August 15, 2016
"My knee pain moves around. Will my doctor think I'm crazy?"
Knee pain that moves around all over the place is just your body telling you to adjust your movements a little here, a little there. Hopefully you'll find a place of comfort within a short amount of time. Knee pain that's getting worse all over can be wear and tear from osteoarthritis, or a symptom of repetitive overuse. Knee pain that moves around the FRONT of the knee but can't be exactly pinpointed may be Patellofemoral Pain Syndrome (PFPS). It can be more bothersome than other types of "moving" knee pain because it affects such a large area.
PFPS affects the kneecap (patella), which covers a large portion of the front of the knee. Since the kneecap moves around, so does the pain. Jumping, running, climbing stairs, kneeling, sitting for too long, and many other activities can cause pain and stiffness. There are all sorts of structures that make the kneecap work correctly: two large tendons above and below it, and cartilage, tissue, and a fat pad underneath it. When any of these fail to provide the right motion or cushion, pain starts to develop. Overtraining is one of the most common causes.
Because PFPS can also be caused by misalignment somewhere else in the legs, it's important to see a knowledgable and experienced doctor. During your initial examination, he or she will look at your body alignment and ask about other musculoskeletal problems to see if the underlying problem starts in another joint.
Once diagnosed, treatment for PFPS is often straightforward. An orthopedic doctor specializing in joint problems and/or sports medicine can diagnose knee pain correctly and set up a treatment program customized to your exact situation. If you are an athlete, you may be able to cut back and change your training for a while instead of having to give it up altogether. The doctor can work with a licensed physical therapist to make sure you are strengthening the knee area safely and effectively and not causing further injury. Anti-inflammatory medication, ice, injections, and other conservative treatments may also be helpful if you and your doctor decide they're right for you. Surgery is rare and usually only for those who don't respond to conservative therapies.
PFPS is an active area of orthopedic research. Seeing a doctor who stays up to date on current studies will help you get the smartest treatment.
September 2, 2015
Do knee cartilage tears need surgery right away?
In the first stages of the injury, a meniscal tear (knee cartilage tear), is painful and swollen. Most people go to the doctor right away and expect to be told they will need surgery. Many meniscal tears, though, can "settle down" with non-surgical treatment and may never require surgery. Common conservative treatments include physical therapy, rest, ice, anti-inflammatory medication, and activity modification. If within about three months the symptoms go away, the treatment will likely be considered successful.
Meniscal tears that require surgery will still bother the patient after conservative therapies have been exhausted. Patients that want to return at the same level to the sport that caused the tear, and those with particularly painful or severe meniscal tears may also be candidates for surgery. Every meniscal tear is unique. A thorough physical examination, imaging, and good communication between the patient and doctor are the best ways to approach this type of injury. An orthopedic doctor who specializes in the knee area and/or sports medicine will have the most experience and training for diagnosing and treating a meniscal tear.
July 2, 2015
"Can I get knee replacements more than once?"
Having knee replacement surgery a second time is called revision total knee replacement. This surgery is still uncommon compared to first-time knee replacement, but it can still be necessary for several reasons:
• The younger a patient is when they have knee replacement, the more likely the hardware will wear out during their lifetime. Accidents, longer lifespans, and more intense athletic activity beginning at a younger age and continuing into older age all contribute to this.
• Knee replacements are mechanical devices, and they can wear out, break, or loosen.
• After knee replacement surgery, patients are advised to stay away from high impact sports and exercises that would twist or torque the knees beyond normal everyday activities. Not everyone heeds this advice, and some people require knee revision surgery sooner than expected.
• Obesity can also cause knee hardware to fail sooner.
• An auto accident, bad fall, or other trauma can damage the knee hardware and/or the surrounding bone and tissues.
• Very rarely, infection can result when the body attacks small plastic particles from an aging knee replacement.
There is a very high success rate (approx. 90%) for people undergoing first-time knee replacement. These people report having a lot less pain, and that have a high level of satisfaction returning to many of their favorite activities.
In general, though, statistics are poorer (approx. 70%) for those undergoing knee revision. That's because knee revision surgery is much more complex. Surgeons performing it must know exactly why and how the original implant has failed. They must have knowledge of and experience with specialized procedures and tools to fix, adjust, remove, and replace parts of the original hardware and in some cases bone cement. The patient must be healthy enough to undergo the surgery. Things like quality of bone and the strength of tissues surrounding the knee replacement are important factors. Statistically, infection rates are also slightly higher because the surgery takes longer than first-time replacement.
Looking to the future, advances in medical technology are producing better knee replacement hardware, better surgical techniques, and in the more distant future, alternatives that could help repair knees without replacing them. Knee replacement hardware today has better range of motion, a more natural fit, and more durability than one manufactured 15-20 years ago or more.
February 27, 2015
Which exercises are bad for knees?
Studies show that regular exercise over a lifetime actually keeps knee cartilage healthier. That said, there are certain types of exercises and sports that wear down the spongy cartilage in the knee faster than others...
At the gym, avoiding deep squats, lunges, and full-arc knee extensions will keep your knees healthier. In sports, tennis, basketball, soccer, football, volleyball, and any other sport that has a lot of twisting and turning at high speeds puts the knees at risk for cartilage wear and injuries. Having a prior injury to a joint makes it more likely to develop osteoarthritis sooner. Exercising too much, too fast, too soon, or all three is also a recipe for knee problems.
The knees are great shock absorbers when they're healthy. With each running or jumping step, a person puts pressure at least four times their body weight on the knee. That's 600 pounds of pressure for the knee of a 150-pound person. To keep that process pain-free, exercise smart:
• Warm up before exercising
• Vary workout intensity from day to day
• Strength train to build lean muscle weight, which stabilizes joints
• Keep body fat within the healthy range recommended by your doctor; extra fat stresses joints
• After an injury, recover fully and get medical guidance before returning to activities
• After a period of time off, re-assess your abilities and return to activities gradually and at the right level
• Listen to your body, especially if pain develops and it doesn't go away
• Pay attention to your body mechanics–not everyone is cut out to run marathons or play tackle football
• Know your genetic history–someone who has osteoarthritis in the family can find a fitness routine that reduces the risk of pain
• Avoid high-heeled shoes, which often stress the knees in the place where osteoarthritis develops
If you're having trouble finding the best ways to keep your knees healthy, it may be time to consult an orthopedic doctor. He or she is the most knowledgeable resource on the subject and will perform a full examination and prescribe the right treatments and exercises for you.
December 19, 2014
"My leg hurts and my kneecap is drooping!"
The quadriceps muscles are located above the knee in the front of the leg. One of the most powerful muscles in the body, they are critical to good performance in running and jumping sports. This also makes them vulnerable to injury through overuse, sudden, forceful movement, and weakness due to other health problems. Middle-aged people who run or jump during exercise are most commonly affected. Not warming up or cooling down properly also contributes to this type of injury.
There are many different symptoms of a quadriceps tear, including a drooping kneecap. Patients usually feel pain and hear a popping sound at the time of the injury. Swelling, cramping, or bruising may occur. It may be hard to walk if the knee is buckling, and it may not straighten all the way.
Quadriceps tears can be small and partial or severe and completely torn away from the knee. Keeping the knee in a brace and using crutches is often enough to treat a small tear. Severe tears usually require immediate surgery. No matter the severity, an orthopedic doctor can create a recovery plan to return you to health and sports. Your goals and lifestyle will be considered carefully by the doctor.
October 10, 2014
CSI Knees: Orthopedic Style
Why should you go to an orthopedic doctor when you're having knee pain? The knee is like a puzzle. It's a complex structure that needs a thorough examination before the right diagnosis and treatment can be given. Knee pain can be caused by flat feet, incorrect exercise form, spine misalignment, muscle imbalance and defects, arthritis, bone fragments, cartilage tears, tendon tears and ruptures, disease…the list goes on. It matters whether the knee is achy or if sudden pain is involved or both. Pain can be in the back, side, front, top, or bottom of the knee. It can feel deep or closer to the surface.
Each piece of information matters to an orthopedic doctor. MRI scans and x-rays can give clues, but they don't always tell the whole story. It's the combination of a thorough exam, which includes your medical history, activities, and overall health, plus high quality imaging, plus your orthopedic doctor's training and experience in treating thousands of patients before you, that will get you the right diagnosis and treatment. Once all of the clues to your problem have been scrutinized carefully and correctly, your recovery prescription will be custom-tailored for you.
October 7, 2014
Walkers & Teens: Protect your hamstrings...
While anyone of any age can strain or tear a hamstring (back of the upper leg) muscle, people who are older and do walking as their primary exercise are especially vulnerable. Over-striding in combination with the muscle imbalance that can come from a single-sport regimen can be a setup for injury.
A hamstring injury happens when the muscle is suddenly forced to contract while it's stretched out and bearing a lot of weight, such as body weight plus the force of sudden motion. Activities like sprinting, basketball, football, soccer, and dancing put athletes at risk. Teens are also more at risk because their muscles are still growing and the hamstrings and quadriceps (top front leg muscles) don't grow at the same rate. This muscle imbalance can put extra strain on the hamstrings.
Dynamic stretching warm-ups and regular stretching cool-downs can help keep the hamstrings free from injury, as well as strengthening exercises and being mindful not to over-stress the muscles when they are fatigued.
Hamstring injuries are painful when they first occur, causing sharp pain in the back of the leg and, when the injury happens while in fast motion, the need to hop on the other leg or even fall to the ground. Swelling, visible bruising, and weakness often follow.
Most people are able to heal from a hamstring injury without surgery. The RICE (rest, ice, compress, elevate) method, medications, physical therapy, and sometimes knee bracing are usually enough for full healing. Surgery is usually necessary when the hamstring pulls completely away from the bone or the muscle has a severe tear.
Once a hamstring injury occurs, it is more likely to happen again. Early treatment increases the likelihood of a full recovery, so see a doctor right away if you think you may have a hamstring injury.
May 27, 2014
Knee Arthritis: When is it time for a joint replacement?
There are three types of knee arthritis, osteoarthritis (gradual wearing away of cartilage), rheumatoid arthritis (inflammatory, any age), and post-traumatic arthritis (may occur after a knee injury). Knee osteoarthritis is the most common, affecting middle aged and older people. It is caused by the knee cartilage gradually wearing away. Many people with knee arthritis seek diagnosis and treatment from an orthopedic doctor.
• Gradual onset of pain in most cases
• Pain and swelling, often worse in the morning or after periods of inactivity
• Increased pain with certain activities, including stair climbing, walking (especially with hills), and kneeling
• Difficulty bending and straightening the knee
• Knee pain affected by weather changes
Seeing an orthopedic doctor while you're in the early stages of knee arthritis may help prolong the life of your knee cartilage. Your doctor may prescribe physical therapy, lifestyle changes, exercise routine changes, use of a knee brace, or other conservative treatments to accomplish this and reduce your symptoms. Medications, injections, and supplements may be also be helpful. Patients who do not respond to the more conservative treatments and who are experiencing severe pain are typically candidates for surgical procedures, ranging from arthroscopy to knee replacement.
March 13, 2014
Knee Pain and a "Giving Way" Sensation?
When the knee-cap (patella) dislocates, it moves laterally, or to the outside. Patients often describe the knee as "giving way" or feeling unstable.
• Direct trauma from an accident or blow
• Non-contact movements such as extreme twisting
• Damaged or defective femoral groove, the area where the kneecap meets the shinbone (tibia)
• Damaged or defective tissues controlling the position of the kneecap
• Popping, bruising, swelling, and pain quickly follow dislocation
• Knee buckling
• Sideways-sliding kneecap
• Knee "catches" during movement
• Pain while sitting
• Tenderness on the inner portion of the knee
• Creaking and cracking sounds during movement
If your orthopedic doctor suspects a patella dislocation, he or she will perform a thorough physical exam and take x-rays and/or MRI scans to rule out damage to other structures, such as ligaments and cartilage.
Options vary depending upon the extent of the injury and whether other soft tissues have been damaged. Icing, bracing, taping, and anti-inflammatory medications are common treatments for most dislocations. Surgical repair is only done in severe cases.
Some patella dislocations cause damage to the underside of the kneecap and other leg bones, which can result in arthritis and further pain later. Doctors sometimes recommend arthroscopic surgery to alleviate this.
January 9, 2014
KNEE PAIN: Injury or Gout?
Gout symptoms appear when excessive uric acid builds up in a particular area of the body. Gout in a joint is often mistaken for an orthopedic condition or injury because it has similar symptoms. These can include pain, swelling, and increased temperature in the area or joint, often the knee or big toe.
Treatment includes diet modifications and anti-inflammatory medications. A patient with severe, chronic gout may need a partial arthroscopic removal of the synovial membrane, a soft tissue in the knee. Exercise is normally recommended to help gout symptoms. Low impact cardiovascular sports like cycling and swimming are usually safe.
Here is a short list of foods to avoid or limit:
• Meat, poultry, fish
• Foods containing high-fructose corn syrup
Drink plenty of water and increase consumption of:
• Complex carbs (whole grain, fruits and vegetables)
• Low fat or fat-free dairy
October 22, 2013
Is Your Spine Making Your Leg Hurt?
WHAT IS SCIATICA?
Sciatica is characterized by low back and buttock pain that radiates along the back of the thigh and sometimes to the toes. Numbness and tingling along with limited trunk range of motion can also present. People will sometimes complain more of leg pain versus low back pain. The pain can be described as dull, aching, or sharp. As we get older, changes occur in our spinal discs. In a herniated disc, the material inside the disc bulges against the spinal ligament.
WHO GETS IT?
This condition is commonly seen with people between the ages of 40-60.
HOW DO YOU GET HELP?
Treatments include short-term bed rest, physical therapy, medications and in rare instances, surgery. Statistics show that the condition resolves within 2-4 months with non-invasive treatment. Only a small number, about 2%, of patients will undergo surgery.
September 23, 2013
Do orthopedic surgeons always want to operate?
An orthopedic surgeon is first and foremost a medical doctor who helps patients get better. Most of the time that doesn't mean actually having surgery. The doctors at TOSMG estimate that for every patient who comes to them with orthopedic problems, less than 1 in 10* will actually have surgery. So what happens to the rest?
Physical therapy, rest, ice, anti-inflammatory medications, changing habits, injection therapy, and stretching are among the most common prescriptions for our patients. It's only when a combination of these more conservative treatments fail that surgery may be suggested. But the simple fact is that most people get better without it.
*Estimate only. Does not include patients who are referred for a surgical consultation, meaning that another doctor has already determined, and that the TOSMG doctor agrees, that the patient needs a highly trained, expert orthopedic surgeon in order to get the best outcome.
April 22, 2013
Ganglion cysts are small cystic swellings around the tendons or joints, most often found in hand, foot, or knee. They are also known as "bible cysts" because the treatment in the past was to hit the cyst with a bible or large book to cause it to rupture.
Ganglion cysts are most common in the hand, more notably the wrist or fingers. They are often on the back of the hand. It is also common to have swelling at the metacarpophalangeal joint (where the finger meets the hand) and interphalangeal joint (the next joint out from there).
There are various causes of ganglion cysts, but the most common reason is a protruding area due to a weakened portion of a tendon sheath or joint capsule.
The most common treatment for ganglion cysts is surgery. A surgeon will aspirate (drain) the cyst and inject the area with corticosteroid. Stiffness and scar formation can occur from the surgery.
Please contact Torrance Orthopaedic & Sports Medicine Group for any of your orthopedic needs, where caring for families in the South Bay is our privilege.
April 9, 2013
Restless leg syndrome:
Restless leg syndrome (RLS) is a disorder that stems from the nervous system. Symptoms of RLS include tingling, throbbing and the urge to move the legs. RLS can also affect a patient's sleep habits because it can interfere with sleep patterns.
Patients who suffer from RLS can take medication such as ropinirole and pramipexole. Many patients reports short-term relief but can also have negative long-term effects.
Studies show that exercise and stretches can help reduce RLS symptoms by 50%. Exercising and completing stretches in small amounts throughout the day are most effective. Make sure to gear the total amount of exercise by your individual endurance and tolerance. Studies show that lower body resistance in coordination with aerobic activity is most beneficial. For example, try easy lunges during a walk. Pumping your ankle (similar to pressing a gas pedal) can help circulation as well. Because tight leg muscles are a common symptom, try stretching your calf, hamstring and quadriceps. Avoid exercise within 2 hours before bedtime to keep your sleep cycle consistent. Most importantly, do no overdo it. For some patients with RLS, too much exercise can increase symptoms. Listen to your body.
March 4, 2013
"Proper Use of a Cane"
Using a cane or other assistive devices can help in relieving/decreasing pain, adding stability and easing the pull of certain muscles.
Here are a few helpful tips on how to use a cane:
A) Walking: The assistive device should be used on the opposite side of the affected limb. If used for balance, pick a side that's most comfortable.
Move the cane and affected limb at the same time. Stand tall with good posture and look ahead, not down at your feet.
B) Proper fit: The length of the cane should be adjusted so that the top of the cane should line up with the wrist joint when standing straight with the arm completely relaxed at your side.
C) Going up Stairs: Up with the "GOOD". Step with the unaffected limb first.
Then move the cane and affected limb up to the step together.
D) Going down Stairs: Down with the "BAD". Step down with the affected limb and the cane together.
Bring unaffected limb down to the same step. When negotiating stairs, it's always safer to use a railing with the free hand whenever possible.
February 22, 2013
A Baker's cyst is a fluid-filled cyst that causes a bulge behind the knee. Common symptoms include tightness behind the knee, swelling, and pain. The pain can get worse when the knee is fully flexed (bent) or extended (straightened). The symptoms may become worse after being active, or after standing for a long time.
The cyst is usually the result of a problem with the knee joint, such as arthritis or a cartilage tear. Both conditions can cause the knee to produce too much fluid, which can lead to a Baker's cyst.
Treatment can include medication, aspiration/drainage of the cyst, physical therapy or even surgery (depending on the cause).
November 30, 2012
Knee Replacements: Partial or total knee replacements can relieve pain and increase mobility. Damaged joint surfaces are replaced with metal and plastic implants. This reduces pain and can help you get back to everyday life activities such as going up and down stairs or standing up from a lower chair with more ease.
The aim of therapeutic exercises is to keep your knee as flexible as possible. It is important to get your knee as straight as you can to bend it enough to do everyday tasks. It is important to strengthen your thigh, hip and calf muscles.
When you start your exercise program you may experience an increase in pain. As you continue to practice these exercises, your pain will improve and the exercises will get easier every day. Here are some Do's and Don'ts:
Use your CPM as directed
Stay as active as possible
Ice your knee 3x a day for 15 minutes (unless otherwise directed)
Do share any concerns with your doctor or physical therapist
Don't give up, doing less leads to weakness and stiffness
Don't be frightened of all pain, some aches/discomfort during exercise is normal and part of treatment.
Don't lie in bed with a pillow under your knee, except for short periods of time (less than 15minutes)
October 1, 2012
Piriformis syndrome is a disorder in which the piriformis muscle compresses the sciatic nerve. The piriformis is a flat band-like muscle located in the buttocks and assists in the stabilization in the hip joint. The sciatic nerve either passes through or runs alongside the piriformis muscle and branches out to innervate the muscles of the leg. Pain, numbness and tingling can originate in the buttock but can travel down the length of the leg, when the piriformis compresses the sciatic nerve. These symptoms can be triggered with firm pressure on the muscle, climbing stairs or sitting for extended periods of time. A physical exam using certain movements to elicit pain by a doctor or physical therapist here at TOSM can be used to help diagnose piriformis syndrome, although there is no definitive test. Avoidance of aggravating factors, rest, ice/heat and a stretching/exercise program are traditional treatments for piriformis syndrome.
September 20, 2012
Iliotibial Band Syndrome (ITBS) is the inflammation of the thick fibrous band that runs down the outside of the thigh. This band originates at the hip and inserts at the outer side of the shin bone just below the knee joint. It is responsible for helping with the stability of the knee. Where the ITB crosses the knee joint, a fluid filled sac called bursae is located below in order to facilitate a smooth surface for the band to glide over. When this bursae inflames the ITB does not glide smoothly and may cause pain or swelling across the outside of the knee. Endurance athletes are prone to developing ITBS or those who have a sudden increase in activity or mileage. Conservative treatment includes rest, ice and NSAIDS. Once acute symptoms are addressed improving mechanics and flexibility can be taught by one of our physical therapists here at TOSMG.
August 31, 2012
Osgood-Schlatter disease can create a painful lump below the kneecap in children experiencing growth spurts during puberty. Children will typically experience pain at the bony prominence on the upper shin bone, just below the kneecap. There are certain activities that may cause an increase in knee pain – running, jumping, and ascending/descending stairs. The severity of pain will vary from person to person and will usually only affect one knee but on rare occasions will affect both knees. The discomfort may last for weeks to months and has the possibility to recur until the child has stopped growing. Typically Osgood-Schlatter will affect boys aged 11-13 and girls 11-12 who participate in high impact activites such as basketball, volleyball and gymnastics. A physical exam in addition to x-rays will help doctors diagnose Osgood-Schlatter. Consider seeing us here at TOSMG if your child is experiencing any of these symptoms as school sports begin.