Are Your Joint Pains Rapidly Reversible?

I didn't really want to get into this quite yet, but I was reading a twitter post from one of my mentors, Jarod Carter, PT, DPT, MCT, on meniscal tears and thought how different it would be if everyone knew this.  Check out the article titled Fake Surgery Just as Good as the Real Thing for Meniscus Tears.  Say What?  This is what my cohorts and I have been saying for many years in our practices!  Not exactly in those words per se, but something close, like I wonder why this patient is doing so well after his meniscal surgery and this one isn't, given that most variables are the same.  As clinicians we see of lot of things that make us say hmmm.  This is one of them.

I  work in a busy orthopedic clinic for 6 orthopedic surgeons 2 days a week where I treat patients for them.  One surgeon there (guess who?) has seen the value in sending patients to PT before operating to see if there isn't an easily treatable condition we refer to as joint derangements.  This improves favorable outcomes for his surgeries.   A derangement syndrome is  defined as "Internal dislocation of articular tissue, of whatever origin, that causes a disturbance in the normal resting position of the affect joint surfaces.  This deforms the capsule and periarticular supportive ligaments resulting in pain, which will remain until such time as the displacement is reduced or adaptive changes have remodelled the displaced tissues.  Internal dislocation of articular tissue obstructs movement attempts towards the direction of displacement."¹  This is just another way of saying that you have something in your joint that feels like a pebble in your shoe.  Will you need a lot of foot therapy or surgical repair once you take that pebble out?  Obviously not!

 Let's look at it this way.  Basically, when we injure our peripheral joints the body will put a little fat in the area to protect it.  When we begin to wear out or degenerate, our body creates nooks and crannies in the bone and, since we don't really like nooks and crannies our body will put fat into these areas for moisture, nutrition, and cushion.  However, if that fat gets too big it is going to get pinched.  Like catching your finger in the door.   Here is a great study by a clinical anatomist that found fibroadipose meniscoids in all joints   Her paper is about elbow joints but she mentions that all joints have these.  I am convinced that most of these derangements (and there is no solid proof of this) are fat based since they are so rapidly changed.    So my question to you is, do you know if this pain and obstructed motion  is from your bone on bone, your rotator cuff tear, your meniscus tear or the extra fat that is sent there to protect you?

We will never really know because when they cut the bone out to give you a new joint they cut all the fat out too, or repair your rotator cuff or your meniscal tear.  It will only take me (or any other certified MDT practioner)  a couple of visits to find out if a fat pad is your problem.   Theses fat pads are malleable, they can change size and shape and you can do it with repetitive movement.  Just like dissolving  a piece of raw bacon by rubbing it between your fingers.

Yum!  BACON!

 Maybe it is the fat that got caught under your rotator cuff tear and not the tear itself causing you all the pain.  You won't know til you give it a try.

In your knee, this derangement could be anything from a fat pad to a torn meniscus that is blocking motion and producing pain. Generally we find increasing symptoms in one direction of movement and decreasing symptoms with increased movement in another.  This helps us to decide what directional preference for treatment would be.  You are then sent home with one or two movements that are designed to abolish your symptoms.  If this works, surgery and endless therapies can be avoided and you can be taught how to self-treat your current problem, how to minimize recurrence and how to manage symptoms if they do happen to reoccur.  Wouldn't you want to avoid surgery if you could?

I would.

Bring your knee, hip, ankle, elbow, shoulder, wrist, hand, finger, and toe pain in today for a mechanical assessment to see if you have rapidly reversible joint pain.  As I am fond of saying "You Deserve a Good Mechanical Assessment!"  Call or text Grimm Physiotherapy at 504-228-0524 to schedule your evaluation and visit us on the web at grimmpt.com.


¹  McKenzie, Robin, and May, Stephen (2011).  The Human Extremities:  Mechanical Diagnosis & Therapy, Spinal Publications, New Zealand Ltd.

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I think I have a Muscle Strain. What should I do?

So I was reading this post yesterday at crossfitinvictus and it got me thinking about muscle recovery after injury.  When you are into muscle strengthening and fitness you tend to walk a fine line between strengthening and over doing it.  For more information on why exercise can make you stronger check out this post.  I know that if you are like me you want to make decisions on your own about recovery so I thought this would be a good time to give you information on muscle injuries and a little on the physiology of muscle healing.  First things first, muscle injuries are known as strains and ligament injuries are sprains.

There are two parts of a muscle:  the belly and the musculotendinous unit.  All skeletal muscles are elastic meaning that they have the ability to lengthen or stretch, extensible which means the ability to shorten but able to return to normal length, excitable which means they respond to nerve impulses, and are contractile which mean they will contract and shorten when a nerve tells them to.  You can tear the muscle belly by over stretching and over doing it and/or over stretch the musculotendinous unit resulting in a muscle strain.

What is important to know about muscles and soft tissue injuries is that they do not regenerate if damaged but are replaced with an inferior and weaker scar tissue.  So listen to your bodies and your coaches!

Muscle strains are classified like ligament sprains into categories:

Grade I - some muscle fibers are actually torn and movement will be somewhat painful but you will still have full motion.

Grade II -  Can you see the depression where
the strain occurred?  

Grade II - Active motion will be extremely painful because more muscle and tendon fibers are torn.  You can actually feel the site at where the injury occurred.  You can feel a divot.  This will probably come with swelling due to bleeding.  Check out the ankle strain here.

 Biceps ruptures

Grade III - This is when there is a complete tear of the muscle fibers in the muscle belly or where the muscle attaches to the bone.  You have heard of biceps rupturing and Achilles tendon ruptures.  Biceps ruptures are fondly referred to as  Popeye muscles.  Pain is usually very severe initally but then subsides quickly because the nerves are separated too.  Movement is severely limited and sometimes totally lost.  A fun fact to know is they rarely operate on proximal biceps ruptures. This just leaves more room for tattoos : )

Achilles tendon ruptures generally require surgery and is a more serious injury.  I have heard that muscles that cross two joints such as your achilles, biceps, hamstrings, and quadriceps are more susceptible to injuries.

So depending on what you are dealing with treatment options will vary but they all start with RICE.
R est  (four-letter word)  I had to say it!  Sorry!
I  ce  (cold pack, frozen peas or corn in a pillowcase) 20 minutes at a time...you don't want frostbite too!
C ompression  (ace wrap)  Snug but not too tight you don't want to cut off circulation!  Wrap from the bottom up to assist with venous flow.
E levation  (injured area elevated above your heart)  Don't go crazy hanging upside down on rings or anything...a nice pillow on the couch will do.        More on the RICE principle

You can begin full gentle range of motion exercises if there isn't any pain.  It would be advantageous to get in at least 5 repetitions every two hours and more often if there is no pain.  Once there isn't any pain then you can begin gentle resistance exercises.  

All injured tissues go through an inflammatory phase which generally lasts less than 5 days.  So ice is really only useful in the first 2 -  5 days of injury.  After that the inflammatory cells are replaced by fibroblasts.  This stage of healing known as the tissue repair stage can last up to 3 weeks.  I like to add gentle range of motion exercises so that the muscle will heal in the line of stress.  You want full movement by the third week so that optimal repair can occur.  However you don't want to overdo it either.  If you do too much too soon you are actually re-injuring yourself and are now back to square one in the inflammatory phase.  Which means the dreaded 4-letter word R-E-S-T again!

The Remodelling stage is very important.  You want to stretch and strengthen the scar tissue so that you will have optimal recovery.  This process can take several months and you may never get full strength back.  So you don't want to mess this process up!  All of these phases have to be gone through to have an optimal recovery.  There really isn't anything you can do to speed this process up other than to proceed with caution and to provide an optimal environment for recovery including nutrition and adequate sleep.

My husband,  Matthew Grimm, MD,  the CrossFitting orthopedic surgeon,  says that if it seems more serious, you don't have to go to the Emergency Room but can wait to see him the next day if there is no deformity.  Check him out at Jefferson Orthopedics or catch him at the gym .

So the bottom line is exercise is good for you and good for healing of strains as long as you don't over do it. We all know how devastating no exercise can be for you.  You know I am going to say that   "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Here at Grimm Physiotherapy we will teach you how to manage your injuries including strains so that you can achieve optimal healing.  We encourage self-management and don't want this to be a chronic problem for you.

Call or text Grimm Physiotherapy at 504-228-0524, visit us on the web at grimmpt.com  to schedule your mechanical assessment today.

What is the deal with all this tape in the Olympics and CrossFit Games?

For those of you who know me you know that I think this tape is cheating when it comes to athletic events.    If I can mimic muscles actions, facilitate muscles, offload muscle tears, resist aberrant movements, provide increased proprioception, enhance lymphatic drainage, redirect the line of pull of muscles or influence accessory motions, inhibit overactive muscles or trigger points, don't you think this is artificial athletic enhancement?

Check out this article about taping in the Olympics CNN article on kinesiotape.  Could this actually be detrimental to an athlete if he/she needs this tape to perform at high levels? Could this tape mask injuries putting the athlete at higher risk for another injury that might be devastating?  Could this actually help them perform an activity that couldn't do otherwise?   I would love to hear your thoughts on this topic. Too bad we can't see all the tape in the winter Olympics like the summer games.  You know it's there.

However, from a healthcare perspective I have a healthy admiration for this tape.  I use it all the time in the clinic.  My patients love it.  I use it to reduce work load of muscles that are overloaded, shortened, fatigued or even have contractures to allow healing.  I use it for postural re-education.  I use it to facilitate muscles that are weakened, using the elasticity in the tape to assist the muscle in its work.  If I have enough tape I could tape a patient's entire body to augment global stability.  Wow!  Think about this for a minute.  It is a pretty powerful tool to use in the clinic.

Tape for meniscal tears or other knee ailments

Taping for tennis elbow

You don't have to be a physical therapist to use this tape.  You can learn how to use this tape for any joint or muscle from the internet.  Here are two of my favorite types of tape and their educational links where you can learn what I know about this tape:  dynamictape and Spidertech tape.  However, if you want to learn about how to treat and abolish your personal painful conditions, then I say You deserve a good mechanical evaluation and treatment plan!  Don't just rely on tape to mask symptoms.

Call or text Grimm Physiotherapy at 504-228-0524, visit us on the web at grimmpt.com  to schedule your mechanical assessment today.

Help! The back of my shoulder is killing me!

Have you ever had this annoying pain between your shoulder blades?  Do you think this is your shoulder bothering you?    No matter how much you stretch your rhomboids and upper trapezium, no matter how much you foam roll or use lacrosse balls to reduce the spasm, it just doesn't seem to go away?  I will venture to say that this is not a shoulder problem at all unless you have previously had a frozen shoulder, or adhesive capsulitis,  but it is a neck or cervical problem. Sorry to bring you the bad news!  It is a neck problem until proven otherwise. The good news is that this is easy to treat and prevent from occurring in the future, once you know the origin of the symptoms.  

Am I touching a nerve here?  Maybe a C5 - C6 or C6 - C7  nerve?  Or both?   This might be the case.   It is too hard to see from here.   This will be a topic for another day, because I have a lot to say about that.  I always have a lot to say about neck, extremity and low back pain.  

Is the pain on both sides between your shoulder blades?  Is it constantly there no matter what you do?  Or, does it come and go?  In either case, a few simple movements performed several times a day could abolish these symptoms.  With some perseverance and attention to symptoms and posture you could avoid this problem from recurring.  

You know what I am going to say...Everyone deserves a good mechanical evaluation and a treatment plan!  However, here is a spoiler alert: check your posture at work...and remember that your mom was always right!  Sit up straight and see what happens.  My shoulder is hurting just looking at this picture. Speaking of that...time to step away from the computer for awhile.  Really, it could be just that simple.

Receive your mechanical evaluation today at Grimm Physiotherapy so that you can learn what it takes to abolish these nagging pains without endless trips to the clinic.  Let us teach you what we know so that you can be in control of your own symptom management.

 Check out our website at grimmpt.com  or call or text 504-228-0524