Tag Archives: knee

Wear Arch Supports!

Because most individuals’ arches collapse in our shoes, we commonly advise our clients wear supplemental supports in their footwear.  Orthotics, or at least foam arch supports have been repeatedly effective in curing pain and mechanical dysfunction.Adding height to the navicular bone at the medial arch of our feet changes it’s functional position, as well as the knee and hip.  These supports dramatically prevents many common problems. Gradually, as the body adjusts to corrective changes, stresses change and the resultant pain subsides.  The problem will continue or return if left uncorrected.

Wear arch supports if you are standing, exercising, shopping, working and always at home.  A number of products are available in stores near you.  Relatively inexpensive arch supports ($20-50) are available at a variety of stores near you.

Everyone should wear supplemental arch supports in their shoes, slippers, athletic footwear, training shoes and cleats.  Orthotics, or at least foam arch supports have been repeatedly effective in curing pain and dysfunction of foot, ankle, knee, hip and back.

Arch supports reduce the degree of:

  • Flat feet or falling arches (pes planus)
  • Foot pronation
  • Ankle eversion
  • Q angles at the knee (valgus)
  • Uneven hips (pelvic obliquity)
  • Lumbar scoliosis.

Supporting the medial arch changes the functional position of the foot, knee and hip.  Residual pain can take a few weeks to go away, but the problem will not get better if left uncorrected.  Leg and back pain sufferers benefit from supplemental arch supports and orthotics. Even if you only stand all day, arch supports will control pain and manage many progressive problems that we commonly treat.

skeletons

TORN MENISCUS: When Do We Need Surgery?

man with sore knee

If It’s Aint Broke, Don’t Fix It

If you were told you had a meniscus tear either by physical evaluation or by testing such as MRI should you have a surgical repair?  If it’s not very painful, not locking and not changing functional tolerance, I say “No”.

Exam Findings – We evaluate using physical findings. Physical exam is as important as testing. You may have a positive test but no other symptoms. Symptoms such at locking or catching and high level of joint effusion (fluid) are as telling as tests when considering management strategies. Increased levels of effusion indicate severity of injury.

Common Symptoms: Popping, swelling and stiffness. Pain, especially when twisting or rotating your knee. Difficulty or inability straightening your knee fully or experiencing what feels like your knee were locked in place.

Location: The location (zone) of the tear is one of the important factors in determining treatment. Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is deemed necessary, the tear can be sewn together. This repair is usually successful in the red zone.

The inner two-thirds (white zone) of the meniscus does not have a good blood supply, so it does not heal well either on its own or after repair. Typically the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth and limit catching.

Type of Tear: Also, the pattern of the tear may determine whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located. Horizontal and flap (oblique) tears are generally not repairable.

Another factor when considering treatment is that repairs to the lateral meniscus (on the outer side of knee) typically heal better than repairs to the medial meniscus (on the inner side of the knee).

Physical Therapy: In many instance we can manage meniscal tears without the risk of surgery and the after effects of surgery. Meniscal rehabilitation can range from 4 weeks to 4 months. Typically we see results to independent programs by 8 weeks. High repetition low intensity exercise with decreased weight bearing can help heal meniscus tears and improve joint effusion. Muscle training to improve support about the knee and keep proper alignment through the entire limb. Modalities and NMES for muscle activation are effective treatments to restore normal function.