What’s wrong with my knee?

Knee injuries are very common during sport and at work. For a faster recovery see your Dr or Physio to understand what structure you have damaged and how to rehab the injury effectively.

A knee sprain managed correctly will allow the tissue to heal fast and strong. Getting you back into what you enjoy most.

The knee is one of the most common joints injured in the body. A joint that absorbs a huge amount of force when running, jumping and lifting. Fortunately the femur and tibia are surrounded by many structures, but it’s usually these supporting structures that take the stress when we have an injury.

What could I have damaged?

Ligaments: About 40% of injuries to the knee involve ligaments either by a sprain or tear. These structures help give extra stability to the knee. When it has been put under excessive tension it damages the fibers. This results in pain, swelling and instability.Ligament injury knee

Patellofemoral: 24% of injuries are involving the knee cap. The patella sits within a small channel and if not guided correctly from surrounding muscles and ligaments pain can develop. This becomes particularly sore when squating, running and even basic functions like climbing stairs and sitting.Patella dysfunction

Meniscus:  11% involve the meniscus. It is fibrocartilage that sits within the knee, providing a level of stability to the ligaments and an element of shock absorption when weight bearing. This can cause a lot of swelling, pain and restrictions. In some cases the knee may lock in certain positions.

Knee injury meniscus

Other Injuries: The remaining 25% consists of fractures to knee, dislocation of the patella, Iliotibial band syndrome, hamstring and quads strains/tears etc.

What to do if I’ve injured my knee?

Firstly if you’ve just injured your knee and struggling with weight-bearing seek medical attention, where a Dr may consider an Xray, prescribe medication and will likely refer you to a physiotherapist. If the symptoms are not too severe, but you’re still concerned, come straight to physio. At Fundamental Physio Newmarket I can provide you with the following:

  • A detailed assessment of your knee using a range of tests to identify the structures involved, also looking at the mechanics of the hip and ankle.
  • Manual therapy to encourage normal movement and faster rate of healing.
  • A personalised exercise program for your identified weakness’. This may involve strength exercises, stretches and balance exercises.
  • Biomechanical assessment and correcting movement dysfunctions that may delay your recovery.
  • Providing you with an understanding of the structures affected and a treatment plan to meet your overall goals.
  • If recovery is slower than expected referrals can be made for Xrays/scans to sports or orthopaedic specialist.

Fundamental Physio Newmarket is supported by ACC. If you have hurt the knee during an accident, whether it was at home, work or on the sports field you will receive treatment cover for the injury.

For an appointment, call on 095290990 

Improving press position

The final part to the 4 shoulder positions that give us stability. The press position is used in so many ways, failing to find a good press shape can produce poor results and pose a risk to injury.

This is the final part of the 4 shoulder shapes we should all be able to achieve. Creating these shapes provides more efficient transitions when under load, making it easier and posing less risk to the shoulder.

So we’ve opened up the over head, front rack and hang shape. The last position is a press. Think of so many positions, bench press, rowing, burpee, chest to bar pull up, muscle up, ring dip….. If we create a poor, unstable position from this point it will make the movement much more difficult.

With the press we need to achieve full shoulder extension without the elbows flaring. Rarely do we get full extension in the shoulder. Even when sat at a desk typing were put in a perfect opportunity to hold the press position, but we get too flexed through the spine and the keyboard is placed to far away.

The other movement is internal rotation, which was part of our hang position. Good internal rotation at the shoulder will stop the elbows from flaring.

The last part being the lack of mobility of our lower cervical and upper thoracic spine. Which when stiff takes us into a rounded shoulder position. Trying to mobilise this area will help improve shoulder and head position.

Below are a series of mobility exercises to help with these directions.


Barbell hold – With the bar racked up to shoulder level and secure in the rack. Reach back with both hands, hold onto the bar and gentle lean forwards till you feel a stretch in the front of the chest and shoulders. Hold for 2 minutes. Gradually work your hands closer together.

Peanut lower cervical – This one you’ll have to get hold of a peanut (two lacrosse balls stuck together). Place the peanut at the base of the neck. Lift the hips to the ceiling. Some gentle rocking or arm movements through flexion or behind the back will help mobilise this point. 2 minutes

Lats smash with LaX ball – Take the ball under the arm pit into the meaty portion at the back, which is your lats. Roll into the lats with the arm in over head position lying on your side. 2 minutes.

Band hold – The other alternative to the bar hold is a band hold. Same position but hold the band behind you. Hold the stretch for 2 minutes.

CrossFit – How can Physio help?

CrossFit has its share of injuries like any sport. An experienced physio with knowledge of the training can get an athlete functioning pain free quickly and performing back to their best.

To perform at your best you need a strong mindset, great coaching staff that are strict with your technique and an experienced physio to prevent aches and pains

Most Kiwi’s are pretty tough, with a ‘she’ll be right” mentality when it comes to injury. You’d think that would be a perfect combination with the image CrossFit portrays. But when you’ve been carrying that niggle for so long and it starts getting worse, it could shut you down completely from training.

Physio and CrossFit work well together

Physio’s are specialists in movement analysis and CrossFit itself is a training regime that goes through gross fundamental movement patterns. So putting yourself through these movements and identifying your weakness’ gives me a lot more insight into where your problem could be coming from.

What are the common complaints?

There have been interesting studies done over the last few years into injuries within CrossFit. Interestingly the studies correlated similar with the same common areas being involved:

  • Shoulder
  • Lower back
  • Knee

Some injuries being severe enough to stop some from working, training and competing. These are the most common areas of injury I see come into the clinic from CrossFit, but I also see others suffering from:

  • Neck and thoracic strains
  • Ankle sprains and hypomobility
  • Hip impingement
  • Patella dysfunction from quad heavy squats
  • Wrist strains

How can Physiotherapy help?

As a physio it’s my job to get you functioning pain free as quickly as possible. Being a Crossfitter myself, who performs daily and understands the training styles, philosophy and terminology I can relate to the frustrations that you may face with limitations in training. Also working on site I can take you into the gym, look at techniques of different movements and provide you with additional drills to perform before your WOD.

What do I offer a CrossFit athlete?

  • An assessment of your movement patterns looking for weakness, asymmetry and any underlying mobility issues.
  • Hands on therapy for immediate pain relief, this may involve soft tissue massage, joint mobilisations and dry needling.
  • Localised taping of problem areas to assist you during your next training session
  • Diagnosis and ongoing management for acute or severe injuries, including referrals for further tests such as x-rays/ultrasounds, scans or to a specialist.
  • Educating you on what caused your injury or pain and steps to prevent further problems.
  • A personalised rehabilitation program – listing corrective, strengthening and stretching exercises to assist your recovery.
  • Liaising with and providing regular updates of your progress directly to your coach or trainer to ensure you get a coordinated approach to your rehabilitation. This also ensures that you are scaling or modifying WOD’s as required.

For an appointment, call on 095290990 

Montalvo et al (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine

Keogh et al (2016) The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine

Weisenthal et al (2014) Injury rate and patterns among CrossFit athletes. Journal of Orthopaedic Sports Medicine, Arthroscopy, and Knee Athroplasty

Improving front rack position

Improving the front rack position can help us in so many movements. This page shows a number of stretches that will improve shoulder mobility. and help prevent injury.

This is the second part of the shoulder, expanding on a previous post about 4 important shoulder positions that we should all be aiming to achieve. It’s quite important that you can find these positions comfortably, especially under load, as it will help to limit the risk of injury but also make it easier for you to transition out of it.

So, we’re all now great with our over head position. Can you now transition back down to a front rack? à la thrusters, hand stand push ups or catching the wall ball into the squat. Front rack is the most complexed out of the 4 positions as there are so many structures feeding into that position.

With Front rack most of us struggle with finding that shoulder external rotation to get the hands outside of the shoulders while keeping the elbows high. This helps line the hands into a stable platform for the bar.

The forearms are often tight making it hard for the wrists to fully extend. How many of us get achy wrists after front squats? Create that stable platform with good wrist extension.

Our triceps can also restrict the elbow from going into full flexion. And finally good Thoracic mobility as mentioned in the over head position. It will impact achieving extension and getting the maximum lift through the elbows.

Below are a series of mobility exercises to improve that Front Rack position.


Stick external rotation stretch – Grab a stick, hold it outside the arm. Lift your elbow and pull the stick from underneath your arm, across the body. This will pull your hand out further and you will feel the shoulder wind up. Hold for 1 minute. To take this further by repeating a hold-relax method, pulling the stick inwards for 5 seconds then relaxing further into external rotation .

Banded External rotation – Put the elbow into the band, take the hand on the inside of the band and hold on. Keep the elbow close to your head and drive the arm pit forwards. Hold the stretch for 2 minutes.

Wrist Flexor stretch – Kneeling on the floor, with palms facing away, put your hands down on the floor and take the wrists into extension, moving your body backwards. Hold for 2 minutes. Next get the band and place the hand in the same position. Have the band pull away while doing small oscillating wrist extensions into the stretch. Repeat for 1-2 minutes.

Triceps smash – Excuse the facial expressions in this video, I don’t always look that way! Resting the tricep on the bar while flexing and extending the elbow. Start at the triceps tendon (above the elbow) repeat 10-12 reps then move higher up the muscle. To increase the pain….I mean load, use the band to get fascia tacked down to the bar.

Thoracic Mobility as mentioned above it’s important to extend at the Thoracic below are two basics.

Improving overhead position

Often we are restricted with overhead movements as it is an action we don’t use often enough. Try these exercises to increase movement if your tight reaching above your head.

So from the last blog we’ve learnt there are 4 positions of high torque when we wind up the shoulder capsule and surrounding muscles. By utilising these positions they will produce better pathways to move from and minimise the risk of injury.

We’ll start off with the over head positions. In every day life we don’t take our hands above our shoulders often enough. It’s understandable the shoulder will feel tight in these positions. But with a little regular mobilising we should be able to feel more comfortable holding our arms up there.

In the shoulder we have big internal rotators and some small external rotators which can cause a bit of an imbalance. Both internal and external rotation needs to be stretched to achieve full over head movement.

The other thing restricting our overhead movements is thoracic mobility. Another area that often gets stiff with a sedentary life. Additional extension at the Thoracic region without hyper extending at the lower back will give us better shoulder flexion.

Below are some basic mobility drills to improve Thoracic extension.

Foam Roller – Slowly moving over the foam roller, trying to extend over the top, keeping steady breathing throughout. Try to keep the neck in a stable position avoiding hyper-extending, also avoid rolling into the Lumbar spine.  Try this for up to 2 minutes. Once you find some stiffness, stay on that point and lift your arms straight above your head. 1 minute.

https://www.instagram.com/p/BT2yyupFzCP/?taken-by=fundamentalphysio

T spine extension – Kneeling, put both elbows up on the step/box. Drop the chest down to the ground. Feeling a stretch at the Thoracic spine and lats. Hold the stretch for 2 minutes. Try to stay strong at the lumbar spine avoiding extending.

https://www.instagram.com/p/BT2zxQgFaYu/?taken-by=fundamentalphysio

Below are just some stretches you can do to access both the internal and external rotation restrictions at the shoulder.

Pec major stretch – Using a resistance band, taking up the slack with the hand behind, turn your body away, producing a large stretch in the chest. Hold for 2 minutes.

https://www.instagram.com/p/BT20WulFJyD/?taken-by=fundamentalphysio

Under arm stretch – Attach a light resistance band to the opposite frame. Hold the other end with your hand behind the neck, pull into the opposite rack and drive the armpit into the poll. You’ll get a good triceps and lats stretch. 2 minutes.

https://www.instagram.com/p/BT20x4YFGYp/?taken-by=fundamentalphysio

Infraspinatus LaX ball smash – Direct the ball into the shoulder blade. With the pressure, take the hand across the body and over head. 1 minute each direction.

Back Pain Myth Busting Part 5

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

And the final part of this Lower back pain blog is regarding factors in our life that we wouldn’t think influence our pain. Also, there is hope for people dealing with persistent back pain.

 

9 Sleep deprivation, stress, low mood and worry influence back pain

Some people feel that pain can only be mechanical, but there are a few other factors that affect our pain perception when we have lower back pain. Life events that cause increased levels of stress or depression can enhance the pain we feel. Understanding these factors and trying to take control of them will help. Studies have shown that with a cognitive approach dealing with stress’, fears relating to the injury and of movement will help lower pain scores and result in good outcomes (1)

 

10 Persistent back pain can get better

As previously noted in the last point and the other parts of this blog, there are many factors influencing back pain and not every individual is the same, requiring a tailored treatment plan to match their needs. Most people with persistent back pain will likely need to address non-physical factors as mentioned in the last point (2).

It is very common as most treatments only address one factor, if someone goes for a massage for their sore muscles, but fails to address their stress at work or fitness levels. You can understand why problems likes this become an “on + off” issue throughout life.

Identifying the different contributing factors for each individual and trying to address them, pain can be greatly reduced and people can live a happier and healthier life.

 

1.     O’Keeffe et al, (2015) Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial, BMJ Open

2.     O’Sullivan, P. (2012) ‘It’s time for change with the management of non-specific chronic low back pain‘, British Journal of Sports Medicine, 46(4), 224-227.