All Posts tagged Knee pain

Knee Pain

First, laser the knee area. Laser is a deep heat that does provide pain relief.

Next lets talk about weight loss if needed. Every pound you lose reduces stress across the knee by 3-4 pounds, even higher if you climb stairs or attempt to run. Don’t run, jump, or do anything that involves impact to your knee.

Next lets talk about natural remedies like fish oil and Bosweillia as effective and helpful. Use BioFreeze cream to rub on the knee! Let me put kinesio-tape on your knee.

Next let me teach you the proper exercises. The best long-term method to relieve pain and restore function is consistent low impact exercise. Exercises that stretch and strengthen the muscles around the knee, not only provide support and maintain motion of the joint, but stimulate endorphins and intrinsic growth hormone release — both of which help to relieve the pain of arthritis.

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Knee Pain & Osteoarthritis Treatment

I coined the term POLITE Method for how I treat my patients. The ‘P’ is for improving posture and creating a plan of treatment.

The ‘OL’ is optimal loading. This means figuring out self-management activities  for knee pain that are not too easy and not too difficult.

The ‘I’ in instruments that I use in the office for knee pain such as laser, DMS, and shockwave therapy that give effective short- and long-term pain relief benefits.

‘T’ is for taping  the knee and I’ll teach you how to apply simple kinesio-tape to the knee for pain relief.

‘E’ is for education regarding the progressive nature of osteoarthritis (OA) and for pain management education; joint-sparing exercise advice including daily walking, balance tips, and falls prevention; and emotional and cognitive skills to improve quality of life; Eating for weight loss for those who are overweight or obese. Weight loss has been shown to improve mobility and reduce pain. For every one pound of weight lost, there is a 4-pound reduction in the load exerted on the knee for each step taken during daily activities. A weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.

A low-carbohydrate diet has been shown to reduce weight in obese patients by ?10% and lead to improvements in self-reported scores for overall progress and functional ability.

If you like my POLITE approach call 310-444-9393 for an appointment.

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Sports Medicine

DMS can be a stand-alone treatment for sports injuries. Dr. Tucker literally wrote the manual with Dr. Jake (the inventor of the DMS).  DMS Method can be combined with numerous other modalities/therapies as a sports medicine approach to improve circulation of lymph, blood capillaries, veins, interstitial liquids, fascia and muscle. The DMS action helps to reroute stagnant fluid in the skin (i.e., edema, primary and secondary lymphedema), mucosa, muscles, viscera, joints, and periosteum.

Clinically we have observed:

Scars and healed surgical-incision sites become more supple.

Trigger points are eliminated.

Toxins are removed, making lymphatic drainage especially effective in tissue repair and regeneration.

Aids the reabsorption of swelling/edema.

The functioning of the immune system is stimulated through increased lymph flow.

Helps with chronic or subacute inflammatory processes.

Releases muscle spasms.

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Flat feet (Pronation) & Orthotics

A common foot dysfunction, such as overpronation or flat feet, can actually lead to dysfunctions in many other parts of the body. This is because the body is an interconnected Kinetic Chain in which the feet, knees, low back, shoulder, and upper extremity regions communicate and sometimes transfer dysfunction.

Dr. Tucker checks the feet for flat feet, overpronation and high arches. Dysfunction in the feet can lead to joint and muscle dysfunction in the knee which in turn leads to abnormal tension in the hips and low back which directly affects the shoulder region which causes shoulder, neck, and upper extremity injuries.

Dr. Tucker uses a laser guided sytem to identify the need for orthotics and has the ability to see if the orthotics you are using are the correct ones. Your current orthotics could be worn out and causing dysfunction without you even knowing. Dr. Tucker’s system to evaluate orthotics is part of his integrative assessment, which consists of:

  1. Movement assessment
  2. Range of motion measurement
  3. Soft tissue, muscle & fascia testing

This laser exam process allows for you and Dr. Tucker to correctly diagnose the need for proper orthotics for dysfunction in the feet.

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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.

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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.

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Gluteal Exercises

Let’s talk about your butt. Why? Because the three gluteal muscles in the buttocks – the gluteus maximus, gluteus medius and gluteus minimus – are crucial for low back health, as well as strength and power in athletic movement. The butt is part of your core!

Weak glutes not only cause  low back pain but are related to other conditions like patellofemoral pain, knee injuries (anterior cruciate ligament injuries), iliotibial band syndrome, ankle injuries and Achilles tendinopathy.

Regarding the glutes, it is less about the maximum weight they can lift, and more about the ability to recruit the glute muscles to perform proper hip extension and gait movements.

I use the squat to assess the glutes, and I use other tests to check stabilty of the hip in an extended position with the pelvis held in neutral.

Depending on position you are moving around in, the gluteals need to be able to act as either a prime mover or a stabiliser, depending on the task.

It is common in athletes for the gluteal muscles to become lengthened (chronically stretched), thus reducing the tension in the range around hip extension. This undermines athletic performance – and makes them more prone to injury as well.

Some of my favorite glute exercises are:

The Bridge

Theraband side walk

Clams

Deadlifts

Side lying hip abduction

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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.

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Weight Loss Boosts Knee Health

ROME — Contrary to some earlier findings, obese patients with knee  osteoarthritis who lost substantial weight showed signs of structural improvement in their damaged joints, according to two studies reported here. In 44 extremely obese patients whose…

full story http://www.medpagetoday.com/MeetingCoverage/EULAR/tb/20768

Repetitive exercises are another way to help arthritic knees: 

  •Use a skateboard. Sit down in a chair. Place your foot on the skateboard. Slide your foot back and forth.

 •Use a furniture mover. Use these on carpeted surfaces. Do the same thing as with the skateboard.

 •Use a rocking chair. Rocking chairs create small, light motions in the hip, knee and spine. They really work.

 •Swing your legs in water while sitting on the edge of a pool. For this to work, you have to swing your legs very slowly. Otherwise, you’ll fatigue the muscles too fast.

•People often ask if they can use cycling as a way to improve their joint health and the answer is, it depends! It depends on how much motion you have in your knee, how irritable your knee is, and how easily you can control the resistance on the bike. Cycling can create body weight or higher loads on your knee so it’s usually not my first choice. But, it is an option. And, only on a stationary bike.

•I suggest ten-fifteen minutes per session and aim for three sessions per day. The key is to move slowly and feel very little fatigue in the muscles. The purpose is not to strengthen your muscles; it’s to improve the fluid in your knee.

Regarding Glucosamine, the original Italian studies circa 1988  were using 1200mg GluS04 and 600mg ChonS04 daily for 6 weeks. These studies claimed that people with osteoarthritic knees felt a 50% symptom  reduction. Arthroscopy of that group revealed evidence of increased meniscal thickness. Histo revealed increased Chondrocyte size and histo density.

The JOG (Joints on Glucosamine) study used Glucosamine Hydrochloride at 1500 mg/day. Glucosamine hydrochloride has been shown to be ineffective in other studies. Glucosamine sulphate is the active form that is most helpful. My experience is that clients need to be on at least 3-4 grams/day for an initial 3 week dose to be effective. At week 4-6 they can take 2-3 grams daily. A maintaince dose is 1500 mg. I do like to change this supplement out every 10-12 weeks.

Using glucosamine hydrochloride has been a common theme of studies showing lack of benefit.

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Knees, back, & hip pain – which supplements?

I’ve been taking glucosamine and chondroitin for a year and I don’t see any changes in my knee, back & hip pain. Do you recommend any other supplements for my joint pain? 

If you have been taking at least 1500 mg per day of those supplements, it’s time for a change. I’ve had good results with clients using UltraInflamX Plus 360 by Metagenics. They use 2 scoops twice daily in a shake. I also use EPA-DHA 720 by Metagenics. I dose them high, often at 3-6 grams daily. In addition, I see good results with Kaprex by Metagenics. The dose is usually 2 gel caps in the morning and 2 at night.

Order at www.DrJeffreyTucker.meta-ehealth.com

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