Incorrectly fitted footwear, foot pain and foot disorders: A systematic search and narrative review of the literature. J Foot Ankle Res. 2018;11:43.
2. Frey C. Foot health and shoewear for women. Clin Orthop. 2000;372:32-44.
3. Richards R. Calluses, corns, and shoes. Semin Dermatol. 1991;10(2):112-114.
4. Chantelau E, Gede A. Foot dimensions of elderly people with and without diabetes mellitus–a data basis for shoe design. Gerontology. 2002;48(4):241-244.
5. Huang Y, Peng HT, Chen ZR, et al. The arch support insoles show benefits to people with flatfoot on stance time, cadence, plantar pressure and contact area. PLoS One. 2020;15(8):e0237382.
6. Wannop JW, Worobets JT, Stefanyshyn DJ. Footwear traction and lower extremity joint loading. Am J Sports Med. 2010;38(6):1221-1228.
7. Andreasson G, Lindenberger U, Renstrom P, Peterson L. Torque developed at simulated sliding between sport shoes and an artificial turf. Am J Sports Med. 1986;14(3):225-230.
8. Lambson RB, Barnhill BS, Higgins RW. Football cleat design and its effect on anterior cruciate ligament injuries: A three-year prospective study. Am J Sports Med. 1996;24(2):155-159.
Tennis elbow is an overuse injury caused by microscopic tears of the tendons that are connected to forearm muscles in the elbow joint. This type of injury develops due to repetitive movements, including repeatedly swinging a tennis racquet. Performing stretches, strength training, and forearm exercises can help reduce the risk of tennis elbow. Taking frequent breaks while playing sports such as tennis, or icing a sore joint, can also help ease minor inflammation before the tissue damage progresses to tennis elbow. In addition, it is important to purchase the right type of racquet to prevent tennis elbow from developing.
The proper racquet can help ensure that the impact or amount of force the forearm and elbow encounter when the ball hits the racquet remains low enough to minimize tissue damage. The force that is transferred to the forearm and elbow depends on several different properties of the racquet and its strings, such as racquet weight, balance, and stiffness (flexibility), as well as string gauge, resiliency, and tension.
Important Features to Look For
A lightweight racquet with a flexible frame helps improve forearm safety by reducing turning force (torsion) and the shock of the ball’s impact. Excess force and shock are two of the main factors that are linked to tennis elbow. Although a racquet that is light and has a flexible frame absorbs more force from the ball’s impact, it also causes a stronger vibration with a greater amplitude than a heavy, stiff racquet. For most players, racquet vibration is uncomfortable, but this issue has not been associated with an increased risk of tennis elbow. However, professional players typically prefer minimal vibration when possible. To address this issue, a racquet of moderate weight (e.g., 10 to 11 ounces) with a close to even balance is ideal for most players.
Balance refers to whether the racquet is head light, head heavy, or even balanced. For a head light racquet, the majority of the racquet’s weight is toward the handle. A head heavy racquet has more weight toward the head or top of the racquet, while the weight of an even balanced racquet feels about the same throughout the length of the racquet. The properties of the racquet strings also influence body dynamics.
Racquet strings that are thin, loose, and resilient are easier on the forearm, as they stretch further, allowing the strings to absorb more force from the ball’s impact. This reduces the shock that tendons and muscles are exposed to while playing tennis. Looser strings make it a little harder to control the direction of the ball upon impact, but control can be improved through practice with a skilled trainer. Stiff strings are harder on forearm muscles because they absorb less force. Additional features to pay attention to include grip size and swing weight, which are features that can be discussed with a sales representative, trainer, or physiotherapist. Before purchasing a racquet, it is always important to perform an equipment check.
Perform an Equipment Check
If you frequently participate in sports that involve swinging movements (e.g., tennis, golf, baseball), a physiotherapist at Interactive Health Physiotherapy & Massage may encourage you to check your equipment for the proper type and fit. Flexible racquets that have medium to moderate string tension help reduce the amount of stress or force that is placed on the forearm. This means the forearm muscles work less hard and are subject to minimal tissue damage.
A physiotherapist can also assess whether the racquet you are using may be too big, as an oversized racquet can be heavy and hard to swing. These are factors that can increase the risk of experiencing tennis elbow. Switching to a smaller racquet can lower the incidence of recurring symptoms, and our highly skilled physiotherapists can evaluate your swing technique to improve postural problems that may contribute to overuse injuries.
Call Interactive Health Physiotherapy & Massage in Crowfoot NW for more information about purchasing the optimal tennis racquet.
References:
1. Cutts S, Gangoo S, Modi N, et al. Tennis elbow: A clinical review article. J Orthop. 2020;17:203-207.
2. Ma KL, Wang HQ. Management of lateral epicondylitis: A narrative literature review. Pain Res Manag. 2020:6965381.
3. Allen T, Choppin S, Knudson, D. A review of tennis racket performance parameters. Sports Eng. 2016;19:1-11.
4. Allen T, Grant R, Sullivan M, et al. Recommendations for measuring tennis racket parameters. Proceedings. 2018; 2(6):263.
5. Grant R, Taraborrelli L, Allen T. Morphometrics for sports mechanics: Showcasing tennis racket shape diversity. PLoS One. 2022;17(1):e0263120.
Cumulative trauma disorder (CTD) is a broad category that includes many common diseases that affect the soft tissues of the body. CTD in itself is not a disease. Doctors use the concept to understand and explain what may have caused, or contributed to, certain conditions. Examples of the conditions that may be caused or aggravated by cumulative trauma include carpal tunnel syndrome, tennis elbow, and low back pain.
Other terms are often used to describe the concept of CTD. These include repetitive stress injury (RSI), overuse strain (OS), and occupational overuse syndrome (OOS). This document will refer to these categories generally as CTD.
This guide will help you understand:
what factors may contribute to CTD
how doctors diagnose conditions related to CTD
what treatment options are available
how to prevent CTD
CAUSES
What causes CTD?
Opinions abound as to what may cause CTD, but there is very little agreement. Some of the theories about how CTD starts are described below. The theories include:
overuse
muscle tension
nerve tension
psychosocial factors
mind-body interaction
contributing factors
OVERUSE
Using muscles and joints after they have become fatigued, or overly tired, increases the likelihood of injury. Overloaded muscles and soft tissues without proper rest have no chance to recover fully. This problem often hampers athletes who have to throw, jump, or run repeatedly. It can also affect people who work in jobs where they keep doing the same action again and again, such as typing, gripping, and lifting.
All body tissues are in a constant state of change. Minor damage occurs continuously, which the body must repair in the normal course of a day. But the damage can occur faster than the repair mechanisms can keep up with it. When this happens, the tissues become weaker. They may begin to hurt. The weaker the tissues become, the more likely they will suffer even more damage. A cycle begins that looks like a spiral–constantly downward.
TENSION
Muscle Tension
Some doctors think muscle tension causes CTD. To function, or work properly, the body and each of its parts needs a steady supply of blood, rich in oxygen and nutrients. Nutrients are the body’s fuel–glucose, for example. Cutting off or slowing the blood supply harms the tissues of the body.
Tense muscles are believed by some to actually squeeze off their own flow of energy and fuel. Muscles can get energy without oxygen, but the process produces a chemical called lactic acid. This chemical can be a potent pain-causing chemical. Lactic acid is a chemical that can produce a burning feeling when muscles are overexercised. Some physicians believe that lactic acid produced by tense muscles may cause some of the symptoms of CTD.
As pain develops, muscles tighten even further because they attempt to guard the surrounding area. Guarding is a term that is used to describe a reflex that all muscles in the body share. When pain occurs anywhere in the body, muscles around the painful area go into spasm (they tighten uncontrollably) to try to limit the movement in the area. As a result, blood flow is slowed down even more. The muscles begin to ache more. The nerves that have their blood supply reduced and squeezed by muscles begin to tingle or go numb.
Nerve Tension
This theory suggests that nerves become extra sensitive when they’ve become shortened and irritable. It is thought that poor postures used over long periods causes muscles to bulk up and interfere with blood flow. The nerves that course through the body then become shortened and may begin to stick to the nearby tissues. Moving the arm or leg puts tension on the nerve and can cause pain to radiate along the limb. The problem is thought to get worse from stress because the muscles and nerves tense up and become even tighter. Also, when the same activities are done over and over again, the tight nerve is pulled and strained to the point that it can’t heal and eventually becomes a chronic source of symptoms.
PSYCHOSOCIAL FACTORS
Problems with CTD tend to be more common among people who suffer from boredom, who have poor working relations, who aren’t satisfied with their jobs, and who have unhappy social circumstances. Reasons why this is so are unclear. The number of CTD cases reported may also be influenced by state worker’s compensation rules. States where claims are processed quickly and with greater benefits tend to have higher volumes of CTD cases. Both of these findings suggest that many cases of CTD may be highly influenced by the patient’s perception of the overall situation. Some patients may subconsciously, or consciously, rationalize their symptoms due to many factors that are not medical but have to do with their overall job and social situation.
MIND-BODY INTERACTION
A newer theory suggests that there isn’t really an injury going on in the soft tissues where symptoms are felt. Instead, the problem is said to be coming from influences within the mind. It is theorized that the brain starts producing pain signals as a cover-up for deep-rooted feelings of past emotional pain or problems. Though the idea sounds hard to believe, practitioners using this approach claim they have had success rates as high as 95 percent. Their patients are reported to have gotten swift relief from treatments aimed at the underlying and unconscious emotional triggers.
CONTRIBUTING FACTORS
The way people do their tasks can put them at risk for CTD. Some risk factors include:
force
awkward or static postures
poor tool and equipment design
fatigue
repetition
temperature
vibration
One of these risk factors alone may not cause a problem. But doing a task where several factors are present may pose a greater risk. And the longer a person is exposed to one or more risks, the greater the possibility of developing CTD. Many different symptoms can arise from the accumulation of small injuries or stresses to the body. CTD is not so much a disease as it is a response to excessive demands these factors can place on our bodies without giving them adequate time to recover between.
SYMPTOMS
What does CTD feel like?
The symptoms of CTD usually start gradually. Patients usually don’t recall a single event that started their symptoms. They may report feelings of muscle tightness and fatigue at first. People commonly report feeling numbness, tingling, and vague pain. Others say they feel a sensation of swelling in the sore limb. Some patients with arm symptoms sense a loss of strength and may drop items because of problems with coordination. Symptoms often worsen with activity and ease with rest.
DIAGNOSIS
When you visit Interactive Health Physiotherapy & Massage, our physiotherapist will begin the evaluation by taking a history of your problem. We’ll probably ask questions about your job, such as the type of work you do and how you perform your job tasks. Answers to other questions will give us information about your work conditions, such as the postures you use, the weights you have to lift or push, and whether you have to do repetitive tasks. We may also ask about how you like your job and whether you get along with your supervisors and coworkers.
Our physiotherapist will then do a thorough physical examination. Your description of the symptoms and the physical examination are the most important parts in the diagnosis of CTD. We will first try to determine what conditions are affecting you. For example you may have symptoms of carpal tunnel syndrome or tennis elbow that need to be treated. Second, our physiotherapist will try and determine if cumulative trauma is playing a role in your condition. If so, part of the treatment will be to try and eliminate the source of the cumulative trauma.
There are no specific tests that can diagnose CTD. There are many different tests that may be ordered as we look for specific conditions.
Interactive Health Physiotherapy & Massage provides physiotherapist services in Crowfoot NW.
Portions of this document copyright MMG, LLC.
PREVENTION
How can I help prevent problems of CTD?
The best medicine for treating CTD is to prevent the problem from occurring in the first place. Key items to consider when attempting to prevent problems with CTD are listed below.
Use healthy work postures and body alignment. Posture can have a significant role in CTD. Faulty alignment of the spine or limbs can be a source of symptoms. Using healthy posture and body alignment in all activities decreases the possibility that CTD will strike. Incorrect posture may lead to muscle imbalances or nerve and soft tissue pressure, leading to pain or other symptoms. Most people spend many hours at their work place, and using unhealthy posture during these long hours increases the likelihood that CTD will develop.
Ergonomics
Assessing where and how a person does work is called ergonomics. Even subtle changes in the way a work station is designed or how a job is done can lead to pain or injury.
Rest and Relax
Rest and relaxation (R and R) have recently become front-line defenses in the prevention of CTD. Methods can be as simple as deep breathing, walking, napping, or exercising.
This strategy is useful during work and off hours. Whether at home or work, our bodies need time to recover, which simply means giving them a chance to heal. Rest and relaxation allow the body to recover and provide a way of repairing these injured tissues along the way, keeping them healthy.
The following ideas may be used to foster rest and relaxation at work:
Be relaxed. Try to work with your muscles relaxed by pacing your work schedule, staying well ahead of deadlines, and taking frequent breaks.
Stop to exercise. Gentle exercise performed routinely through the day helps keep soft tissues flexible and can ease tension.
Change positions. Plan ways to change positions during work tasks. This could include using a chair rather than standing or simply readjusting your approach to your job activity.
Rotate jobs or share work duties. This can be fun by offering a new work setting, and it allows the body to recover from the demands of the previous job task.
Avoid caffeine and tobacco. These can heighten stress, reduce blood flow, and elevate your perception of pain.
OUR TREATMENT
What can I expect with treatment?
Getting treated right away for symptoms of CTD can shorten the time it takes to heal. Symptoms can sometimes go away within two to four weeks when steps are taken quickly to address the factors that may be causing your symptoms. However, people who keep doing activities when they have symptoms and don’t seek help right away may be headed for a long and frustrating recovery time, perhaps as long as a year.
At Interactive Health Physiotherapy & Massage many nonsurgical treatment approaches are used by our physiotherapy and occupational therapists to reduce the symptoms of CTD-related conditions. Our physiotherapist will want to gather more information and will further evaluate your condition. The answers you give along with the results of the examination will guide us in tailoring a treatment program that is right for you.
Our physiotherapists often begin by teaching patients relaxation techniques which may include helping you learn to breathe deeply by using your diaphragm muscle. Taking the time to relax and breathe deeply eases tense muscles and speeds nutrients and oxygen to sore tissues.
We may suggest that you wear a splint initially to protect and rest the sore area. Anti-inflammatory drugs, suggested by your doctor, are often used together with therapy treatments, which may include heat, ice, ultrasound, or gentle hands-on stretching to reduce pain or other symptoms. Our physiotherapist may use muscle stretching to restore muscle balance and to improve your posture and alignment. We sometimes apply stretches that are designed to help nerves glide where they course from the spine to the arms or legs. Strengthening exercises are also used to restore muscle balance and to improve your ability to use healthy postures throughout the day.
Our physiotherapist will pay close attention to your posture and movement patterns. You may receive verbal instruction and hands-on guidance to improve your alignment and movement habits. Helping you see and feel normal alignment improves your awareness about healthy postures and movements, allowing you to release tension and perform your activities with greater ease.
We will spend time helping you understand more about CTD and why you are experiencing symptoms. Our physiotherapist may provide tips on how to combat symptoms at work using rest and relaxation. You may also be given specific stretches and exercises to do at work. Our physiotherapist may visit your work place to analyze your job site and to watch how you do your job tasks. Afterward, we can recommend changes to help you do your job with less strain and less chance of injury. These changes are usually inexpensive and can make a big difference in helping you be more productive with less risk of pain or injury.
At Interactive Health Physiotherapy & Massage, our goal is to help you understand your condition, to look for and change factors that may be causing your symptoms, and to help you learn how to avoid future problems. When your recovery is well underway, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of practicing the strategies and exercises you’ve learned as part of an ongoing home program.
Interactive Health Physiotherapy & Massage provides services for physiotherapy in Crowfoot NW.
SURGERY
Surgery is rarely indicated for CTD. Specific conditions that can occur as a result of CTD may require surgery. Unless the doctor is quite sure there is a structural problem, such as a pinched nerve or severely inflamed tendon, then surgery is not usually suggested.
When a child or adolescent complains of pain and tenderness near the bottom of the kneecap, the problem might be from jumper’s knee. Kids in sports that require a lot of kicking, jumping, or running are affected most. Repeating these actions over and over can lead to pain in the tendon that stretches over the front of the kneecap (the patellar tendon.)
Sometimes the bone growth center at the bottom tip of the kneecap is affected instead of the patellar tendon itself. This condition is known as Sinding-Larsen-Johansson disorder. It is mostly likely to occur during growth spurts. Disruption within the developing bone in the bottom tip of the kneecap also produces pain and tenderness in the front of the knee.
Fortunately, this condition is not serious. It is usually only temporary and will improve with age.
This guide will help you understand:
what part of the knee is involved
what causes the condition
what the condition feels like
how health care professionals identify the problem
what treatment options are available
what Interactive Health Physiotherapy & Massage’s approach to rehabilitation is
ANATOMY
What part of the knee is involved?
connects the large and powerful quadriceps muscle in the front of the thigh to the tibia (shinbone). The patellar tendon wraps over the front of the patella (kneecap). The upper end of the patellar tendon connects to the bottom tip of the patella. This area is called the inferior pole of the patella. The lower end of the patellar tendon connects to a small bump of bone on the front surface of the tibia. This bump is called the tibial tuberosity.
CAUSES
How does this problem develop?
Jumper’s knee is usually caused by overuse of the patellar tendon. Kids who play sports with a lot of squatting and jumping are most at risk. In order to squat and to land softly from a jump, the quadriceps muscle must work extra hard to slow the body down and protect the knee. It does this by lengthening as it works, which is called an eccentric contraction. This muscle action places very high tension on the patellar tendon. When squatting and jumping are performed over and over, the repetitive stress on the tendon causes injury to the individual fibers of the tendon. The tendon becomes inflamed and painful. This is the condition called jumper’s knee.
In addition to overuse of the tendon causing the patellar tendon pain, abnormal alignment of the lower limbs can play a major part in the development of jumper’s knee. Kids who are knock-kneed or flat-footed seem to be more prone to the condition. These altered postures cause a sharper angle between the quadriceps muscle and the patellar tendon. This angle is called the Q-angle. Having a large Q-angle puts more tension on the patellar tendon and the risk of developing jumper’s knee is thus higher.
A large Q-angle also places abnormal tension on the bone growth plate of the inferior pole of the patella, also increasing the risk for Sinding-Larsen-Johansson disorder. A high-riding patella, called patella alta, is also thought to contribute to development of jumper’s knee in children and adolescents.
Pain around the patellar tendon pain can start simply from a growth spurt in an active child whose bones are not done growing. Increased tension in the tendon starts during the growth spurt. The patellar tendon is unable to keep up with the growth of the lower leg. As a result, the tendon is too short. This causes the tendon to pull on the bottom tip of the kneecap. Heavy or repetitive sports activity during this time stresses this area even more. Eventually the increased tension disrupts normal growth of the bottom tip of the patella. Again, this is known as Sinding-Larsen-Johansson disorder.
Sinding-Larsen-Johansson disorder is part of a category of bone development disorders known as the osteochondroses. (Osteo means bone, and chondro means cartilage.) In normal development, specialized areas called growth plates change over time from cartilage to bone. The growth plates expand and unite. This is how bones grow in length and width. Bone growth centers are located throughout the body.
Children with bone development disorders in one part of their body are likely to develop similar problems elsewhere. For example, children who have Sinding-Larsen-Johansson disorder also have a small chance of bone growth problems where the lower end of the patellar tendon attaches to the tibial tuberosity. This is known as Osgood Schlatter’s disease.
SYMPTOMS
What does this problem feel like?
Jumper’s knee commonly produces pain and tenderness directly over the patellar tendon, just below the kneecap. Sometimes there is a small amount of swelling. Kneeling on the sore knee usually hurts. Activities where the quadriceps muscle works eccentrically, such as squatting, jumping, and going down stairs, are often painful.
Kids with Sinding-Larsen-Johansson disorder may feel similar symptoms right along the bottom of the kneecap, where the patella meets the patellar tendon. Sometimes they feel tightness in this area, especially when they try to fully bend the knee.
DIAGNOSIS
How do health care professionals identify the problem?
The history and physical examination are often enough to suspect a diagnosis of jumper’s knee. Your physiotherapist at Interactive Health Physiotherapy & Massage will ask many questions and will want information about your child’s age and activity level. They will also ask about where precisely the pain is, when the pain began, what your child was doing when the pain started, and what movements aggravate or ease the pain. Jumper’s knee generally begins insidiously, but on occasion it can be instigated by a trauma to the knee such as a fall or hard knock to the knee.
Next your physiotherapist will do a physical examination of the knee and entire lower extremities. They will palpate, or touch, around the knee and particularly along the patella and patellar tendon to determine the exact location of pain. Your physiotherapist will look for factors such as bony alignment (Q-angle,) muscle flexibility, mobility of the patella, and joint laxity that may be contributing to your child’s knee pain. They may want to look at how your child stands, their foot position, or watch them walk, squat, or jump. Your physiotherapist will also check the strength and lengths of the muscles surrounding and affecting the knee joint such as the quadriceps, hamstrings, calves, hip flexors and buttocks muscles. All of these muscles, if weak or tight, can contribute to the forces applied to the knee joint and contribute to the development of jumper’s knee. They may also assess your child’s core stability (specific lumbar and abdominal muscles) as poor functioning of the core can also contribute to the development of knee problems.
Lastly, resistance while your child straightens their knee will be checked to see if it elicits pain. This action generally reproduces the pain associated with jumper’s knee because it puts tension on the patellar tendon.
If Sinding-Larsen-Johansson disorder is suspected, it is wise to have an X-ray. The X-ray is taken from the side of the knee. This view may show small fragments of bone where tension in the patellar tendon has disrupted the growth plate in the bottom tip of the patella. The X-ray may also show calcification or roughness around the bottom of the patella.
If a trauma to the knee instigated the pain then an X-ray is also required to rule out a patellar fracture.
An ultrasound may also be suggested as a way to directly view any damage to the patellar tendon itself, but it is not frequently needed to confirm the diagnosis.
Occasionally, a magnetic resonance imaging (MRI) scan will be ordered in addition to an X-ray as it may show more detail. The MRI can give a better view of any calcification in the patellar tendon where it attaches on the bottom tip of the kneecap. The MRI can also detect swelling, which is not seen well on X-ray. It can also show if injury or inflammation is present within the patellar tendon itself.
Interactive Health Physiotherapy & Massage provides services for physiotherapy in Crowfoot NW.
TREATMENT
What treatment options are available?
Nonsurgical Rehabilitation and Treatment
In the case of Sinding-Larsen-Johansson disorder, the disease is often self-limiting, which means that with a certain passing of time, the pain will entirely go away. This time frame coincides with the bone growth plates that form the inferior pole of the patella growing together to form one solid bone. This generally takes one to two years. Once the bones have grown together, the pain and symptoms usually go away completely. Physiotherapy treatment at Interactive Health Physiotherapy & Massage during this time, while the bones are still growing together, can be very useful to manage the injury by decreasing pain and inflammation, as well as to monitor the appropriate level of physical activity that your child partakes in. For true jumper’s knee, where the patellar tendon itself if affected and not the growth plate, physiotherapy is also very useful for the same reasons.
In some cases of jumper’s knee, your child may need to stop sports activities for a short period. This allows the pain and inflammation to settle. Usually patients don’t need to avoid sports for a long time. ‘Relative rest’ may be suggested rather than a complete cessation of physical activity. ‘Relative rest’ is a term used to describe a process of rest-to-recovery based on the severity of symptoms. If your child is experiencing pain while doing nothing (resting) it means the injury is more severe and your physiotherapist will advise a period of strict cessation of activity. If, however, your child’s pain is not severe and only occurs intermittently with certain activities or after activity, then your child may be able to continue to partake in a moderate amount of activity (relative rest) while being treated for jumper’s knee. Your physiotherapist will provide advice on the appropriate activity level that your child can safely partake in while dealing with their jumper’s knee.
The initial treatment for jumper’s knee at Interactive Health Physiotherapy & Massage will aim to decrease the inflammation and pain in the knee. Simply icing the knee can often assist with the inflammation and relieve a great deal of the pain. In cases of chronic pain (lasting longer than 3 months), heat may be more useful in decreasing pain. Your physiotherapist may also use electrical modalities such as ultrasound or interferential current to decrease the pain and inflammation. Massage, particularly for the quadriceps muscle, may also be helpful.
Medication to ease the pain or inflammation can often be very beneficial in the overall treatment of jumper’s knee. Your physiotherapist may suggest you see your doctor to discuss the use of anti-inflammatories or pain-relieving medications in conjunction with your physiotherapy treatment. Your physiotherapist may even liaise directly with your doctor to obtain their advice on the use of medication in your individual case, and suggest you see them if they feel it would be beneficial.
Cortisone injections performed by a doctor are commonly used to control pain and inflammation in other types of injuries involving the patellar tendon, however, a cortisone injection is usually not appropriate for this condition. Cortisone injections haven’t shown consistently good results for jumper’s knee and there is also a high risk that the cortisone will cause the patellar tendon to rupture.
Once the initial pain and inflammation has calmed down, your physiotherapist will focus on improving the flexibility, strength, and alignment around the knee joint and entire lower extremity. Static stretches for the muscles and tissues around the knee (particularly the quadriceps and iliotibial band on the outside of the knee) will be prescribed by your physiotherapist early on in your treatment to improve flexibility.
Again, any tightness in the muscles or tissues around the knee can increase the pull on the patellar tendon or affect alignment during walking, running or jumping so it is important to address this immediately. Dynamic stretching (rapid motions that stretch the tissues quickly, similar to that of an eccentric contraction,) will also be taught and will be incorporated into your child’s rehabilitation exercise routine as part of their warm-up when doing more physical activity. Dynamic stretches more effectively prepare the tissues for rapid and repetitive activity than static stretches, which focus more on gaining overall flexibility.
Strength imbalances will also affect the alignment of the knee and can cause muscles to tighten which puts more pressure on the knee and can contribute to the cause of jumper’s knee. Your physiotherapist will determine which muscles in your child’s individual case require the most strengthening. Strength in both the knee and the hip (which controls the knee position) are very important. When bending the knee, as stated above, the patellar tendon is placed under load while it is stretching (eccentric load.) This load can be tremendous especially when jumping and landing. In order to prepare the healing tendon to take this load once your child returns to activity your physiotherapist will prescribe ‘eccentric’ muscle strengthening. Bending the knee quickly into a squatting position and then stopping rapidly (drop squats) encourages the patellar tendon (and entire knee joint) to adapt to the force that will eventually be needed to return to physical activity. When appropriate, weights can be added to simulate the increased body weight that the knee endures during running and jumping.
Your physiotherapist may ask your child to do this exercise on a board slanting downwards (approximately 25 degrees) which has been shown to also increase the force through the tendon. In addition, an electrical muscle stimulator may be used on the quadriceps muscle during the activity which encourages improved recruitment of the muscle, particularly the medial quadriceps portion which has a considerable effect on the position of the patella and pull on the patellar tendon. All exercises should be completed with minimal or no pain and advancing the exercises should be done at the discretion of your physiotherapist as not to flare up the healing tendon. Once these exercise are mastered, your physiotherapist may add even more advanced exercises such as jumping and landing from a height or on different surfaces.
As part of your treatment your physiotherapist may choose to use a hands-on technique to mobilize your kneecap and improve its flexibility. In cases where the patella does not move well, improved movement can change the overall pull on the patellar tendon and therefore assist in decreasing overall pain.
Bracing or taping the knee or kneecap may also help your child do exercises and activities with less pain. Your physiotherapist can educate you on which brace would be most appropriate for your child but an initial trial of taping is an easy and cost-effective way to determine if a brace will in fact decrease your child’s pain before actually investing in one. Your physiotherapist may even teach your child how to tape their own knee or show you how to do it for them. Taping over a longer time frame will cause irritation to the skin and can be cumbersome, therefore if the taping helps, a brace, which performs a similar function, may be suggested. Braces used for jumper’s knee are made of soft fabric, such as cloth or neoprene. There are different types of braces that may help. The braces work by one of two mechanisms. They either work to encourage proper alignment of the patella as it glides down the knee, and therefore decreases the abnormal pull on the patellar tendon, or the brace presses into the patellar tendon itself and distributes the force of the load through a greater region of the patellar tendon. Patients commonly report less pain and improved function with both taping and bracing.
As mentioned above, proper alignment of your child’s entire lower extremity is paramount to decreasing the overall stress that is placed on the patellar tendon. In addition to strengthening, stretching, hands-on treatment, and taping, foot orthotics may be useful to assist with alignment. Foot orthotics can correct a flat foot position, which in turn then encourages proper alignment up the lower extremity chain. Your physiotherapist can advise you on whether orthotics would be useful for your child, and also on where to purchase them.
A critical part of our treatment for jumpers knee at Interactive Health Physiotherapy & Massage includes specific education on returning to full physical activity. Bending and straightening the knee occurs often in everyday activities such as walking or stair climbing so a patellar tendon that is recovering from injury can easily be aggravated. Returning your child back to normal physical activity at a graduated pace is crucial to avoid repetitive pain or a chronic injury. Your physiotherapist will advise you on the acceptable level of activity at each stage of your child’s rehabilitation process and assist your child in returning to his or her activities as quickly and as safely as possible.
With a well-planned rehabilitation program and adherence to suggested levels of rest and activity modification, most children and adolescents dealing with jumper’s knee or Sinding-Larsen-Johansson disorder eventually recover fully without recurring symptoms. By following the rehabilitation plan, most children are also able to partake in a level of activity that suits them while recovering.
Interactive Health Physiotherapy & Massage provides services for physiotherapy in Crowfoot NW.
SURGERY
Surgery is rarely needed for jumper’s knee. Surgery may be considered if the problem involves only the tendon (not the growth plate) and if symptoms have not gone away with other forms of treatment. In these cases, the surgeon may do an operation to strip away (debride) inflamed and damaged tissue on the surface of the patellar tendon. In this procedure, a small incision is made down the front of the knee, below the patella.
The skin is opened to expose the patellar tendon. Next, the surgeon carefully peels damaged tissue off the surface of the tendon. Three to five thin lengths of the tendon are removed. In some cases, small drill holes are made in the bottom tip of the patella. This drilling causes a small amount of bleeding, which signals the body to begin to heal the area. The surgeon also removes any damaged tissue nearby the area before completing the operation by stitching up the skin and wrapping the area with a bandage.
Surgery is not generally used when symptoms are caused by Sinding-Larsen-Johansson disorder, unless bone growth is complete and symptoms have not gone away with nonsurgical treatment. Even then, surgery for Sinding-Larsen-Johansson disorder is unusual.
AFTER SURGERY
The surgeon may recommend wearing a hinged knee brace for a few weeks after surgery. The brace lets the knee bend, but it doesn’t let the quadriceps muscle fully straighten the knee. This decreases the amount of force put through the healing tendon. Crutches may be needed for a few days after the operation, until the patient can bear weight without pain or problems, and walk without a limp.
Patients will follow up with their surgeon 10 to 14 days after surgery. Stitches will be taken out at this time, and patients are encouraged to begin actively bending and straightening the knee. Post-surgical rehabilitation at Interactive Health Physiotherapy & Massage can begin at this time.
POST SURGICAL REHABILITATION
Post-surgical rehabilitation at Interactive Health Physiotherapy & Massage will initially focus on minimizing the pain and swelling from the surgery. Similar to non-surgical rehabilitation, your physiotherapist may use modalities such as ice, ultrasound, or interferential current to accomplish this. They may also use gentle massage around the muscles of your child’s surgical knee. If your child is still using crutches when we initially see them, your physiotherapist will ensure your child knows how to use them properly on level ground as well as stairs, and they will advise your child when it is safe to go without using the crutches at all.
One of the first exercises your physiotherapist will prescribe will be some gentle range of motion exercises for your knee to gradually regain full movement. This should be done within a pain free range of motion, however, movement will be encouraged even if it causes a slight bit of discomfort as the movement itself can greatly assist with dispersing any inflammation as well as improving the overall level of pain. A stationary bicycle can be very useful in the initial stages of gaining range of motion in the knee, so if able, you will be encouraged to use one. Even if you are unable to fully rotate the pedals, the back and forth motion on the bike is an excellent method of slowly encouraging the knee to regain its full range of motion.
Once the pain and swelling is under control your child’s rehabilitation will follow a similar pattern to that described above under non-surgical rehabilitation. Your physiotherapist will prescribe a series of exercises that address the strength, endurance, and flexibility of the muscles of the knee and hip joints. They will also address the overall alignment of the entire lower limb during both the rehabilitation exercises as well during everyday activities and sporting endeavors. Eccentric exercises are an important part of post-surgical rehabilitation and will be introduced as soon as your physiotherapist feels it is appropriate.
Daily activities will be resumed fairly quickly but vigorous activities and exercise should be avoided for at least six weeks after surgery to give adequate rest to the healing tendon. High-level athletes, unfortunately, may be restricted in their sporting activities for up to six months to allow the tendon to heal and to ensure there is not a recurrence of the injury.
Recovery from surgery for jumper’s knee in adolescents or children generally progresses very well with rehabilitation at Interactive Health Physiotherapy & Massage. If however, your child’s pain lasts longer than it should or their rehabilitation is not progressing as quickly as your physiotherapist feels it should be, they will ask you to follow up again with your child’s surgeon to ensure there are no complicating factors impeding the recovery.
Interactive Health Physiotherapy & Massage provides services for physiotherapy in Crowfoot NW.
Let’s face it; Caeleb Dressel has made the sport of swimming incredibly cool. It was amazing to watch him glide through the water like it was his home, as if he had flippers instead of hands and feet.
While the sport has always typically been considered low risk, with the exception of holding your breath and staying under the water too long, there is an opportunity to hurt yourself and keep you in the shallow end through the repetitive motion that can lend itself to a shoulder injury.
This specific section of our site is dedicated to you, the swimmer. It is here that you will find the information and exercises that will keep you competing in the butterfly relay and not doggie paddling in the kiddy pool.
A popliteal cyst, also called a Baker’s cyst, is a soft, often painless bump that develops on the back of the knee. A cyst is usually nothing more than a bag of fluid. These cysts occur most often when the knee is damaged due to arthritis, gout, injury, or inflammation in the lining of the knee joint. Surgical treatment may be successful when the actual cause of the cyst is addressed. Otherwise, the cyst can come back again.
This guide will help you understand:
how a popliteal cyst develops
why a cyst can cause problems
what can be done for the condition
ANATOMY
What is a popliteal cyst?
The knee joint is formed where the thighbone (femur) meets the shinbone (tibia). A slick cushion of articular cartilage covers the surface ends of both of these bones so that they slide against one another smoothly. The articular cartilage is kept slippery by joint fluid made by the joint lining (the synovial membrane). The fluid is contained in a soft tissue enclosure around the knee joint called the joint capsule.
Knee Joint
A popliteal cyst is a small, bag-like structure that forms when the joint lining produces too much fluid in the knee. The extra fluid builds up and pushes through the back part of the joint capsule, forming a cyst. The cyst squeezes out toward the back part of the knee in the area called the popliteal fossa, the indentation felt in the back part of the knee between the two hamstring tendons and the top part of the calf muscle.
Popliteal Fossa
Most people will be able to feel the cyst in the hollow area right behind the knee joint.
A popliteal cyst may form after damage to the joint capsule of the knee. The weakening of the joint capsule in the damaged area can cause the small sac of fluid to form. This can lead to a bulging of the joint capsule, much like what occurs when an inner tube bulges through a weak spot in a tire. The cyst may become larger over time.
A popliteal cyst can actually be a response to other conditions that cause swelling in the knee joint. This swelling is most often from problems of osteoarthritis or rheumatoid arthritis in the knee joint. It can also be caused by trauma, either from a direct blow to the knee or from repetitive activities that lead to overuse in the knee joint. A popliteal cyst is not from of a blood clot in the leg, although sometimes it can be mistaken for a blood clot.
SYMPTOMS
What does a popliteal cyst feel like?
The symptoms caused by a popliteal cyst are usually mild. You may have aching or tenderness with exercise or your knee may feel unsteady, as though it’s going to give out. You may feel pain from the underlying cause of the cyst, such as arthritis, an injury, or a mechanical problem with the knee, for instance a tear in the meniscus. Along with these symptoms, you may also see or feel a bulge on the back of your knee. Anything that causes the knee to swell and more fluid to fill the joint can make the cyst larger. It is common for a popliteal cyst to swell and shrink over time.
Sometimes a cyst will suddenly burst underneath the skin, causing pain and swelling in the calf. A ruptured popliteal cyst gives symptoms just like those of a blood clot in the leg, called thrombophlebitis. For this reason, it is important to determine right away the cause of the pain and swelling in the calf. Once the cyst ruptures, the fluid inside the cyst simply leaks into the calf and is absorbed by the body. In this case, you will no longer be able to see or feel the cyst. However, the cyst will probably return in a short time.
DIAGNOSIS
When you visit Interactive Health Physiotherapy & Massage, we will ask you to describe the history of your problem. Then our physiotherapist will examine your knee and leg. A physical exam is usually all that is needed to diagnose a popliteal cyst. Unless the cyst has ruptured, further testing is typically not needed.
Ruptured Cyst
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Interactive Health Physiotherapy & Massage have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
OUR TREATMENT
What can be done for the condition?
There are two types of treatment for popliteal cysts: surgical and nonsurgical. Whether or not the cyst has ruptured, how painful the cyst has become, or how much it interferes with the normal use of your knee will determine which is the best course of treatment for you. In adults the treatment is most often nonsurgical. If surgery is needed, it is usually done on an outpatient basis, meaning you can leave the hospital the same day. Unless there is a lot of discomfort from the cyst, surgery is rarely required.
Non-surgical Rehabilitation
Nonsurgical treatments are usually most effective when the underlying cause of the cyst is addressed. In other words, the effects of arthritis, gout, or injury to the knee need to be controlled.
Your physiotherapist at Interactive Health Physiotherapy & Massage may use massage treatments, compression wraps, and electrical stimulation to reduce knee swelling. We may also use flexibility and strengthening exercises for the lower limb to help improve muscle balance in the knee.
Our physiotherapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. This treatment is especially helpful for patients who can’t tolerate injections.
Although the time required for recovery varies, with nonsurgical rehabilitation, a popliteal cyst may improve in two to four weeks. Improvement, however, depends a great deal on improvement in the underlying condition (the problems that are causing the knee to swell). As long as the joint continues to swell, the size of the cyst will ebb and flow. If the knee is kept from swelling, the cyst won’t swell.
If nonsurgical methods fail, complete removal of the cyst may be needed. Once they are reassured that the cyst is not dangerous, many people simply ignore the problem unless it becomes very painful.
Post-surgical Rehabilitation
If you have surgery to remove the cyst, you can resume your daily activities and work as soon as you are able. You should keep your knee propped up for several days to avoid swelling and throbbing. Take all medicines exactly as prescribed, and be sure to keep all follow-up appointments.
You may need to use crutches or a cane for awhile, and avoid vigorous exercise for six weeks after surgery. Although the time required for recovery is different for each patient, you should be able to resume driving about two weeks after surgery. Your physiotherapist can then develop a personalized program to help you regain the strength in your leg.
Interactive Health Physiotherapy & Massage provides services for physiotherapy in Crowfoot NW.
SURGERY
The goal of surgery is to remove the cyst and repair the hole in the joint lining where the cyst pushed through. Unfortunately, about half of the time the cyst comes back, or recurs, after being removed. Surgeons are cautious when suggesting surgery to remove a popliteal cyst because they are prone to recur. The cure is often permanent, but preventing further cysts depends a great deal on the success of treating the underlying cause. You should be aware that there is a very real chance that your cyst may return after being removed and there is no guarantee that the surgery will be successful.
Surgery can take more than an hour to complete. It is performed either under a general anesthetic, which causes you to sleep during the surgery, or using spinal anesthesia, which numbs the lower half of your body only. With spinal anesthesia, you may be awake during the surgery, but you won’t be able to watch what’s happening.
An incision will be made in the skin over the cyst.
The cyst is then located and separated from the surrounding tissues. The area of the joint capsule where the cyst appears to be coming from is identified.
A synthetic patch may be sewn in place to cover the hole in the joint capsule left by the removal of the cyst.
Your knee will be bandaged with a well-padded dressing and a splint for support.
Your surgeon will want to check your knee within five to seven days. Stitches will be removed after 10 to 14 days.
You may have some discomfort after surgery, and you will be given pain medicine to control the discomfort.
A popliteal cyst forms very near the major nerve and blood vessels of the leg. It is possible that these structures can be injured during surgery.
If an injury happens, it can be a serious complication. Injury to the nerves can cause numbness or weakness in the foot and lower leg. Injury to the blood vessels may require surgery to repair them.
In addition, it is uncommon but possible that another cyst can occur.
A cane may be recommended by a doctor or physiotherapist to support balance and stability. Coordination issues, balance difficulties, and muscle weakness may develop due to injuries, a disability, degenerative diseases, or surgical procedures. When minor assistance is needed to move around, a cane may offer sufficient help.
In some cases, the use of a cane is temporarily needed to promote balance and stability during recovery from an injury or following surgery. However, certain conditions (e.g., serious stroke, Parkinson’s, multiple sclerosis), a major disability, or even the aging process may cause some people to rely on a cane daily for long-term use.
The standard cane has a single-point base, but a quad cane that consists of four bases is also available. The quad cane offers more support due to its broader base, but it is also harder to use than the single-point cane. There are also different types of grips and heights that provide added comfort while holding a cane. The choice of a grip often depends on personal preference, while the height and base of a cane (single-point versus quad) depend on physical factors (e.g., person’s height, hand strength) and limitations (e.g., injury type or condition). Additionally, choosing the appropriate grip and height can reduce stress on the joints.
Speaking with a trained professional can help ensure that the right type of cane is chosen. Canes that are purchased without professional advice may lead to unsafe and inefficient use.
How to Choose and Use the Right Cane
When choosing a cane, it may be best to work with a healthcare professional such as a physiotherapist who can direct the decision-making process. In addition, a doctor may recommend physiotherapy that involves learning how to use a cane for rehabilitation purposes.
Two of the most important aspects of cane selection are base structure and height. Most people prefer to use a single-point cane, but a physiotherapist may insist that a quad cane be used for cases of severe balance issues such as following a major stroke. Quad canes are a little more difficult to use initially, but physiotherapists specialize in helping individuals learn how to use any type of cane. A quad cane, depending on the style, may also need the base, or the actual quad portion of the cane, adjusted or turned so that the legs of the quad base portion of the cane are not impeding on a walking or gait pattern.
Next, it is important to ensure that the cane is of appropriate height. It is best to select a cane that can be adjusted, these are metal canes with sliding pins for selecting the correct height, rather than a wood cane that may need to be cut to the proper height if it is too high or can’t be lengthened if it is too short. An heirloom wood cane, that a person may wish to use for sentimental reasons and not be willing to shorten/cut if it is too high/tall, is not always the best option. Proper cane height is when the top/crest of the cane handle reaches the crease of the wrist. Furthermore, the elbow should bend at a comfortable angle of about 15-20 degrees while holding the cane. A cane that is too long may be hard to move and one that is too short may cause an individual to lean forward or to one side. Pain in the elbow or lower back and leaning to one side indicates that the cane height is wrong.
Another key aspect is grip comfort. When gripping a cane, pain or numbness in the fingers or hand indicates that the wrong type of grip was chosen. A physiotherapist can monitor the use of a cane and assess possible complications (finger pain) to help make any necessary adjustments or suggest a different cane.
Your physiotherapist will also educate you about what hand your cane should be in so that you may maximize the use of a cane to its full potential for your condition. With leg surgeries and injuries the cane needs to be used in the opposite hand of the leg that requires support. This is so that the weight can be shifted off the involved leg and transferred to the other/good leg, making it easier to walk with the “swing” phase of a gait pattern. A physiotherapist can show you how to walk properly with a cane using this technique and biomechanical principle.
If you or your loved one requires a cane to assist with balance and stability, a physiotherapist at Interactive Health Physiotherapy & Massage can guide you through this process. Not only will our dedicated physiotherapists offer recommendations during the selection process, but they will also show you or your loved one how to properly use a cane. Choosing the right cane and using it efficiently can help prevent further injuries and falls—a major risk factor for disability. A cane now can also be a fashionable walking accessory with the colours, patterns and designs that are now available on the market to suit a user’s personality; ladies there are even designer canes with “bling”.
Call today to speak with a highly trained physiotherapist who can make the transition to using a cane much easier and safer.
2. Allet L, Leemann B, Guyen E., et al. Effect of different walking aids on walking capacity of patients with poststroke hemiparesis. Arch Phys M. 2009;90:1408.
3. Lam R. Choosing the correct walking aid for patients. Can Fam Physician. 2007;53(12):2115-2116.
4. Beauchamp M, Skrela M, Southmayd D, et al. Immediate effects of cane use on gait symmetry in individuals with subacute stroke. Physiother Can. 2009;61(3):154-160.
5. Hesse S, Jahnke MT, Schaffrin A, et al. Immediate effects of therapeutic facilitation on the gait of hemiparetic patients as compared with walking with and without a cane. Electroen Clin Neuro. 1998;109:515-522.
Stretching is essential when heading into the garden. At the start of gardening season numerous new injuries show up both at the local emergency department as well as at Interactive Health Physiotherapy & Massage. Gardening therefore needs to be taken seriously and treated like any other physical activity you are about to engage in. A stretching routine can help you avoid a gardening injury. Stretching before and after gardening helps to minimize muscle imbalances, prevent injury, and improve your ability to garden for longer periods. The following stretching program is designed for people who do not have any current injuries or individual stretching needs. If you have an injury, or a specific mechanical imbalance that may be inhibiting your ability to garden, your Interactive Health Physiotherapy & Massage physiotherapist can design a stretching program more specific for you.
When is the Best Time to Stretch?
When your muscles are warm and relaxed! For optimum performance you should stretch after you have done a general body warm up of about 5-10 minutes. A brisk walk around your yard or around your block in order to get the heart rate and body temperature up can do the trick. You can use this time to assess your gardening situation and think about your best plan for tackling the task at hand.
Dynamic stretches are used prior to gardening (but after your warm up) and are essential in preparing your muscles for the repetitive movements required with gardening. Your pre-gardening stretches can be done in any part of your garden or yard that affords you a bit of room. Be sure not to let your body cool down between warming up and doing the dynamic stretches, and starting the gardening. Static stretches, on the other hand, are more useful to improve your overall flexibility and are most effectively done after you have finished your gardening; soon after the tools are washed, dried, and hung ready for next time!
Rules for Dynamic Stretching:
Warm up your body first, then stretch while your muscles are still warm and do not let your body cool down before engaging in the task at hand.
Move through your range of movement, keeping control of the movement with your muscles. Do not allow momentum to control the movement by “flinging” or “throwing” your body parts around.
You may feel light resistance in your muscles, but you should never feel pain during a stretch.
Start with slow, low intensity movements, and gradually progress to full-speed movements through range of motion. Complete these motions for several repetitions (10-15 times.)
Rules for Static Stretching:
Be sure to stretch while the muscles are still warm after gardening.
Slowly take your muscles to the end of their range. You will feel slight resistance in the muscle, but you should never feel pain during a stretch.
Hold the stretch in a static position. Do not bounce.
Maintain each stretch for 20-30 seconds. Repeat each stretch 2-3 times.
Essential Stretches for Gardening:
These muscles are the key muscles used when gardening Don’t forget to stretch both sides. The stretching program shown below will take about 10-12 minutes to complete.
