Currently Browsing: Knee pain

Foot Pain

I think we all agree that any dysfunction of the foot and ankle complex can cause problems into the knees, lumbo-pelvic-hip complex, spine and upper extremities. Because of this, people must wear proper footwear to protect the foot and prevent injuries…to read more

http://www.dcpracticeinsights.com/mpacms/dc/pi/article.php?id=57026&aoid=dcpinu_20140619_magneceutical

Foot Pain – GAIT ANALYSIS

Because your feet are subject to enormous use and constant wear, even small abnormalities can cause big problems. Orthotics – inserts for shoes – can effectively correct many physical problems that arise from improper foot mechanics. Ask me to perform a gait analysis on you.

GAIT ANALYSIS

This service includes video analysis of your gait using a specially equiped treadmill, and a precise, computerized assessment of the biomechanics of your feet as you walk. This test will help determine if you need orthotics.

Consider a Gait Analysis if:

You suffer from general aches and pains from the foot to the lower back

You have “flat” feet or “high arches”

You suffer from pain anywhere in the foot, or in the ankles, knees, calves, hip or low back, either chronically or with athletic activity

You have calluses or corns

You have abnormal wear on your shoes

You have arthritis in your lower back

Knee Pain – Patello Femural Pain Syndrome (PFPS)

Dr. Tucker discusses simple, home-based routines for rehabilitation of PFPS that require little or no equipment and have the advantage of resembling activities of daily living. Read more…

https://www.acatoday.org/JacaDisplay1.cfm?CID=5263&Template=JacaDisplay1&T3ID=27&DisType=Text&T2ID=53&T1ID=11&CFID=11826973&CFTOKEN=53637835

Shock Wave Therapy

Dr. Tucker has added Radial Shock Wave Therapy (RSWT) to his list of treatments. This is the latest advancement in pain relief technology. RSWT is a especially useful for plantar fasciitis, tennis elbow,  Achilles tendinitis, and other pain and stiffness in muscles and joints do to scar tissue and adhesions.

Knee Osteoarthritis

2007-2009. For men and women, the prevalence of age-adjusted arthritis increased significantly with increasing BMI (P <.001 for trend). The age-adjusted prevalence of OA among people who were obese (25.2% for men and 33.8% for women) was nearly double that of people who are underweight/normal weight (13.8% for men and 18.9% for women). Source: CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation— United States, 2007-2009. MMWR. 2010;59(39):1261-1265.

Treatment options for OA

In patients with knee OA, my approach tends include shoe inserts. These  are good adjuncts to supplements, laser, Deep Muscle Stimulation (DMS), injectables, taping, and exercise therapy. I recommend swimming, recumbent bicycles, rowing machines and elliptical trainers. I teacgh my clients a lot of low load, easy to do stretches and strenghtening exercises. Weight loss is really important here. 

On laser therapy for treating patients with knee OA:  It depends on the patient and the severity of his or her OA. For example, if the patient is older and has a severely arthritic knee, a total knee replacement will probably be necessary. If a patient has OA and joint effusion, I might recommend laser, aspiration and corticosteroid injection.

If I have a patient with symptoms of OA who may have incurred an injury such as an ACL tear, I will use warm laser and DMS. 

If you have undergone an arthroscopic procedure, but not yet fully out of pain, I will use laser. 

I often use glucosamine and chondroitin sulfate with high dose omega 3’s.

I like topical menthol products such as BioFreeze. These have evidence of efficacy.

There are dangers of using cortisone, which has been administered for years as an injection in the joints. If any of my patients ask for cortisone because it worked when administered to them 10 years ago, I would educate them on safer long-term options. The most common recommendation I have for most of my patients is to eat less carbs and exercise more. I love the anti-inflammatory diet coupled with UltraInflamX by Metyagenics and high dose omega 3 fish oils. Through weight reduction and a low-impact exercise program, many patients will achieve dramatic improvements in their arthritis pain.

My goal for patients is to decrease pain and inflammation, maintain or improve function and retard disease progression if possible. In this regard, preventing damage to subchondral bone, cartilage, joint space narrowing and osteophyte formation is the goal. 

The contraindications for NSAIDs include gastrointestinal (GI) bleeding or adverse effects to the kidneys or liver. Some patients worry about taking a glucosamine product because they have diabetes, but I inform them no data support this concern. 

I might recommend UltraInflamX by Metagenics alot. I like garlic, ginseng and gingko — but these affect bleeding time. If used in conjunction with NSAIDs, the risk of GI problems increases.

Patellofemoral Knee Pain

Often also referred to as anterior knee pain, this condition is an overuse injury which results in non-specific pain at the front of the knee, often aggravated by walking down stairs or hills and getting up after sitting for long periods (movie-goers knee).

It is most common in women, due to a wider pelvis, resulting in an increased angle between the thigh bone and patella tendon (Q angle), at the knee. Other postural factors which can contribute include overpronation at the feet and weakness in the hip abductors which both cause the knee to fall inwards.

I treat patellofemoral knee pain with warm laser, muscle therapy and corrective exercises.

‘Dead Butt Syndrome’

December 21, 2010, 11:42 am

When the Diagnosis Is ‘Dead Butt Syndrome’


By JEN A. MILLER

Jen Miller at the finish of the Ocean Drive 10 Miler in Wildwood, N.J.

My butt, unfortunately, is dead.

“Dead butt syndrome,” the sports medicine doctor said to me after making me go through a series of circus-act contortions that involved swiveling my hip in all directions. His voice was very serious, his tone stern. I wondered if I should start making funeral arrangements for my rear, maybe a New Orleans-style blowout parade?

Hold the tuba. My butt’s not really dead. It can’t be revived with defibrillator paddles, but it can be fixed.

The technical name of the condition I have is gluteus medius tendinosis — an inflammation of the tendons in the gluteus medius, one of three large muscles that make up the butt. It’s a very isolated and painful injury that knocked me out of marathon training in January with stabbing pains in my hip. It’s a symptom related to what running experts hammer at: the need for cross-training and strength training. I was running so much that I told myself I didn’t have time for the exercise machines or weights, so I have no one to blame but myself.

I’ve been running for five years, but I’d never heard of the problem. I ran it by a friend, a former track coach at the University of Pennsylvania, and he was baffled too. I haven’t seen any coverage, though the doctor said it’s fairly common with runners who train for half marathons and beyond. It took him five minutes to figure out the problem.  

“A new thought in running medicine is that almost all lower extremity injuries, whether they involve your calf, your plantar fascia or your iliotibial band, are linked to the gluteus medius,” said Dr. Darrin Bright, a sports medicine physician with Riverside Methodist Hospital in Columbus, Ohio, and medical director of that city’s marathon. “In the last five to 10 years, we’ve just realized how much of an important role the gluteus medius plays in stabilizing the hips and the pelvis in running.”

If you think of the pelvis as a cup, the muscles that attach to it, including the three gluteal muscles and the lower abdominals, interact in an intricate choreography to keep the cup upright when you run or walk. If these muscles are strong, the cup stays in place with no pain. If one or more of those muscles is weak, the smaller muscles around the hip take on pressure they weren’t designed to bear.

The cup still stays up, but at a price. First come muscle tears and inflammation, followed by scar tissue in the muscle. If left untreated, this process becomes a cycle that keeps feeding into itself.

“For people who have persistent pain, it’s healing gone wrong,” Dr. Bright said. “That gluteus medius isn’t firing the way it’s supposed to. You’re getting an inhibition of the muscle fibers. It’s kind of dead.”

Some of us run through the pain, which is what I did. And many compensate by adjusting their strides in a way that impedes the gait and can lead to problems in the quads, hamstrings, Achilles tendons, heels, knees, calves, ankles, feet or toes.

“Whether they’re recreational weekend runners up to the elite marathoners, the majority of runners I see have weak gluteus medius and gluteus maximus muscles,” said Dr. David Webner, a sports medicine doctor at Crozer-Keystone Health System in Springfield, Pa.

For about 70 percent of his patients, physical therapy that stretches the muscles in the hip and leg and strengthens the gluteus muscles, along with a temporary reduction in the mileage and intensity of running, resolves the problem. Deep tissue massage, which sends more blood to the area to break up scar tissue, along with strength training may also help to break the cycle of inflammation and scarring.

More advanced approaches include ultrasound guided tenotomy, which uses ultrasound to identify the affected muscles and then “poke little holes in the area of the scar tissue,” Dr. Webner said, or platelet-rich plasma therapy, which involves injections of centrifuged blood products and is what Tiger Woods underwent after knee surgery last year.

Fortunately, I didn’t need to take it that far. I’m lucky — the pain has ebbed with physical therapy and changing one of my weekly runs to a cross-training workout.

“Those runners who do multiple types of exercising are less prone to have weakness than runners who do just running,” said Dr. Webner. “Triathletes who come into my office don’t have as much weakness as just solo runners.”

So I’m biking. I row. I sweat through elliptical workouts at the gym.

And I no longer have the feeling that a pin is stabbing my hip every time I drive. I can sit for more than a half hour without pain. And last month I ran the Amish Bird-in-Hand half marathon, and felt no more discomfort than you’d expect to endure running 13.1 miles through the hills of Pennsylvania Dutch country.

To keep my rear alive, I must be vigilant about continuing to strengthen my lower abdominal and gluteal muscles. Last week, I slacked off and the pain came creeping back.

Is it annoying to have to focus so much on these muscles to run? Absolutely. But if it’ll revive my butt, it’s worth every leg lift and crunch.

Jen A. Miller is the author of “The Jersey Shore: Atlantic City to Cape May.”

Laser Treatments

Laser therapy has been around for a long time but it is considered cutting edge treatment for musculoskeletal injuries and pain.
Laser therapy stimulates cellular activity, expediting the healing processes to reduce inflammation and repair damaged tissue. 

You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.

Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:

Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.

Treats acute and chronic conditions as well as post surgical pain.

Pain relief is often felt immediately.

Most laser treatments take only 10-20 minutes.

Are you a potential candidate?

  • If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
    This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
  • If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
  • If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
  • If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
  • If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
  • Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.

Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442

Patellar tendinitis

Patellar tendinitis is the most common knee disorder found among competitive athletes. Known as ‘jumper’s knee’, it is most likely to affect you if you play high impact sports involving bursts of intense or repeated stress, notably basketball and volleyball (these sports demand twisting on the spot, deep knee bends and sprinting).

However, anyone from the casual jogger to contact sport players may develop the condition – all too often with far-reaching consequences. One study has estimated that more than half of athletes diagnosed with patellar tendinitis were forced to retire from their sporting activity.

Classically patellar tendinitis has been explained as chronic inflammation of the tendon connecting the kneecap (patella) to the main shin bone (tibia), at the point of connection to the kneecap. Recent research has, however, revised our understanding of the condition.

Both intrinsic (specific to the individual) and extrinsic (environmental) factors can be contributing factors to patellar tendinitis. 

Treatment involves corrective exercise (with proper exercises you can avoid the need for surgery). Partellar tendinosis is also very responsive to warm laser therapy and nutritional recommendations.

Thera-Band® exercise program for total knee replacement featured in Lower Extremity Review

Ongoing research at the University of Louisville and Bellarmine University is investigating the effectiveness of Thera-Band® resistance band exercises before surgery for total knee arthroplasty (TKA). “Prehabilitation” consistshttp://lowerextremityreview.com/wordpress/wp-content/uploads/2010/03/Resistance-Training-Excerises-2.pdf of pre-operative exercises that are meant to improve strength and functional levels before surgery with the expectation of better rehabilitation and a faster recovery after surgery.

The TKA Prehab Program was featured in an article in the March 2010 edition of Lower Extremity Review. The program utilizes Thera-Band resistance bands, step-up exercises, and stretching exercises.  A full-color printable handout of the program is available online.

Reference: Brown K et al. 2010. Preoperative exercise boosts TKA outcomes. Lower Extremity Review: March 2010.

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Copyright © 2009 Dr.Jeffrey Tucker