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

Olympia

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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

Do you have whiplash pain? Want to get better? You can!

Do you have whiplash pain? Have you been in a car accident and been rear ended or hit from the side? You don't need to be in a car accident to have whiplash; I had whiplash as a child when I fell head first off my bike at age 6 and knocked my 2 front teeth out.

Whiplash can cause significant pain. You may have headaches, neck pain, upper back pain, shoulder pain and tingling in your arms.

whiplash image

Neck pain
whiplash


Whiplash hurts; the sooner you get treatment, the sooner you will feel better. How can physical therapy help? Our physical therapists can massage injured muscles, for example, the muscles pictured to the right.
Referral pain pattern  headaches from sternocleidomastoid

Referral pain pattern
headaches from sternocleidomastoid

We will also give customized gentle exercises to get your muscles back on the path to recovery. Other treatments designed to reduce the pain such as ultrasound, electric stimulation and cold laser can be provided. We can coordinate care with other providers such as acupuncturists, chiropractors, and massage therapists as needed.

At Comstock Physical Therapy the Muscles In-Sync approach reduces muscle spasms, increases mobility and increases strength.

Science tells us with whiplash the core muscles in your neck become out of sync or out of order. They need to be retrained to contract in the right order, then strengthening will be a lot less painful and your results will last.

Longus Colli and Capitas

Longus Colli and Capitas
“Core” muscles of the neck

Why is there a need for a "special" training program? If you have whiplash the normal sequence of the muscles contracting becomes disordered. Normally the core muscles contract to make your neck stable, then large muscles (sternocleidomastoid and scalenes) pull on the neck to rotate it or pull on your neck as you lift your arm.

After whiplash, large muscles (the big ones you can see on the sides of your neck) contract first to splint the neck. The problem is, the right order of muscle contraction does not come back and the large muscles (sternocleidomastoid

sternocleidomastoid

sternocleidomastoid

and scalenes
scalenes

scalenes

) keep contracting, which causes headaches (see the headache referral pattern for sternocleidomastoid) and arm tingling and pain (see the scalene brachial plexus picture below). We will massage these muscles to help them relax and retrain.

“Wikipedia medical illustration thoracic outlet syndrome brachial plexus anatomy with labels” by Nicholas Zaorsky, M.D. – Nicholas Zaorsky, M.D.. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Wikipedia_medical_illustration_thoracic_outlet_syndrome_brachial_plexus_anatomy_with_labels.jpg#/media/File:Wikipedia_medical_illustration_thoracic_outlet_syndrome_brachial_plexus_anatomy_with_labels.jpg

>What can you try at home to help this pain?  Nod your head in little tiny nods, like you are nodding "yes" to getting better. Also, ice is helpful after you first hurt your neck and heat for stiff muscles.

photo (1)

 

 

Give us a call at 360-455-8014 to schedule an appointment to get relief from your whiplash pain!

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!

Morton’s Neuroma–why does it happen, what muscles out of sync?

On our website, Comstockpt.com and MusclesInSync.com, you’ll notice a tab which is called Muscles InSync (TM). It describes muscles getting out of sync with injury, and how we look to get the timing and coordination of the muscles working well again to get you better. How does this idea relate to Morton’s Neuroma? And….how can it help you if you have Morton’s neuroma?

First, what is Morton’s Neuroma? mortons-neuroma2 It is tangle of nerves which bunch up between the bones on the bottom of the ball of the foot. It causes a lot of pain when you walk and put pressure on the ball of the foot when you walk. It is a lot worse when you wear high heel shoes or heeled boots.

What Muscles get Out of Sync causing Morton’s Neuroma? The foot, when you put weight on it spreads the weight in the “foot tripod” position. Here is the foot tripod:
tripod-foot

If your foot puts pressure down on the ball of the second toe, instead of the first toe, you end of lifting the outer toes too early, and the weight of your body can spin on the ball of the second toe. Below is a video from The Gait Guys which demonstrates the foot tripod

Which muscles are out of sync if you have a poor foot tripod? In the foot, the adductor halluces muscle, transverse portion (runs under the ball of the foot) supports the piece of the tripod which runs from the big toe to the little toe. adductor_hallucis

The Gait Guys are of the opinion that the extensor halluces brevis also plays a role in tripod support:

Try these two exercises slowly for 2 weeks and see if you can achieve a good tripod!

Pelvic and abdominal pain: What kind of treatments help?

I've recently treated 2 ladies with significant pelvic pain. One patient is fairly young, and for some unknown reason seemed to develop pelvic floor pain, specifically by the soft tissue on and below the pubic bone, as well as in the bladder area. Sometimes the pain was referred down into her leg and sitting and walking were difficult. Chronic-Pelvic-Pain-Treatment

She has received 3 treatments consisting of gentle stretches as well as manual therapy/myofascial release to the fascia and tissue which are painful and tight. The major problem turned out to be a sprain of the round ligament on the right:

round ligament is shown in blue

round ligament is shown in blue

Another patient had endometriosis which caused significant scarring through her abdominal area, including on the bladder, bowel, uterus, and ligaments. Douglas_endometriose2 She received gentle stretches as well as core strengthening and has returned to a normal workout routine. She also has avoided another surgery and higher intensity medication.

If you have questions, please feel free to comment.

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