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PATELLOFEMORAL JOINT SYNDROME – JULY 2012 NEWSLETTER

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North Shore Orthopeadic & Sports Clinic has started a program for in-home cold therapy. These “cryotherapy” units may be rented or purchased. Two negative side effects of orthopedic trauma or surgery include pain and swelling. These conditions affect the healing pocess and can lead to longer rehabilitation times. Cold therapy is widely recognized as an effective treatment strategy to combat these issues. By using cold therapy you are taking an important step in speeding up the recovery process, getting you back to the pain-free life you deserve. For further information please feel free to contact our office or visit our web site at www.nsosc.com

North Shore Orthopoedic - Allow/Download Image to view Patellofemoral Joint Syndrome North Shore Orthopoedic - Allow/Download Image to view
Patellofemoral Joint Syndrome P.F.J.S.
If you are diagnosed with peripatellar or P.F.J.S. pain it is still possible to continue to lead an activity-based lifestyle. You may choose to address the potential mechanical causes, alongside administered medical treatment. We will assess the mechanical causes and incorporate simple solutions in which you are a pro-active participant. The goal is to permit a confident return to your chosen activity, at a superior performance level. On the other side of the equation, if you refer to yourself as an “older” patient, we also offer solutions. You may lead a more sedentary lifestyle yet experience similar P.F.J.S. pain.
Complaints
NSOSC Newsletter ImageThe pain may also be mechanically-based, yet the expressed goals may simply be pain reduction & the resumption of modest activity.
Pain
Pain is described as mild, moderate or severe and, subjectively, it may appear to switch location. Often associated with the pain, is the description of a “clicking sensation.”Functional non-traumatic P.F.J.S. may present as retro-patellar pain possibly exacerbated by:

1. walking and running short or long distances
2. ascent or descent of inclines, including stairs
3. sitting for long periods of time
4. changes of postural position such as getting up from a squat or chair

Structural P.F.J.S. may be secondary to an increased “Q” angle and can be exacerbated by the same variables as the “functional” P.F.J.S.

Treatment Plan
NSOSC Newsletter ImageWe advocate:
1. Lateral femoral condyle regional soft tissue stretching,
Palpating the peripatellar retinaculum may reveal local
tenderness in patients with patellar mal-alignment and
anterior knee pain
2. Patellar tracking mobilization starting at 0 degrees
progressing to 90 degree flexion to re-establish optimal
patellar gliding, or “tracking.”
3. Correct overuse muscle imbalances and weaknesses:
(a) open kinetic chain exercises. (b) closed kinetic chain,
non-weight bearing exercises.
4. Correct aberrant neuromuscular patterns by re-programming sequential muscle
firing patterns and enhancing length/tension ratios of shortened myofascial
structures.
5. Re-programming incorrect lower extremity biomechanical usage patterns.
6. Evaluate relevant articulations to determine other causes of aberrant P.F.Jt.
mechanics.
7. Patellar tracking taping techniques.
8. Education to avoid positions of loaded flexion, as the result is an increase P.F.Jt.
articular surface pressure and potential pain. For example, sitting may reproduce
P.F.J.S. pain due to increased P.F. Jt. compression. You will be educated to sit
with your knees in a position of extension, to minimize P.F. Jt. compression forces.
Conclusions
Optimal results includes a relatively pain free return to pre-incident activity level, usually within 8 weeks. You will be equipped with a preventative program to counteract P.F.J.S. re-occurrence, including:

a) P.F. Jt. Taping and support
b) Flexibility training and
c) Activity specific strength retraining

Structural”Q” Angle P.F.J.S. is treated as above and also, potentially, requires external assistance to counteract the effects of the non-correctable bio-mechanics such as bracing, supports and orthotics.

Evidence to Assess and Treat the Gluts for PFJS!
Reference: Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Spors Phys Ther. 2007 May; 37(5):232-8.

Decreased gluteus maximus and medius strength, control and endurance may be associated with greater femoral medial rotation and adduction during weight-bearing activities, leading to patello-femoral pain syndrome (PFPS).

The Question: Are deficiencies in hip strength more prevalent in young girls (12-35 y.o.) with unilateral PFPS?

The Study: 10 patients with unilateral PFPS were compared to 10 control subjects with no knee pain.

The Results: Compared to the weaker limbs of control subjects, the symptomatic limbs of patients with PFPS had:

.
.
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52% less hip extension strength (P<.001)
27% less hip abduction strength (P=.007)
30% less hip external rotation strength (P=.004)

Clinical Relevance: Assess and if indicated, provide intensive exercise for the gluteal muscles. The typical strengthening of the quads & VMO, taping & mobilizing the patella, stretching the hams, using foot orthotics, etc. may all be a waste of time if the gluts are not addressed!

Stay tuned for our next newletter!
NSOSC Staff

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R.I.C.E NEWSLETTER – JUNE 2012

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NSOSC Cryotherapy Rental ProgramCryotherapy Purchase and Rental ProgramNorth Shore Orthopeadic & Sports Clinic has started a program for in-home cold therapy. These “cryotherapy” units may be rented or purchased. Two negative side effects of orthopedic trauma or surgery include pain and swelling. These conditions affect the healing pocess and can lead to longer rehabilitation times. Cold therapy is widely recognized as an effective treatment strategy to combat these issues. By using cold therapy you are taking an important step in speeding up the recovery process, getting you back to the pain-free life you deserve. For further information please feel free to contact our office or visit our web site at www.nsosc.com
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R.I.C.E.

REST • ICE • COMPRESSION•ELEVATION

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REST  •  ICE  •  COMPRESSION  •  ELEVATION
A proactive approach to your healthcare helps create a healthier and more enjoyable lifestyle.
Our goal is to provide insight into injury principles using application of the well known acronym “R.I.C.E,” (Rest, Ice, Compression, Elevation).
This represents the initial injury self-management, which most effectively facilitates recovery.
PRINCIPLE #1 – REST
Rest does not imply that you terminate all activity / training and become inactive. In fact, our philosophy is to encourage “non-agressive” activity. It may not be your habitual pattern. “Rest” implies placing the injured tissue, whether muscle, tendon or ligament into the position of least tension / strain for up to 72 hours. This “Relaxed” position is maintained with external assistance (tape, support or bracing). Experience suggests that injuries which have become chronic were not appropriately treated, in the early stages, either by resting completely, or by not selectively resting the injured
PRINCIPLE  #2 – ICE
NSOSC Newsletter ImageThe correct first thought(s) following injury or irritating discomfort is always to apply Ice. In fact, if you are not sure whether ice or heat is the self-treatment of choice, remember ALWAYS ICE FIRST, “If in doubt Ice.” However, please do not “fall asleep” while resting on an ice pack. It may be applied frequently, but never for longer than 20 minutes at a time. Following the first 72 hours from injury onset, evaluation may indicate that it is appropriate to progress from ice to a “contrast” (cold / hot).
PRINCIPLE  #3 – COMPRESSION
NSOSC Newsletter ImageCompression is the component of RICE that seems least understood, in our experience. Circumferential compression combined with ice is the optimal, having its’ most observable impact within the first 0 – 72 hours following injury. During this time the volume of swelling progresses to a peak. To interrupt or prevent this swelling increase expedites healing because we reverse the course of swelling accumulation & pressure build-up. The more peripheral the injury, the easier it is to apply circumferential compression usually with compression taping or tensor bandages
PRINCIPLE  #4 – ELEVATE
Elevation counter-pressures the peripheral movement of the interstitial fluid away from the injured area and directs it back towards the heart. Elevation combined with circumferential compression within the first 0 – 72 hours is most efficient. If, after training, you visibly see swelling persisting in the injured area continue to elevate the affected extremity (combined with ice if necessary). Often the “E” for elevation may be modified to read, Elevation / Exercise, usually following the initial 72 hours following acute injury
CONCLUSIONS
Remember that the first 24 hours following acute injury is critical in often directing the prognosis for successful return to your selected activity. Following clearance from your physician, rehab may commence. It is not necessary to suffer with an acute or chronic injury. If you are not sure of the correct approach to use, please phone. Also, if an injury has not cleared or does not appear to be resolving with the above-mentioned principles, do not “leave it.” You may require more comprehensive, professional consultation.
Massage Therapy & Stress, Anxiety Release
Do you suffer stress anxiety poor sleep?
Stress is something we experience as we adjust to our continually changing environment; it can be both positive and negative. Positive stress can encourage action and raise our awareness and excitement. Negative stress causes feelings of anxiety,depression, create sleep loss, anger, high blood pressure and other medical problems. Massage therapy can help reduce the negative outcomes of stress and induce relaxation.Treatment
Registered Massage Therapists May Help:

• reduce muscle soreness
• decrease stress and anxiety
• promote relaxation
• decrease muscle tension
• improve sleep
• decrease depression

Research
Stress hormone is reduced by massage therapy.

In this article the positive effect of massage therapy on biochemistry was reviewed. Findings including decreased levels of cortisol and increased levels of serotonin and dopamine. The research review included studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies ( including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress.(Field T, Hernandez-Reif M, Diego M, Schuanberg S, Kuhn C. Int.J Neurosci. Oct;115(10):1397-413
Less pain, depression, anxiety and improved sleep with reduced lower back pain and range of motion
The group receiving massage therapy, as compared to the relaxation group suffering from low back pain, reported a reduction in anxiety and improved sleep. They also showed improved trunk and flexion performance, and their serotonin and dopamine levels were higher.

(Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Int. J Neurosci 2001: 106(3-4):131-45).

Stay tuned for our next newletter!
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GOLFER’S ELBOW – OCTOBER 2012 NEWSLETTER

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NSOSC Cryotherapy Rental ProgramCryotherapy Purchase and Rental ProgramNorth Shore Orthopeadic & Sports Clinic has started a program for in-home cold therapy. These “cryotherapy” units may be rented or purchased. Two negative side effects of orthopedic trauma or surgery include pain and swelling. These conditions affect the healing pocess and can lead to longer rehabilitation times. Cold therapy is widely recognized as an effective treatment strategy to combat these issues. By using cold therapy you are taking an important step in speeding up the recovery process, getting you back to the pain-free life you deserve. For further information please feel free to contact our office or visit our web site at www.nsosc.com
Golfer’s Elbow
“Golfer’s Elbow” or Medial Epicondylitis is a common condition affecting the elbow. The pain is located on the inner side
(medial epicondyle) of the elbow within the muscle mass which permits you to make a fist and flex your wrist. When these
“flexor” muscles are:
1. overused by repetitive flexing movements
2. overloaded with too much force
3. forcefully stretched without warning or
4. not warmed up
The result can be a “pull” at the attachment site of the tendon into bone, producing a tendon “fraying.” The result is
inflammation, irritation and pain especially associated with gripping motions and resisted wrist flexion…
Symptoms
The most common symptom is ‘pain”, specifically located over the inner side of the elbow, at rest, when flexing the wrist, when lifting or grasping objects & hand-shaking. There may be visible swelling and “thickening”
Mechanism of Injury
Some causes of “tennis elbow”, include:
1. Racket sports – forehand movement
2. Carpentry, painting – motions which mimic the racket sport forehand
3. Machine work which has a lot of vibration
4. Very prevalent in throwing sports
5. Motorcycle, bicycle – hand brake squeezing motion
6. Carrying suitcases, briefcases, grocery bags
7. Incorrect golf swing mechanics,
8. Incorrect weight lifting technique wherein the load is to great & the wrist has been placed in the stretch position to commence repeated eccentric contractions of the flexor muscles
Treatment
Following the principle of R.I.C.E., one must:1. Physician: consult with your physician
2. Rest: avoiding activities which produce or aggravate the condition
3. Ice: applied for 15 minutes as frequently as hourly
4. Compression: using a “tennis elbow” strap to re-distribute forces
5. Elevation: is not indicated therefore we take liberty to insert exercise.
6. Physical Therapy: a treatment regimen may include laser, ultrasound & cryotherapy.
Acupuncture is often incorporated. Exercise progression is very specific,
beginning only after healing has occurred to the point that the exercises do not
increase pain.
7. Exercise Modification: modifying of the method of performing the injurious
activity. For example, lifting weight with your palm upwards or lifting with the
palm downwards but the load repositioned so that it is above the wrist joint.
Correct progression, including positioning, ensures the minimum strain thereby
facilitating the necessary scarring. Begin slowly, do not overdo, and stop
immediately if pain begins.
8. Stretching: daily stretching exercises for the flexor muscles of the hand, wrist,
and forearm help prevent further episodes of golfer’s elbow.
9. Biomechanical Evaluation: see your golf professional
10. Registered Massage Therapy: the RMT works with your upper extremity &
elbow to ensure that muscle tightness is at a minimum.
Return To Activity Prevention
Generally, the longer you experienced symptoms prior to seeking treatment, the longer will your prospective return to activity be. As general guidelines, we recommend:1. Being able to forcefully grip your racket, club, handle, hammer, etc

2. Bearing weight through your elbows as for example with push-ups or tricep dips

3. Have full range of elbow pre-injury movement

4. Have full restoration of pre-injury elbow strength

To avoid recurrence, we recommend:1. Professional Evaluation: Have the golf professional review your swing mechanics prior to returning back to the sport. Your professional may also make recommendations regarding grip size, & other strategies.

2. Warm-up: include stretching and gentle repetitive movement to warm the tissue

3. Stretching: ensuring the correct muscle length/tension balance

4. Strength: guided strengthening program, including regular forearm endurance activity

5. Occupational: if exacerbated by computer work, regularly interrupt repetitive computer data entry and seek the assistance of an ergonomics expert to review your computer alignment and positioning

Stay tuned for our next newletter!
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Genetic Diseases – Visit with MP Andrew Saxton

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The Clinic’s manager, Kristina Vandervoort, and Huntington Society of Canada Director, Janice Waud Loper, recently met with North Vancouver’s MP, Andrew Saxton. Mr. Saxton was very interested in H.D. research information as well as the Society’s forthcoming events. The need to protect Canadians from genetic discrimination was also raised – there are now more than 1,500 genetic tests available for diseases which can be inherited. For more information visit: http://www.ccgf-cceg.ca/ and http://www.huntingtonsociety.ca


Minimalist Running Trend talk at North Shore Athletics February 21, 2012

berold News and Events Comments Off on Minimalist Running Trend talk at North Shore Athletics February 21, 2012

Well done to Jacqui Steinberg, our physiotherapist who gave a very informative talk at North Shore Athletics to their clinic members. The topic of the Trend towards Minimalist Shoes was well received and sparked many interesting questions. Jacqui would love to talk to you if you are interested in trying out minimalist running.