165 Lilly Rd NE, Suite B, Olympia • 360.455-8014

Joint Pain

When I have knee pain, does it mean I need a knee replacement?

knee-rolling-in-___-internal-femoral-rotation I developed right knee pain about 2 months ago. I didn’t fall or traumatize the knee. How did this happen? From what my physical therapist tells me, I have been using my hamstring too much for strength and stability in the right leg; not using the right gluteus maximus enough. It has become short and tight as well as my iliotibial band. My lower leg muscles have become tight as well, making full bend of the knee, especially in kneeling and squatting.

It is surprising to me how much less I want to use the knee due to pain. If I try to fully squat, or get up and down from the floor, my knee hurts, so I tend to avoid it. Being a physical therapist, I know the importance of staying active so I have been making sure I fully bend my knee, even if it hurts, but with no weight on the leg (laying down or sitting with my leg out straight). I have also been working on hamstring stretches, iliotibial band stretches, and strengthening the vastus medialus portion of my quadriceps, which has become weak. My calf muscles are also tight, so I have been stretching those, both the upper calf muscle (gastrocnemius) and the lower calf muscle (soleus). My front shin muscles are tender and tight and part of my treatment has been myofascial release from the physical therapist.

X-rays were completely negative for knee arthritis, and I am so excited! The last thing I want is a new knee as the rehabilitation process for that is very very painful!

I am about 50% better; I’ll let you know how this goes in the future

Right knee pain caused by left hip and pelvis! What???

knee image

knee pain image

This doesn’t really make sense, does it; right knee pain caused from the left hip? Until…you look at this video and see that the right knee tends to fold into a knock kneed position as the patient puts weight onto the right leg.

A concept called “crossover gait” has been around for a long time in running circles (at least since 1994, as noted in a medical article, “Relationship between foot placement and mediolateral ground reaction forces during running–Clinical Biomechanics March 9, 1994”. Here is the definition of crossover gait: The runner places the weight bearing foot under the center of the body or across the center to the opposite side. It happens with same sided hip weakness and opposite abdominal weakness.

The idea of crossover gait also happens with walking as well as running, but the consequences can be different. In the video shown above, the client’s left pelvis is higher than her right when she is, at the same time, putting weight through her left hip and leg as she lifts the right leg to place it onto the step. She SHOULD be contracting her left glut muscles and right abdominals at the same time to assist in lifting the right leg, (whether stepping up onto a step of taking a step forward) but she does not. Instead her left pelvis shifts to the left and the right side of the pelvis drops as she lifts her right leg. This causes her to have to fold her right knee into a knock knee position. THAT will cause knee pain.

If you watch the video, you can see she has been taught to lift her right pelvis and contract her left side glut muscles, which raises her right pelvis allowing the right knee to unfold to a straight position from a knock knee position!

Physical Therapy in Olympia, Tumwater and Lacey, Where should I go?

There are many fine physical therapy clinics in the Olympia, Tumwater and Lacey area. How do you chose where to go?

You can choose based on location. A friend of mine told me today she chose to go to physical therapy at a clinic close to her house. What would prompt a close choice versus reputation? Maybe she needed to go 2 or 3 times per week. If someone needs to go to PT 2 or 3 times a week for a month or so, then going close to your house would be very convenient, HOWEVER, ask yourself the question: does your condition warrant 2 or 3 times per week?

Recently a former patient returned for a new session of physical therapy. She is a fairly frail 80 something year old, and was sent for BOTH headaches AND shoulder pain by her physician. Her prescription from the physician was directed to be 2 to 3 times per week for 4 to 6 weeks. She may have thought she needed to come that often, but…….when I evaluated her headache AND shoulder pain, I determined that both problems were mainly caused by the same anatomical structure.

I gave her an exercise program based on this one problem, and added customized and specific exercises for the shoulders and neck. As of Friday (January 30) 100% better in the headache and 75% better in the shoulders. She came for 6 visits at 1 x per week.

So the bottom line is, unless you actually NEED to have therapy 2 or 3 times per week consider going somewhere that uses less visits more effectively and you may save yourself some time and money.

The therapists at Comstock Physical Therapy, Joyce Mills, Lori Waterman and Linnea Comstock have extensively studied the body to make our exercise programs very effective and efficient. Give us a call if you would rather go to PT once per week instead of three times a week!

Why does my pain keep coming back? :(

WHY, WHY, WHY does my pain keep coming back? 

I go to my doctor and get pain medications yet the pain returns.  I go to a health care practitioner and feel somewhat better, get a standard protocol for certain exercises, or some other treatment, then my pain returns. 

I go to a MELT class (a self massage class using foam rollers and ball) and the pain returns.  (See this link)  http://www.nytimes.com/2015/01/02/arts/a-class-in-the-melt-method-of-body-work.html?src=me&module=Ribbon&version=origin&region=Header&action=click&contentCollection=Most%20Emailed&pgtype=article

headache

occipital headache
tension headache


Headache

I garden on my hands and knees, weeding for a few hours and get a headache that night AGAIN! 

Heel Pain

I have pain in my heel that comes on for no known reason, and get a cortisone shot, and still have pain. 

plantarrfasacia

plantarfascia

I have wrist pain and can't fully bend my wrist forward and I have weak grip.   

wrist pain

wrist pain

What is the problem?

Probably an old injury or a bad habit of movement.  What to do? 

To help the headache, strengthen the muscles which lift and support the shoulder blades;  that will take strain off the other shoulder blade muscles which connect to the head and cause the headache. 

scapular elevation and upward rotation

scapular elevation and upward rotation

To help the foot pain, have your physical therapist stretch the heel bone away from the ankle bones to take pressure off the plantar fascia.

plantarfascia relief

plantarfascia relief

wrist strengthening

wrist strengthening


Wrist Pain

To help the wrist pain have your physical therapist give you a specific exercise to strengthen bending and twisting your wrist up and in.

In short, Comstock Physical Therapy is here to help you help yourself by diagnosing the exact problem and giving you the exact exercise program you need to fix your problem!

Why are you giving me Shoulder Blade exercises if I have Shoulder pain–Part 2

More about how the shoulder blade works with the shoulder and how bad shoulder girdle strength can cause shoulder impingement. The image and movie clip below show shoulder blade elevation, with the actress in the video showing LESS elevation and upward rotation on the left than the right.

scapular elevation and upward rotation

scapular elevation and upward rotation

Like this:

The space between the ball (humeral head) and the shelf above (acromium) which sits on the shoulder blade is where impingement of one or two of the rotator cuff tendons happens (supraspinatus or infrapinatus).
Here is an image of a normal shoulder and one with impingement:

normal shoulder anatomy

normal shoulder anatomy

shoulder pain impingement

shoulder pain caused by impingement

If the shoulder blade is hanging low (like the one on the left in the video) the space for the tendon is a lot smaller. So doing shoulder blade strengthening exercises to elevate the shoulder blades will help with shoulder blade pain itself.