First and foremost, a large proportion of low back pain episodes are non-specific, which means that they are not attributable to a specific, known pathology such as an infection, tumor, fracture, inflammatory disorder, cauda equina syndrome, radicular syndrome, etc. This essentially means that most episodes of low back pain are self-limiting and are not related to serious diseases³. That being said, that does not mean that a medical consultation is unnecessary. On the contrary, it is extremely important that a health professional such as a doctor or physiotherapist perform a comprehensive evaluation to identify the small portion of patients who could potentially have a more serious underlying condition. In addition, a medical consultation will also provide you with the necessary tools to better manage your pain (i.e. a doctor would prescribe pain medication and a physiotherapist would treat your low back pain, as well as prescribe certain exercises/stretches to help manage the condition). Before we take a look at common causes of low back pain, let’s go over the anatomy of the low back, also known as the lumbar spine.

Anatomy of the Lumbar Spine

The low back is composed of 5 segments or vertebra (L1 to L5). Between each vertebra are intervertebral discs. The intervertebral discs consist of an inner gelatinous fluid, referred to as the annulus pulposus, which is responsible for attenuating shock. This is facilitated by the outer fibrous layer, referred to as the annulus fibrosis⁴.

Photo Credit: https://www.flickr.com/photos/chiropractic/3813001068/in/photolist-6NWCnJ-hLRpz-bzYYMa-4fKVqj-huDfD4-4PWZiU-9KZSM3-pkRNp3-74MbRt-6Q1PWA-ax8op3-pnBzVB-bD46YY-qMkBAq-696Gsg-5g9hpP-hu1UBa-6NWC1J-cytrAS-6zJ38X-gj78Wz-noojYH-rqoo2c-mZQFEg-88QBKv-6NWC8N-3JTX7V-9iED4b-6NYAFL-3JTWVM-pisaEj-ppjPTe-FVPmXb-ccYgUs-cxxMzs-cyto5y-Nx4K-gyaiRN-6NUr4t-4htVaq-6NSsTX-4CQyYg-6NStn6-6NUrxr-5BXxEM-8qLzGU-dcVEWT-hu1USR-dcVGEQ-8qLzX

Causes of Non-Specific Low Back Pain

Once any serious spinal pathology and specific causes of back pain have been ruled out, the patient is classified as having non-specific low back pain. Any innervated structure in the lumbar spine (i.e. muscles, ligaments, dura mater, nerve roots, zygapophyseal joints, annulus fibrosis, thoracolumbar fascia, vertebrae, etc.) can cause symptoms of low back and referred pain into the extremity or extremities. According to previous research and international guidelines, it is not necessary, nor is it possible, to identify the specific tissue source of pain in order to effectively manage patients with non-specific low back pain because as the name suggests, there is no identifiable pathoanatomical source⁵ ⁶ ⁷.

Specific Causes of Low Back Pain

Some episodes of low back pain can be attributed to an injury and/or pathology. One common cause of more specific low back pain is a disc herniation. This occurs when the fluid part of the disc that can be found between two vertebrae gets pushed outward, compressing the spinal cord or nerve root, which can cause pain that radiates down into the leg⁴. This can be caused by repetitive bending and twisting movements. Similarly, narrowing of the joint spaces between vertebrae or the spinal itself canal, also termed spinal stenosis, can also lead to compression of the spinal cord or a nerve root⁸.

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Another common cause of low back pain is a lumbar sprain or strain, characterized as an overstretching of the muscles and/or ligaments of the lower back. The latter can occur with a sudden intense movement such as lifting a heavy object or repetitive flexing and twisting movements. Lastly, with age, the disc can degenerate, losing its capacity to act as a “shock absorber”. This degeneration also leads to a decrease in height between two vertebrae, which can compress neural structures around the spinal cord and cause further degeneration⁹.

That being said, it is crucial to understand that the above conditions CAN be causes of low back pain. However, this does not necessarily mean that you will have pain if a disc degeneration or a bulging disc are present. We have to move away from a “pain = injury” mindset. This is often not the case. For instance, a recent systematic review of 33 articles examining the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals (patients who do not report any pain) demonstrated that imaging findings of spine degeneration are present in high proportions of asymptomatic individuals. More specifically, the prevalence was 37% in 20 year-old individuals, and increased up to 96% in 80 year-old individuals. Moreover, disc bulges ranged from 30% in people 20 years of age, to 84% in people 80 years of age. Lastly, disc protrusion prevalence increased from 29% in individuals who were 20 years old, to 43% in individuals who were 80 years old. I must re-iterate that these prevalence numbers are taken from people who are asymptomatic, which means they do not report any pain whatsoever¹⁰. Therefore, positive imaging findings must be taken with a grain of salt. They can be the source of your pain, but they can also be completely unrelated. The evidence suggests that certain imaging-based degenerative features are likely part of normal aging and unassociated with pain.

When is Low Back Pain An Emergency?

If you have a history of any of the following, please consult a doctor immediately¹¹:

• Recent trauma
• Prolonged use of steroids
• Previous history of cancer or current cancer

If you are experiencing any of the following symptoms, please consult a doctor immediately¹¹:

• Numbness/loss or sensation between the thighs and around the
• Bladder/bowel dysfunction (incontinence)
• Sudden/severe weakness in one or both legs
• Erectile dysfunction
• Pain that is increased or not relieved by rest
• Unexplained sudden and significant weight loss

How To Manage Your Low Back Pain Right Now

Stay Active: Limit bed rest and begin a gradual return to your daily activities. However, refrain from activities that increase your pain. Avoid prolonged sitting, as well as repetitive bending, lifting and twisting movements.

Cold packs/ice: Place a cold pack on your lower back for 15–20 minutes at a time, every 2 hours, as needed. The cold pack will help relieve your pain, reduce muscle spasms and reduce any inflammation caused by the injury. Avoid heat within the first 48 hours after injury.

Proper posture: Modify your sleeping, sitting and standing postures to minimize the stress on your low back.

Consult your doctor: Please consult your doctor to inquire about any medications you can take to help relieve your low back pain, as well as to inquire whether any further medical investigation is required for your low back pain.

Consult a physiotherapist: Physiotherapists are highly trained health professionals who can perform a comprehensive evaluation to determine whether or not there is an underlying serious pathology present. In addition, a physiotherapist can treat your low back pain through the use of various techniques such as manual therapy and myofascial release, and will provide you with a home exercise program comprised of strengthening and stretching exercises.

How To Prevent Low Back Pain

A systematic review and meta-analysis of 41 studies published by Taylor et al. in 2014 examined the incidence of low back pain and risk factors associated with either first-time low back pain or transition to low back pain from a baseline of a pain-free state¹².

RISK FACTORS FOR A FIRST OCCURRENCE OF LOW BACK PAIN

Examples of risk factors identified for a first occurrence of low back pain include standing or walking > 2 hours per day, frequent moving or lifting > 25 lbs, increased driving time, poor Mental Health Composite Scale Short Survey-12 score (i.e. higher anxiety, depression ,etc.) and obesity, among others¹². How can we interpret this information? Staying in certain positions for long periods of time (i.e. standing or walking for 2 hours, sitting while driving for prolonged periods, etc.) are not so well tolerated, especially if you have poor posture. If you have poor posture, the muscles, ligaments and vertebrae of your lower back have to work harder to support the forces that are being transmitted through the spine, increasing unnecessary compression at the spine and tiring the muscles. Consequently, this will increase the risk of an injury. The key to having proper posture is a neutral spine. A neutral spine ensures that the stresses experienced by the spine and the surrounding structures are minimal. To ensure that your spine is in a neutral position in standing, it should be exactly mid-way between having a fully rounded and a fully arched back. To ensure that you have proper posture while standing, you should be able to trace a line from your ears down to the front of your shoulders, through the mid-way point of your hips, down to the back of your knees and to the front of your ankles.

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Moreover, repetitive movements soliciting the spine (i.e. bending forward to pick up objects repeatedly) are also not well tolerated. Proper posture when performing daily activities and/or work is crucial for the prevention of low back injuries. For instance, when lifting heavy objects, keep them close to you, bend your knees and hips, and avoid twisting movements and most importantly, don’t forget to take breaks. In addition, psychosocial risk factors such as depression or increased anxiety are sources of mental distress and play an important role. These are crucial to address, as they can often be involved in the persistence of low back pain. Lastly, obesity an important risk factor for developing low back pain. Did you know that being overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain¹³? This is why it is so important to address this early on.

RISK FACTORS FOR A RECURRENCE OF LOW BACK PAIN

Examples of risk factors identified for a recurrent episode of low back pain include sitting, standing or walking >2 hours per day, frequent moving or lifting >25 lbs, strength <50%, poor back endurance, obesity, poor health, prior low back pain frequent moving or lifting >25 lbs, manual jobs, awkward posture & mental distress¹². Do any of these look familiar? That’s because the majority of these risk factors were identical, if not similar, to the risk factors identified for a first time occurrence of low back pain. If the previously mentioned risk factors are properly addressed, the risk of first-time or recurring low back pain can drastically decrease.

If you have any questions or concerns regarding your low back pain, please consult your doctor and/or physiotherapist.

Did you enjoy the content of this post? If so, please comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

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DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. The information contained on this blog is a resource for information. This blog was created to inform the population about different musculoskeletal injuries with the ultimate goal of better informing them concerning their condition and to provide the necessary tools to better manage their pain and impairments. For any further questions or concerns regarding low back pain, please consult your doctor and/or physiotherapist.

References

1. National Institute of Neurological Disorders and Stroke. (2014). Low Back Pain. National Institutes of Health. Retrieved from: http://www.ninds.nih.gov/disorders/backpain/low-back-pain-brochure.pdf

2. DeLitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle,…Godges, J. J. (2012). Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 42(4):1–57.

3. Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. Lancet, 379(9814): 482–491.

4. OrthoInfo. (2012). Herniated Disk in the Lower Back. American Academy of Orthopaedic Surgeons. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00534

5. Hancock, M.J., Maher, C.G., & Latimer, J., Spindler, M. H., McAuley, J. H., Laslett, M., & Bogduk, N. (2007. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. European Spine Journal, 16(10): 1539–1550.

6. Koes, B.W., van Tulder, M., Lin, C. W. C., Macedo, L. G., McAuley, J., & Maher, C. (2010). An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal, 19(12): 2075–2094.

7. van Tulder, M., Becker, A., Bekkering, T., Breen, A., del Real, M. T., Hutchinson, A., Koes, B., Laerum, E., & Malmivaara, M. (2006). Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal, 15(Suppl 2):S169–191.

8. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2016). Spinal Stenosis. National Institutes of Health. Retrieved from: https://www.niams.nih.gov/health_info/spinal_stenosis/

9. McGill, S. (2009). Ultimate back fitness and performance (4th ed.). Waterloo, Ontario: Backfitpro Inc.

10. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol, 36(4): 811–816.

11. Bratton, R. L. (1999). Assessment and Management of Acute Low Back Pain. Am Fam Physician, 60(8): 2299–2306. Retrieved from: http://www.aafp.org/afp/1999/1115/p2299.html

12. Taylor, J. B., Goode, A. P., George, S. Z., & Cook, C. E. (2014). Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. The Spine Journal, 14(10): 2299–2319.

13. Shiri , R., Karppinen, J., Leino-Arjas, P., Solovieva, S., & Viikari-Juntura, E. (2010). The association between obesity and low back pain: a meta-analysis. American Journal of Epidemiology; 171(2): 135–154.

Photo Credit: https://www.nhl.com/canadiens

An Interview With Donald Balmforth, Consulting Physiotherapist for the Montreal Canadiens

Anthony: How long have you been a physiotherapist for? What made you choose this field?

Donald: “I’ve been a physiotherapist since 2004. I always knew I wanted to work in the sciences and I was always playing sports growing up. The sports environment really appealed to me. I injured myself one day playing hockey and when I went in for treatment, I found it so interesting. My physiotherapist, at the time, was working with a football team so I was like “forget about my ankle, tell me more”. That’s where I got the idea of becoming a therapist. I must have been 16 or 17. From there, I applied to McGill University in Physical Therapy and the Athletic Therapy program at Concordia University. I chose the Physical Therapy program at McGill University and I graduated in 2004".

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Anthony: What is your background in physiotherapy?

Donald: “It all started in my second year at McGill University when I started working with the McGill football team. I worked with them for 3 seasons. That led to a position with the Montreal Alouettes, whom I worked with for 4 seasons, and from there I sprang into working with the Montreal Canadiens. However, ever since I graduated, I’ve always worked full time in a private clinic. It’s like having two full-time jobs but I find it refreshing. I really have the best of both worlds”.

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Anthony: How did you get involved with the Montreal Canadiens and Catalyst Santé?

Donald: “I started working with the Alouettes before I graduated from McGill. The Alouettes’ head therapist, Scott Suter, was a great mentor, and once I graduated, I started working at his private clinic, an Action Sport. Scott and I left Action Sport at about the same time, and as a new graduate, I was eager to learn as much as possible. I took advantage of an opportunity to work with Dave Campbell, an athletic therapist/osteopath at Concordia Physio Sport. I really wanted to see how things were done differently. Dave taught me a lot, and gave me the opportunity to work with the Canadiens as he introduced me to Graham Rynbend, Head Athletic Therapist with the Club. Six years later, Scott and I rekindled our professional relationship, around 4 years ago, and that’s how we began at Catalyst Santé”.

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Anthony: What is your role in each setting?

Donald: “Here at Catalyst Santé, I can treat anyone: all sorts of orthopedic injuries, adolescents, geriatrics, referrals from players’ mothers or grandmothers’, etc. We want to promote wellness through physical therapy. My clientele is a huge spectrum. Over with the Montreal Canadiens, I’ll work 3–4 morning a week, 3–4 hours per morning. I see myself as treating three categories of players. The first group is what we think of most: injured players who need rehab to get back in to the line-up quickly and safely. The second is with players who are safely playing, but still have pain and/or limitations. This is probably where I dedicate most of my time. Lastly, the third group is one of my favorites: prevention and performance, where I work with players without necessarily having any particular complaints. With the Canadiens, we are a team of three physical therapy consultants. There’s myself, Steve Villeneuve, and Matthew Romano who is also an athletic therapist”.

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Anthony: How is Catalyst Santé different?

Donald: “Scott and I realized that we didn’t like working with the traditional half hour treatments. Clients would come in, take off their boots (in winter), we’d ask them how they’re doing, and before you know it, you’re 10 minutes in to your 30 minute treatment. We found that we didn’t have enough time, in a half hour block, to treat and manage a client’s rehab plan effectively. Clients need to be heard and we simply felt rushed as we tried to connect with our clients while assessing, treating, reassessing, treating, educating, and showing exercises. I began to notice that my last client of the day was not getting the same energy and enthusiasm as my last. So, that’s how we developed our one hour appointments here at Catalyst. As a client, you get the attention you need and, as a therapist, you are not running around. You are able to focus on your client easier, and stay fresh. The concept at Catalyst Santé is that your work should be your playground…feel great, treat great. This being said, should it be a more appropriate plan, we do offer 30 minute time slots, but 60 minutes have become the standard. We also don’t use electromodalities very often here and our clients do really well without them. Having the one hour time slots allows us to really check joints below, joints above, and work on stability. We get to focus on manual skills and more on exercise and I’d like to think we help the cause of the problem a little more as well as the symptoms. I’ll gladly do 8–10 hours and see 8–10 clients and I’d like to think that my first client and my last client get the same experience. I’m not drained. Seeing 16 clients in a day in half hour spots, and having the charting to do afterward, can make a day seem a little harder even if it’s shorter. At Catalyst, continuing education is also paramount, whether it is an informal in-service or taking courses overseas, ongoing education is a must. I feel like my answer would not be complete if I did not add that we really love the open concept here at Catalyst Santé. We want to feel like a second home. We have private rooms, but generally, if our clients are comfortable in the open, they can speak and laugh together during the treatment. They live the success of others and talk about their experiences. I think if a client is able to smile and laugh during their treatment, they have an opportunity to get better a little bit quicker”.

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Anthony: Are you still involved with McGill University?

Donald: “Yes, actually. I’m a supervisor for students during their clinical placements. I’ve always wanted to work with students. I think when you teach, you learn. Even when it’s about fundamentals, like endfeels, you can go back and review things and it sets a great foundation. I also go in as a guest Faculty Lecturer for certain courses”.

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Anthony: If you could recommend one course to take post-graduation, what would it be?

Donald: “I think there are three levels of education. The first is day-to-day: just speaking with colleagues and discussing cases and treatment ideas. It’s the cheapest, most accessible and most common. The second level is in-services: they aren’t expensive, are quite accessible and they allow you to go into more depth. The third and final one is formally taking a course. However, going into a course blind is difficult. I always like to get a taste for a course before committing valuable time (and money). I’ll speak to someone who has taken it and try and get a feel of the concepts and how they could fit into my way of treating. That being said, I would recommend this: I think when you go to do a course, especially if it is a one-technique course, you need to be confident about that course and you can’t go in with the misrepresentation that that course can solve everything. Sometimes, you give somebody a hammer and everything looks like a nail. You can’t just go down one path. You need to find what works best with your style and what gets you the best results. What I find amazing is taking all of the positives from each course, and putting them together. It’s hard to choose one course and I would suggest continuing manual therapy in conjunction with soft tissue courses, be it a Mulligan courses, Active Release Technique (ART) courses or a muscle activation technique course. However, I find dry needling to be phenomenal so I would have to suggest that one. It’s one of the more cutting edge courses out there right now”.

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Anthony: Who was your most influential mentor throughout your career?

Donald: “I’ve been fortunate enough along the way to have had many mentors, a lot of small lessons, and some bigger ones! The two most influential career mentors would have to be Scott Suter and Dave Campbell. Scott and Dave are great clinicians, great teachers, and great people. These are three separate qualities and both Scott and Dave excel in all of them. They really have a magical way of putting things together; they are unselfish with their knowledge and have a genuine desire to help people. I have learnt a lot about therapy and about life from them”.

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Anthony: What qualities do you look for in a new graduate?

Donald: “Everything that you can’t teach someone! Everything that can be taught, can be learnt. When I worked with the McGill football team and the Alouettes, I was still a student and far from being a skilled therapist but I was ready to learn and I was eager. This is what got me my opportunities. When you have someone with a passion, not only for physiotherapy, but any domain they would like to work in, and you combine that with a genuine desire to help people, it’s a magic formula. Everything else concerning how to get people better will come with time and experience. A passion to learn and a genuine desire to help others are truly important. You simply can’t teach these qualities”.

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Anthony: If there was one thing you could go back and do differently, what would it be?

Donald: “There are many smaller things. I would already taken more courses. When I take a course, I end up having flashbacks of clients who I had a harder time treating or only got a certain percent better, and I always think to myself, “why didn’t I take this course earlier!”. That being said, if I could really go back and do one thing differently, I would have been a better student. I had a lot of things going on during my time at McGill. I had a full schedule, working at Glass Experts to earn an income, with the McGill football team as well as the Alouettes to gain clinical/on field experience, and to be honest, non-concentration courses were not my priority at the time. When I look back now, I’ve had the chance to work and surround myself with incredible people. I have been very fortunate”.

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Anthony: Where do you see the profession of physical therapy in 20 years?

Donald: “That’s a good question. The things that I did 10 years ago are not the same things that I am doing now. I mean, when I was in school, stretching before exercise was the thing to do. Things are definitely evolving. We are a young profession and if you look at the momentum of the profession, knowledge is now growing at an exponential rate. It is becoming a challenge to stay ahead of that curve. I think our ability to help people in the future is going to be a lot more than it is now, and that such a future is not so distant. I’d also really like to see more physical therapists collaborating with other health professionals. I love a interdisciplinary approach: a kinesiologist, an athletic therapist, a physical therapist, a nutritionist, a psychologist. I can’t get everyone better, and the more you know about other professions, the better you’ll be at referring your patients to another professions. This is a huge opportunity to best surround our clients for more of a general wellness approach”.

Written by: Anthony Teoli MScPT, registered physiotherapist

If you have any questions or concerns regarding the content of this article post, you may contact me directly at infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

Anatomy of the Acromioclavicular Joint

The acromioclavicular (AC) joint is one of four joints that make up the shoulder complex. It consists of the acromion process of the scapula and the distal end of the clavicle, as well as the anterior, posterior, superior and inferior acromioclavicular ligaments. Additional vertical stability is provided by the coracoclavicular ligaments (conoid and trapezoid ligaments), which branch from the coracoid process of the scapula to the inferior clavicle¹.

Photo Credit: https://www.flickr.com/photos/internetarchivebookimages/14579263097/in/photolist-owrvYz-odjwZ8-ouprEZ-w3MA29-otruqA-ovJCEz-ouex7q-ow95Ui-ow5zrY-oeGE2M-ouaBj1-oxWWqr-oePJ2z-ouawfy-ovX4bR-oxXc4e-ow2WQ5-trez6s-oefNbH-wHjhDt-ow3SA1-ovPbAX-wHmceB-wHma44-sM1c2K-oeFp9v-wHmcY2-wZQQjx-tFxS3j-sLZR7e

Clinical Presentation

Injuries and degenerative changes at the AC joint are a common cause of shoulder pain and have important implications for the stability of the shoulder complex. Injuries may occur due to either a direct or indirect impact to the AC joint. A direct impact to the AC joint could occur, for instance, in a hockey player who falls onto the AC joint with the arm in an adducted position. An indirect impact could occur as a result of a fall onto an outstretched hand. In this case, the humerus is driven superiorly into the acromion process, which is in turn, driven superiorly relative to the distal clavicle, potentially causing an AC joint injury¹. Moreover, certain weight-lifting activities such as push-ups or dips have also been shown to aggravate the AC joint².

After having sustained an injury to the AC joint, the patient will typically report pain on the superior aspect of the shoulder. Pain may also be present in the area of the upper trapezius and/or anterior shoulder as well. In addition, swelling or deformity may be observed at the superior aspect of the shoulder² There may also be limitations and/or pain with active and passive range of motion, as well as increased joint laxity with accessory glides at the AC joint.

Clinical Diagnostic Tests for the Assessment of the AC Joint

An AC joint injury or instability may be diagnosed with proper history taking, physical examination and imaging¹. That being said, imaging tools are not necessarily readily available and often require that the patient be placed on a waiting list for an undetermined time period. Therefore, many health professionals, such as physiotherapists, must rely primarily on subjective history taking and physical examination.

As previously mentioned, numerous clinical diagnostic tests have been identified for the physical examination of the AC joint. Before I present these tests, I would just like to define several key statistical terms that will be relevant to the application of these tests. For the sake of simplicity, let us say that a certain test has been shown to have 90% sensitivity and 30% specificity. This means that in 90% of the cases, a positive test would correctly identify the presence of a certain condition, and in 30% of the cases, a negative test would indicate the absence of a certain condition. In this example, this test is said to have high sensitivity, but low specificity. Another important term is the likelihood ratio (LR). The likelihood ratio is the likelihood that a given test result would be expected in a patient with the condition compared to the likelihood that that same result would be expected in a patient without the condition. Simply put, it is the ratio of the probability that a test result is correct compared to the probability of the test result being incorrect. The likelihood ratio can be positive or negative, and is typically presented as a number (i.e. LR: + 6)³ A positive LR ≥ 10 provides a clinically significant degree of certainty that the patient with a positive test has the disorder for which you are testing. A negative LR ≤ 0.1 provides a clinically significant degree of certainty that the patient with a negative test result does not have the disorder for which you are testing⁴.

Now that we’ve covered some basic statistics, let’s get to the fun stuff. Below, you will find numerous clinical diagnostic tests identified in the scientific literature for the assessment of the acromioclavicular joint. Each test is explained in detail, and the diagnostic accuracy of each tests is presented as well.

1. Palpation of the Acromioclavicular Joint: this test is quite self-explanatory. It consists of palpating the acromioclavicular joint. Local AC tenderness with palpation would indicate a positive test. Diagnostic Accuracy: Sensitivity: 96%. Specificity: 10%. Likelihood Ratio: +1.07/-0.4⁰⁵.

2. Cross-body Adduction Sign

The cross-body adduction sign is performed with the arm flexed to 90° and then adducted across the body. The test is positive if it caused pain on the superior aspect of the shoulder near the AC joint².

Diagnostic Accuracy: Sensitivity: 77%. Specificity: 79%. Likelihood Ratio: +3.67/-0.2⁹².

Credit: Figure 1 — Taken From Chronopoulos et al., 2004 (see References)

3. Acromioclavicular Resisted Extension Test

For the AC Resisted Extension Test, the patient’s arm is brought into 90° of shoulder flexion and bent at 90° of elbow flexion. The patient is then asked to horizontally abduct the arm against resistance. The test is positive if pain is reproduced at the AC joint. Diagnostic Accuracy: Sensitivity: 72%. Specificity: 85%. Likelihood Ratio: +4.8/-0.3³².

Credit: Figure 2 — Taken From Chronopoulos et al., 2004 (See References)

4. O’brien’s Test/Active Compression Test

This test is performed with the shoulder flexed at 90° and adducted approximately 10°. The patient is then asked to resist a downward force on the arm with the thumb facing down and then with the thumb facing up. The test is considered positive if pain was localized to the AC joint with the first technique, but was reduced or eliminated with the second². Three studies examined the diagnostic accuracy of this test² ⁵ ⁷. However, their results were rather conflicting, except for the specificity of the test, which remained rather consistent throughout all three studies. Diagnostic Accuracy: Sensitivity: between 16–93%. Specificity. between 90–96%⁶.

Credit: Figure 3 — Taken From Chronopoulos et al., 2004 (See References)

5. Paxinos Sign

The examiner’s hand is placed over the injured shoulder. The thumb should be rested under the posterolateral aspect of the acromion and the index and long fingers of the same or contralateral hand are placed superior to the midpart of the ipsilateral clavicle. The examiner then applies pressure to the acromion with the thumb, in an anterosuperior direction, while applying a force inferiorly to the midpart of the clavicular shaft with the index and long fingers. The test is considered positive if pain was felt or increased in the region of the acromioclavicular joint and negative if there was no change in the pain level. Diagnostic Accuracy: Sensitivity: 79%. Specificity: 50%. Likelihood Ratio: +1.58/-0.4²⁵.

Applying The Evidence

Before I wrap things up, I would like to emphasize that what has been presented in this article is essentially the evidence that is currently available to assess the clinical utility of the above tests. What you may be asking yourself is, “what do I do with all of this information?”. The clinical application is the hard part. That being said, let me simplify it for you. An article published in 2006 by Powell et al. did a great job at explaining how this information can be applied clinically⁸.

Based on the above information, three tests were consistently shown to have high sensitivity: the cross-body adduction sign, paxinos sign and AC joint palpation. This means that a negative result on the latter three tests (i.e. no pain) would indicate a decreased likelihood that AC joint dysfunction is present. Therefore, according to the evidence, to rule out a painful AC joint dysfunction, the cross-body adduction sign, paxinos sign and AC joint palpation should be negative⁸.

Based on the above information, three tests were consistently shown to have high specificity: the cross-body adduction sign, the resisted AC extension test and O’brien’s test. This means that a positive result on the latter three tests (pain reproduction at the AC joint) would indicate an increased likelihood that AC joint dysfunction is present. Therefore, according to the evidence, to rule in a painful AC joint dysfunction, the cross-body adduction sign, the resisted AC extension test and O’brien’s test should be positive⁸.

Written by: Anthony Teoli MScPT, Physiotherapist & Founder of InfoPhysiotherapy

Website: www.infophysiotherapy.blogspot.com

___________________________________________________________________

If you have any questions or concerns regarding the content of this article post, you may contact me directly at infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

References

1. Saccomanno, M. F., De Ieso, C., & Milano, G. (2014). Acromioclavicular joint instability: anatomy, biomechanics and evaluation. Joints, 2(2): 87–92.

2. Chronopolous, E., Kim, T. K., Park, H. B., Ashenbrenner, D., & McFarland, E. G. (2004). Diagnostic Value of Physical Tests for Isolated Chronic Acromioclavicular Lesions. The American Journal of Sports Medicine, 32(3): 665–661.

3. Centre for Evidence-Based Medicine. (2017). Likelihood Ratios. Centre for Evidence-Based Medicine. Retrieved from: http://www.cebm.net/likelihood-ratios/

4. Davidson, M. (2002). The interpretation of diagnostic tests: A primer for physiotherapists. Australian Journal of Physiotherapy, 48(3): 227–233.

5. Walton, J. Mahajan, S., Paxinos, A., Marshall, J., Bryant, C., Shnier, R., Quinn R., & Murrell, G. A. C. (2004). Diagnostic Value of Tests For Acromioclavicular Joint Pain. Journal of Bone and Joint Surgery, 86A(4): 807–812.

6. Hegedus, E. J., Goode, A., Campbell, S., Morin, A., Tamaddoni, M., Moorman III, C. T., & Cook, C. (2007). Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. British Journal of Sports Medicine, 42(2) : 80–92.

7. O’Brien, S. J., Pagnani, M. J., Fealy, S., McGlynn, S. R., & Wilson, J. B. (1998). The Active Compression Test: A New and Effective Test for Diagnosing Labral Tears and Acromioclavicular Joint Abnormality. The American Journal of Sports Medicine, 26(5): 610–613.

8. Powell, J. W., & Huijbregts, P. A. (2006). Concurrent Criterion-Related Validity of Acromioclavicular Joint Physical Examination Tests: A Systematic Review. The Journal of Manual and Manipulative Therapy, 14(2): 19–29.

What Is A Foam Roller?

Foam rollers are a form of self-myofascial release in which the client uses their body weight to apply pressure on a specific soft tissue by rolling on it with the ultimate goal of enhancing myofascial mobility¹. Foam rollers come in a variety of shapes and sizes, varying from 6 inches by 36 inches, to 6 inches by 18 inches. Different foam densities and material allow for varying depths of self-myofascial release. Other forms of self-myofascial release include using massage rollers, which are typically applied against a soft tissue with the upper extremities, as well as tennis balls¹.

Foam roller: 6 inches by 18 inches

6 Simple Exercises Using A Foam Roller

I would like to take a minute to mention a few things about foam rolling. Firstly, there is currently insufficient evidence to support any specific training protocol and/or parameters. That being said, research studies that have demonstrated improvements in flexibility (although short term), typically foam rolled between 30 seconds and 2 minutes, 2 to 5 times within one session ¹ ². Therefore, the parameters recommended for the following exercises are based on the available literature on foam rolling. Secondly, I must mention that foam rolling is not meant to be comfortable. You will likely experience discomfort and/or pain while foam rolling. If you are new to foam rolling, go at your own pace. I typically suggest foam rolling for 1 to 2 minutes, for 3 sets. You can also begin by foam rolling for 30 seconds, for 3 sets, and work your way up to 1 minute as you being accustomed to it. You can also adjust the amount of pressure on the selected muscle by removing or adding more of your body weight while rolling. Lastly, due to the high level of compression generated while foam rolling, any individuals with peripheral neuropathy, diabetes mellitus, osteoporosis, or any individuals with an increased risk of developing a deep vein thrombosis should not be using a foam roller³.

1. Foam Roller — Right Quadriceps: 3 sets of 1–2 minutes, 3–4 times per week

Description: Place the front of your right thigh on the foam roller. Your left leg should not be in contact with the foam roller. Roll slowly from the top of your thigh down to just above your knee. Do not foam roll over the front of your knee joint. A cycle consists of going from the top of your thigh, to above the knee, and back up. This cycle should typically take at least ten seconds to allow for a slow and controlled cadence.

2. Foam Roller — Right Iliotibial Band (IT Band): 3 sets of 1–2 minutes, 3–4 times per week

Description: Place the lateral part of your right thigh on the foam roller. Your left leg should be crossed over the right leg and should not be in contact with the foam roller. Roll slowly from the top of your lateral thigh down to just above your knee. Do not foam roll over the side of your knee joint. A cycle consists of going from the top of your thigh, to above the knee, and back up. This cycle should typically take at least ten seconds to allow for a slow and controlled cadence. This is likely to be one of the more uncomfortable and/or painful exercises.

3. Foam Roller — Left Gluteals: 3 sets of 1–2 minutes, 3–4 times per week

Description: Cross your left leg over your right leg as shown in the picture above and place your right buttock on the foam roller. Shift your body over the right buttock so that you are weight bearing on the right hand. Roll frontward and backward over the gluteal region. One cycle should typically take at least ten seconds to allow for a slow and controlled cadence.

4. Foam Roller — Left Hamstring: 3 sets of 1–2 minutes, 3–4 times per week

Description: Place the back of your left thigh on the foam roller. Your left leg should not be in contact with the foam roller. Roll slowly from the top of your posterior thigh down to just above your posterior knee. A cycle consists of going from the top of your thigh, to the knee, and back up. This cycle should typically take at least ten seconds to allow for a slow and controlled cadence. The area behind the knee is referred to as the popliteal fossa. This area is important because the popliteal artery and vein run through this area, and this is also where the sciatic nerve bifurcates into the tibial and common peroneal nerve. These structures are delicate and vulnerable to compression at this location. Therefore, DO NOT foam roll the posterior part of the knee.

5. Foam Roller — Right Adductors: 3 sets of 1–2 minutes, 3–4 times per week

Description: Place the inside of your right thigh on the foam roller. Your left leg should not be in contact with the foam roller. Roll slowly from the inside of your thigh nearest to the grown, all the way to your inner thigh closest to the knee. Do not foam roll over the knee joint. A cycle consists of going from the inner thigh nearest to the groin, to your inner thigh nearest to the knee, and back. This cycle should typically take at least ten seconds to allow for a slow and controlled cadence.

6. Foam Roller — Left Calf: 3 sets of 1–2 minutes, 3–4 times per week

Description: Place your left calf on the foam roller. Your left leg should not be in contact with the foam roller. Roll slowly from the top of your calf down to just above your ankle. As previously mentioned, do not foam roll over the back of your knee. A cycle consists of going from the top of your calf, to the bottom of your calf just above the ankle, and back up. This cycle should typically take at least ten seconds to allow for a slow and controlled cadence.

If you have any questions or concerns regarding how you to use a foam roller, please consult your physiotherapist or any other qualified health professional. If you have any questions or concerns regarding the content of this blog post, you may contact me directly infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The content of this blog is a resource for information only. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding how you to use a foam roller, please consult your physiotherapist or any other qualified health professional.

References

1. Cheatham, S. W., Kolber, M. J., Cain, M., Lee, M. (2015), The Effects of Self-Myofascial Release Using A Foam Or Roller Massager On Joint Range Of Motion, Muscle Recovery, And Performance: A Systematic Review. International Journal of Sports Physical Therapy, 10(6): 827–838.

2. Beardsley, C. & Skarabot, J. (2015). Effects of self-myofascial release: A systematic review. Journal of Bodywork & Movement Therapies, 19(4): 747–758.

3. Freiwald, J., Baumgart, C., Kuhnemann, M., & Hoppe, M. W. (2016). Foam Rolling in sport and therapy — Potential benefits and risks Part 2. Sports Orthopaedics and Traumatology, 32(3): 267–275.

What Is A Foam Roller?

Foam rollers are a form of self-myofascial release in which the client uses their body weight to apply pressure on a specific soft tissue by rolling on it with the ultimate goal of enhancing myofascial mobility¹. Foam rollers come in a variety of shapes and sizes, varying from 6 inches by 18 inches, to 6 inches by 36 inches. Different foam densities and material allow for varying depths of self-myofascial release. Other forms of self-myofascial release include using massage rollers, which are typically applied against a soft tissue with the upper extremities, as well as tennis balls¹.

Foam roller: 6 inches by 18 inches

Why Are Foam Rollers Used?

Before I dive into why foam rollers are used, I would like to quickly gloss over a term you may or may not be familiar with: “fascia”. Fascia is a connective tissue that encases all muscles, organs, glands, neural pathways and blood vessels². It has both a mechanical and metabolic role². That being said, the main purpose of using a foam roller is to achieve a massage and/or stretch of the underlying soft tissue and fascial connective tissue. Biomechanically speaking, several purposes have been previously identified³:

• To improve fascial remodelling
• To improve elastic recoil of fascial tissues
• To improve myofascial health
• To improve fascial hydration
• To improve prioceptive refinement

Do Foam Rollers Actually Work?

I must admit to being a frequent user of foam rollers, especially for myofascial release of the lower extremities. More specifically, I use them to release my adductors, quadriceps, hamstrings, glutes, iliotibial band and calves. I typically roll each muscle group for 2 minutes with a generally slow cadence, taking at least ten seconds to complete a cycle (a cycle would be rolling from the origin to the insertion of a muscle group and back). Throughout this process, pain and discomfort make me wonder why I chose to foam roll in the first place, but afterward, I feel fantastic! This is when I began to ask myself: is this just a placebo effect or do foam rollers actually work? I’ve had this burning question on my mind for a while now and took it upon myself to explore the scientific literature to see if any recent research had been published regarding this topic. I stumbled upon two systematic reviews, both published in 2015, which reviewed the literature concerning the effective of foam rollers on a variety of different outcomes such as range of motion, delayed onset muscle soreness (DOMS) and muscle performance, among others¹ ⁴. It is important to note that one systematic review included 14 studies whose quality of evidence varied between 6 and 10 on the Pedro Scale (maximum score is 11, which would indicate excellent quality of evidence)¹. The second systematic review included 22 studies, whose quality of evidence varied between 4 and 8 on the Pedro scale (mean score of 5.91). The latter would indicate that the quality of evidence of the scientific literature on foam rolling currently available is quite variable, depending on the study. Now, below I present the results of the two systematic reviews separated by outcome:

RANGE OF MOTION ¹ ⁴

The research suggests that foam rolling may confer short-term benefits for joint range of motion at the hip, knee and ankle without affecting muscle performance. The increases of joint range of motion tend to be limited to approximately 10 minutes⁴. It is important to note that self-myofascial release has been shown to be more effective when combined with static stretching⁵ ⁶. However, there is conflicting evidence with respect to the long-term effects of foam rolling on joint range of motion⁴. Lastly, there is no consensus regarding optimal parameters for foam rolling due to the increased variability of study designs and intervention protocols across research studies. However, interventions typically consisted of 2 to 5 sessions of foam rolling for 30 seconds to 2 minutes.

MUSCLE PERFORMANCE¹ ⁴

The majority of studies included in both systematic reviews demonstrated that self-myofascial release did not impede athletic performance, measured through a wide range of different force and power production outcome measures⁴. More specifically, one systematic review found that a short bout of foam rolling (1 session of 30 seconds) to the lower extremity after a dynamic lower body warm-up did not acutely enhance nor negatively impact muscle performance¹. This could potentially make foam-rolling a viable alternative to static stretching prior to exercise, as it does not seem to acutely affect muscle performance as static stretching does⁷.

DELAYED ONSET MUSCLE SORENESS & RECOVERY¹ ⁴

According to the scientific literature, using a foam roller between 10 to 20 minutes after high intensity exercise has been shown to reduce delayed onset muscle soreness through the reduction of perceived pain levels. It has also been suggested that a patient’s perceived pain level may be further decreased with 20 minutes of continued foam rolling over a three day period¹. The latter has been demonstrated in both trained and untrained populations, as well as through the use of different outcome measures for perceived pain (i.e. pressure pain threshold, self-reported pain using a visual analogue scale and self-reported pain using the BS-11 Numerical Rating Scale)⁴. The latter may make foam rolling an interesting option for recovery enhancement post training or competition for athletes.

ARTERIAL FUNCTION, ENDOTHELIAL FUNCTION AND PARASYMPATHETIC NERVOUS SYSTEM ACTIVITY⁴

Preliminary evidence suggests that self-myofascial release may also lead to improvements in arterial and endothelial function⁸, as well as parasympathetic nervous system activity⁹, which may potentially contribute to recovery enhancement. However, the evidence is limited.

Potential Risks of Foam Rolling

As with any form of exercise prescription, potential risks must be taken into consideration. Foam rolling can exert a high mechanical pressure to the fascial connective tissue, bones, nerve receptors and blood vessels¹⁰. For instance, one study published in 2008 demonstrated that the maximum mean pressure load generated at the lateral thigh with a foam roller was found to be 10 times higher than the highest medical compression category¹¹. Consequently, relative and absolute contraindications for foam rolling should include patients with peripheral neuropathy, diabetes mellitus, osteoporosis, as well as patients with an increased risk of developing a deep vein thrombosis¹⁰.

Conclusion

I would like to take a minute to emphasize several key points when considering the summarized results of both systematic reviews. Firstly, current research concerning foam rolling on flexibility, delayed onset muscle soreness and muscle performance is far from sufficient to generate any form of consensus regarding the effectiveness of foam rolling. The majority of research studies had relatively small sample sizes and there was high variability between study designs (i.e. study protocols, intervention parameters, type of foam roller used, outcome measures etc.). The heterogeneity between studies makes it difficult to establish a firm conclusion regarding the effectiveness of foam rolling, and complicates the development of an optimal training program. Moreover, all research studies only found short-term benefits. The long-term benefits of foam rolling, if any, are unknown¹. Therefore, further research should focus on generating more high-quality randomized controlled trials with more consistent foam rolling intervention protocols and study designs, as well as increased sample sizes. Lastly, further research should examine both the short-term and long-term efficacy of foam rolling.

That being said, the current scientific literature appears to suggest that foam rolling may provide a range of potentially valuable benefits for both athletes and the general population, including increasing flexibility, reducing delayed onset muscle soreness and enhancing recovery without detriment to acute muscle performance. There is very limited evidence to support the effect of foam rolling on arterial and endothelial function, as well as parasympathetic nervous system activity. Moreover, there is conflicting evidence regarding whether or not foam rolling can confer long-term flexibility benefits. Lastly, the physiological effects of foam rollers on soft tissue are still under investigation and no consensus currently exists regarding the optimal program parameters (foam rolling duration, repetitions, frequency, cadence, etc.) for range of motion, recovery, and performance¹ ⁴.

How To Use A Foam Roller?

This is the next logical question for those of you who are new to foam rolling. In this article, I provide 6 easy exercises for the lower extremities, targeting the quadriceps, hamstring, gluteals, iliotibial band, calves and hip adductors.

If you have any questions or concerns regarding how you to use a foam roller, please consult your physiotherapist or any other qualified health professional. If you have any questions or concerns regarding the content of this blog post, you may contact me directly infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The content of this blog is a resource for information only. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding how you to use a foam roller, please consult your physiotherapist or any other qualified health professional.

References

1. Cheatham, S. W., Kolber, M. J., Cain, M., Lee, M. (2015), The Effects of Self-Myofascial Release Using A Foam Or Roller Massager On Joint Range Of Motion, Muscle Recovery, And Performance: A Systematic Review. International Journal of Sports Physical Therapy, 10(6): 827–838.

2. Freiwald, J., Baumgart, C., Kuhnemann, M., & Hoppe, M. W. (2016). Foam Rolling in sport and therapy — Potential benefits and risks Part 1. Sports Orthopaedics and Traumatology, 32(3): 258–266.

3. Schleip, R., & Muller, D. G. (2013). Training principles for fascial connective tissues: scientific foundation and suggested practical applications. J. Bodyw. Mov. Ther, 17(1):103–115.

4. Beardsley, C. & Skarabot, J. (2015). Effects of self-myofascial release: A systematic review. Journal of Bodywork & Movement Therapies, 19(4): 747–758.

5. Mohr, A. R., Long, B. C., Goad, C. L. (2014). Effect of foam rolling and static stretching on passive hip-flexion range of motion. J Sport Rehabil, 23(4): 296–299.

6. Škarabot J., Beardsley, C., Štirn, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes. Int J Sports Phys Ther, 10(2): 203–212.

7. Kay, A. D., & Blazevich, A. J. (2012). Effect of acute static stretch on maximal muscle performance: a systematic review. Med. Sci. Sports Exerc, 44(1):154–164.

8. Okamoto, T., Masuhara, M., & Ikuta, K. (2014). Acute effects of self-myofascial release using a foam roller on arterial function. J. Strength Cond. Res, 28(1) 69–73.

9. Kim, K., Park, S., Goo, B.O., Choi, S.C., 2014. Effect of self-myofascial release on reduction of physical stress: a pilot study. J. Phys. Ther. Sci. 26(11): 1779–1781.

10. Freiwald, J., Baumgart, C., Kuhnemann, M., & Hoppe, M. W. (2016). Foam Rolling in sport and therapy — Potential benefits and risks Part 2. Sports Orthopaedics and Traumatology, 32(3): 267–275.

11. Curran, P. F., Fiore, R. D., Crisco, J. J. (2008). A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. J. Sport Rehabil, 17(4): 432–442.

Photo Credit: Flickr

How Does A Pedometer Work?

Pedometers possess a horizontal, spring-suspended lever arm that moves up and down as a result of vertical accelerations at the hip. A step will be counted when the vertical acceleration surpasses the force sensitivity threshold of the pedometer designed by the manufacturer. The force sensitivity threshold is an important feature of a pedometer because it will omit any “non steps” that may occur from light movement when in a car or on a train or subway, for instance. That being said, it is important to note that there is a certain trade-off due to the design of the force sensitivity threshold, where low acceleration steps (i.e. advancing in a line) may not be accounted¹. However, regular walking speeds or brisk walking are walking speeds commonly encouraged by health professionals and those commonly adopted by patients. Therefore, the omission of these low acceleration steps are not a significant loss. It goes without saying that pedometers will not track physical activity levels for activities such as swimming, cycling or weight lifting, among others.

Photo Credit: Flickr

Why Have Pedometers Become So Popular?

The answer is simple: a pedometer provides a simple estimate of physical activity level using the number of steps taken throughout the day. The majority of pedometers are user friendly and their incorporation into fashionable accessories such as watches has made them both more practical (i.e. having a watch that can count your steps is more practical than attaching a simple step counter to your body) and stylish. In addition, walking is both the most commonly encouraged activity and it is also the activity most commonly reported as a leisurely activity¹.

Do Pedometers Actually Increase Physically Active Levels?

Based on the scientific literature, pedometers are a feasible and cost-effective method to increase physical activity levels in people of all ages.

CHILDREN AND ADOLESCENTS

One systematic review published in 2009 examined the effectiveness of pedometers in promoting physical activity among youth². Of the 14 studies included in this review, 12 studies demonstrated significant increases in physical activity. It must be noted that there were differences in the magnitude of the effect, likely due to differences in study participants, outcome measurement methods and study duration. It has been suggested that pedometer step feedback alone may not be enough to successfully increase physical activity levels in youth. To increase adherence, proper goal setting and self-monitoring (i.e. recording daily step counts) are crucial. It is important to note that less active adolescents typically respond better to goal setting and self-monitoring, whereas little to no change has been observed in youth who are already sufficiently active². However, in children, increases in physical activity levels was observed in all participants. Seeing as the study durations for this review varied between 1 week and 6 months, further research still needs to evaluate long-term effectiveness of pedometers for increasing physical activity, as well as participant adherence after the intervention has been completed to examine whether or not the behavior has been maintained. In addition, there are few studies with similar study samples, providing limited comparability. Therefore, further research should focus on increasing the volume of research with similar study designs in this field.

ADULTS

The results of a systematic review published in 2007 suggest that the use of a pedometer is associated with significant increases in physical activity, as well as significant decreases in body mass index (BMI) and blood pressure³. This systematic review included 26 studies with a total of 2627 participants (8 randomized controlled trials, 18 observational studies). The mean age of the participants was 49 years of age (+- 9 years) and 85% were women. The mean intervention duration was 18 weeks. Overall, participants increased their physical activity by 26.9% over baseline with the use of pedometers. The intervention group demonstrated an increase in steps per day between 2183 and 2491 steps more than the control group, depending on study design. Once again, goal setting was determined to be an important predictor of physical activity increase. Participants in the intervention group also demonstrated significant descreases in BMI by approximately 0.38 kg/m² and significant deceases in systolic blood pressure by approximately 3.8 mmHg. It is important to note that whether or not these changes were maintained over the long term is unknown. Therefore, further research should examine physical activity level adherence and maintenance post intervention.

What Factors Are Related To Pedometers Successfully Increasing Physical Levels¹?

1. Pedometer characteristics: ease of use, affordable, readily accessible, provides immediate feedback, immediately increases awareness of physical activity levels, simple estimate of physical activity levels by providing number of steps taken, etc.
2. Program characteristics: program must implement self-monitoring, personalized feedback and incremental goal setting, importance of goal setting, program structure must be flexible, need to record or submit daily values (provides sense of accountability), etc.

The Importance Of Goal-Setting

The use of pedometers reflect individual behaviors, incorporating aspects such as self-monitoring, personalized feedback and self-selected goal setting. That being said, it has been demonstrated that programs encouraging increased physical activity with no specific goal have shown no significant improvements in steps/day compared with those with incremental increases of approximately 2000 steps per day in programs promoting the use of the 10 000 steps per day goal or other goals¹.

How Many Steps Is Enough?

• For adults: the research has identified being sedentary as having completed less than 5000 steps per day⁴. Healthy adults take anywhere between 4000 and 18 000 steps per day. Therefore, 10 000 steps per day is a reasonable goal for the healthy adult population as per the normative data in the research literature. That being said, this goal may not initially be reasonable for the less physically active individual. Goal-setting that is tailored to an individual is best in this case⁵.
• For children and adolescents: For children, boys should average between 12 000 to 16 000 steps/day and girls should average between 10 000 and 13 000 steps/day. For adolescents average steps per day is expected to decrease gradually until approximately 8,000–9,000 steps per day at 18 years of age⁶.
• For older adults and special populations: Typically older adults take on average between 2000 and 9000 steps given the high variability of physical capacity and functioning in this population. Therefore, research suggests an average daily step goal between 7100 and 8000 steps per day. For special populations (i.e. those living with disability and/or chronic illness that may limit mobility and/or physical endurance), the average has been observed to be between 1200 and 8800 steps per day. Therefore, research suggests an average daily step goal between 4600 and 5500 steps per day⁷.

If you have any questions or concerns regarding how you can become more active, please consult your doctor or physiotherapist. If you have any questions or concerns regarding the content of this blog post, you may contact me directly infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The content of this blog is a resource for information only. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding how you can become more active, please consult your doctor or physiotherapist.

References

1. Tudor-Locke, C. & Lutes, L. (2009). Why Do Pedometers Work? A Reflection upon the Factors Related to Successfully Increasing Physical Activity. Sports Med, 39(1), 981–993.

2. Lubans, D.R., Morgan, P.J., Tudor-Locke, C. (2009). A systematic review of studies using pedometers to promote physical activity among youth. Preventative Medicine, 48(4), 307–315.

3. Bravata, D. M., Smith-Spangler, C., Sundaram, V., Gienger, A. L., Lin, N., Lewis, R., Stave, C. D., Olkin, I., & Sirard, J. R. (2007). Using Pedometers to Increase Physical Activity and Improve Health. Journal of the American Medical Association, 298(19), 2296–2304.

4. Tudor-Locke, C., Craig, C.L., Thyfault, J.P., & Spence, J. C. (2012). A step-defined sedentary lifestyle index: <5000 steps/day. App Phys Nutr Met. 38(2), 100–114.

5. Tudor-Locke, C., Craig, C. L., Brown, W, J., Clemes, S. A., De Cocker, K., Giles-Corti, B., Hatano, Y., … Blair, S. N. (2011). How Many Steps/day are Enough? For Adults. International Journal of Behavioral Nutrition and Physical Activity, 8(79), 1–13.

6. Tudor-Locke, C., Craig, C. L., Rowe, D. A., Spence, J. C., Tanaka, S., Blair, S. N., Beets, M . W., … Raustorp, A. (2011). How Many Steps/Day are Enough? for Children and Adolescents. International Journal of Behavioral Nutrition and Physical Activity, 8(78), 1–14.

7. Tudor-Locke, C., Craig, C.L., Aoyagi, Y., Bell, R. C., Croteau, K. A., De Bourdeaudhuij, I., Ewald, B., Gardner, A. W., … Blair, S. N. (2011). How many steps/day are enough? For older adults and special populations. International Journal of Behavioral Nutrition and Physical Activity, 8(80), 1–19.

Photo Credit: Flickr

Common Causes of Plantar Fasciitis

• Faulty biomechanics of the foot (i.e. overpronation of the foot)¹
• Flat feet/high arches¹ ² ³
• Being overweight²
• Inappropriate footwear ²
• Sudden increase in training volume (i.e. increasing running frequency, intensity and/or distance) ² ³
• Decreased flexibility of the gastrocnemius, soleus and hamstring muscles³
• Decreased strength of the gastrocnemius, soleus and intrinsic foot muscles³

How To Manage Your Plantar Fasciitis² ⁴

• Rest: Refrain from exercise or physical activity that aggravates your pain initially (i.e. running). Avoid prolonged standing and walking for long periods of time so as not to aggravate the pain. You can gradually return to exercise or physical activity when there is no pain with daily activities such as standing, walking and going up or down the stairs.
• Medications: Please consult your doctor to inquire about any medications you can take to help relieve your plantar fasciitis.
• Cold packs/ice: Place a cold pack underneath your foot for 15–20 minutes at a time, multiple times a day, as needed. Wait minimum two hours between icing periods. Another alternative is rolling a frozen water bottle underneath your foot. The cold pack will help relieve your pain and reduce any inflammation caused by the injury.
• Gentle stretching: gentle, pain-free stretching of the calf and plantar fascia can also help reveal your pain. For detailed instructions on how to do so, please click here.
• Consult your physiotherapist: A physiotherapist will perform a comprehensive evaluation to determine the causes of your plantar fasciitis. Treatment may include modalities for pain, myofascial release of tight muscles, manual therapy to optimize mobility at the joints of the lower extremity, stretching and strengthening exercises for the ankle and foot to optimize efficient foot biomechanics, as well as arch taping to provide temporary support to the arch of your foot to decrease some of the stress on the plantar fascia² ⁴.

How To Prevent Plantar Fasciitis From Recurring

Proper footwear: shoes with thicker soles provide more cushioning and support to the arch of the foot, relieving some tension from the plantar fascia¹ ² ³ ⁴.

Orthotics/taping: Pre-made or custom-made orthotics may be helpful to correct faulty biomechanics of the foot and provide additional support to the arch of the foot² ⁴.

Consult your physiotherapist!

Surgery: Typically only considered after no improvements with 12 months of conservative treatment. Include procedures such as a gastrocnemius recession or plantar fascia release⁴.

If you have any questions or concerns regarding your plantar fasciitis, please consult your doctor and/or physiotherapist. If you have any questions or concerns regarding the content of this blog post, you may contact me directly at infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The information contained on this blog is a resource for information. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding plantar fasciitis, please consult your doctor or physiotherapist

References

1. Bogla, L. A., & Malone, T. R. (2004). Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link To Clinical Practice. Journal of Athletic Training, 39(1), 77–82. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC385265/pdf/attr_39_01_0077.pdf

2. Canadian Physiotherapy Association. 2014. Plantar Fasciitis. Retrieved from: http://physiocanhelp.ca/wp-content/uploads/2014/04/PlantarFasciitis_EN.pdf

3. Young, C. C. (2012). Plantar Fasciitis. Medscape Reference. Retrieved from: http://content.partnerunning.com/praresourcedocs/6_injurypreventionandtreatment/plantar_fasciitis.pdf

4. OrthoInfo. (2010). Plantar Fasciitis and Bone Spurs. American Academy of Orthopaedic Surgeons. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00149

Definition: A deep vein thrombosis (DVT) is a blood clot that forms in a deep within the body¹. This condition must be taken seriously because if the blood clot is dislodged, it can travel throughout the body and become lodged in the other parts of the body, such as the lungs, causing a pulmonary embolism.

Photo Credit: Flickr

DVTs and Cancer Patients

• In oncology patients, it has been estimated that approximately 20–30% of all first venous thromboembolic events are cancer associated².
• Cancer is recognized as, “an independent and major risk factor” for the development of a thromboembolic event³.
• The incidence of venous thrombosis in cancer patients has increased. This may be due to several factors such as increased awareness and detection of DVTs, as well as an increase in the survival rate of the aging population, who are at an increased risk of developing DVTs².
• Cancer patients are between 4 and 7 (relative risk) times more at risk of developing a DVT than the general population².

Why Are Cancer Patients More At Risk of Developing a DVT?

Cancer patients have a prothrombotic state (Virchow’s triad)³:

• Stasis or pooling of the blood caused by bed rest or tumor compression. If there is a disruption of blood flow, it facilitates the formation of a clot.
• Vascular injury caused by invasion of cancer cells, drugs (i.e. chemotherapy) or therapeutic devices (i.e. central venous catheters). Vascular injury initiates the formation of a blood clot to help heal the latter injury,
• Blood hypercoagulability due to release of cancer cell procoagulant factors. Hypercoagulability simply refers to a state in which there is an abnormally increased tendency to form blood clots.

Blood Clot Formation

1. Injured endothelial and cancer cells expose “tissue factor” on their membranes, which is a receptor for factor VII ( initiates the blood clot cascade)
2. Circulating fibrinogen is converted into fibrin, forming a matrix that traps platelets
3. As more and more platelets are trapped, a blood clot forms to aid with tissue repair
4. Enzymes such as plasmin remove the clot via activation of urokinase-type plasminogen activator (uPA) or tissue-type plasminogen activator (tPA)

In cancer patients, the last phase, which consists of the breakdown of the clot, is counteracted by plasminogen-activator inhibitors (PAI) 1 and 2, particularly activated by cancer cells. Consequently, this enhances the risk of developing a DVT.

Patient-Related Risk Factors for the Development of a DVT² ³

• Age (>60 years)
• Obesity
• Prolonged immobility
• Prior history of venous thrombosis
• Number of comorbidities (greater than or equal to 3)
• Ethnicity
• Biomarkers

Cancer-Related Risk Factors for the Development of a DVT

• Type of cancer: pancreas, brain, lung and ovarian cancer have the highest risk. Lymphomas, myeloma, kidney, stomach and bone cancers have been reported to have a high risk as well².
• Stage of cancer: metastatic disease a time of cancer diagnosis was found to be the strongest predictor of subsequent venous thrombosis².
• Histological type of tumor: adenocarcinomas are associated with higher risks when compared to squamous cell carinomas³.

Treatment-Related Risk Factors for the Development of a DVT²

• Surgery
• Chemotherapy
• Immunomodulatory agents
• Hormonal therapy
• Anti-angiogenic drugs
• Erythropoiesis-stimulating agents (ESAs)
• Blood transfusions
• Central venous catheters

Signs and Symptoms of a DVT

Classical Signs and Symptoms of a DVT in the General Population: pain, swelling, redness, warmth and engorged superficial veins³.

Most Common DVT Signs and Symptoms in Cancer Patients: extremity edema (80%), pain (75%), erythema or reddening of the skin (26%)⁴. Bilateral DVTs are more common among cancer patients when compared to the general population. Moreover, upper limb DVTs are common among cancer patients when compared to the general population because of the frequent use of central venous catheters to administer certain cancer treatments². Therefore, it is important to emphasize that differences do exist in terms of how a DVT will present in oncology patients when compared to the general population.

NOTE: IF YOU ARE EXPERIENCING ANY OF THE ABOVE SIGNS AND SYMPTOMS, I WOULD STRONGLY ENCOURAGE YOU TO CONSULT A DOCTOR IMMEDIATELY.

DVT Recurrence and Prognosis in Oncology Patients²

• Cancer patients are at a 2–3x greater risk of a recurring venous thrombosis compared to patients without cancer.
• Thrombotic events are reported to be the second leading cause of death in cancer patients.
• Cancer patients with DVTs have a lower survival rates than cancer patients without DVTs.
• Higher risk of bleeding complications during anticoagulant therapy.

Conclusion

A deep vein thrombosis (DVT) is a serious medical condition that must be addressed immediately to prevent the development of more life-threatening conditions, such as a pulmonary embolism. Furthermore, oncology patients are at an even greater risk of developing DVTs, and previous research has shown that they also have lower survival rates after the development of a DVT when compared to the general population. Therefore, it is of utmost importance to closely monitor and address patients presenting with the above risk factors and/or signs and symptoms to prevent further life-threatening complications, especially in oncology patients.

If you have any questions or concerns regarding a possible deep vein thrombosis, please consult your doctor immediately. If you have any questions or concerns regarding the content of this blog post, you may contact me directly at infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The information contained on this blog is a resource for information. This blog was created to inform the population about different musculoskeletal, neurological or cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding deep vein thromboses, please consult your doctor and/or physiotherapist.

References

1. National Heart, Lung, and Blood Institute. (2011). What is Deep Vein Thrombosis? National Institute of Health. Retrieved from: https://www.nhlbi.nih.gov/health/health-topics/topics/dvt

2. Timp, J. F., Braekkan, S. K., Versteeg, H. H., & Cannegieter, S. C. (2013). Epidemiology of cancer-associated venous thrombosis. Blood, 122(10): 1712–1723.

3. Khalil, J., Bensaid, B., Elkacemi, H., Afif, M., Bensaid, Y., Kebdani, T., & Benjaafar, N. (2015). Venous thromboembolism in cancer patients: an underestimated major health problem. World of Surgical Oncology, 13(1): 1–17.

4. Agnelli, G., Verso, M., Ageno, W., Imberti, D., Moia, M., Palareti, G., Rossi, R., & Pistelli, R. (2008). The MASTER registry on venous thromboembolism: description of the study cohort. Thrombosis Research, 121(5) :605–610.

Androgen Deprivation Therapy (ADT) is commonly used in the treatment of prostate cancer. Side effects include hot flashes, lethargy, and weakness, as well as sexual dysfunction and anemia. Moreover, there are adverse effects on quality of life, cognition, mood and body composition (loss of muscle and bone mineral density, and gain in fat). Previous research has shown that ADT can increase fracture risk by over 30% and more importantly, ADT-associated fractures have a higher all-cause mortality rate compared to the general population². Consequently, exercise prescription should be modified accordingly.

Furthermore, it has been shown that patients with prostate cancer on ADT have decreased muscular strength, aerobic fitness and functional performance, as demonstrated on repeated sit-to-stand and walking tests³. This is of clinical significance because patients with prostate cancer on ADT potentially possess the physical fitness and functional performance ability of someone who is approximately 10–20 years older³.

In addition, fatigue is a common symptom experienced by patients with cancer despite the form of treatment³. The fatigue may also be caused by the cancer itself, anemia, anxiety or depression⁴. The latter significantly interferes with the patient’s functional performance and contributes to a decrease in their quality of life. If left unaddressed, fatigue may decrease the likelihood that the patient will take part in enough physical activity/exercise to demonstrate any health benefits, increasing their risk for the development of metabolic syndrome³.

The Role of Physiotherapy

Exercise/physical activity: It is estimated that only 30% of prostate cancer patients engage in sufficient physical activity for health benefits. However, according to a systematic review published in 2012, resistance training, aerobic training, and combined resistance and aerobic training all had Level A or B grade evidence for improving physical fitness, functional performance, quality of life, and fatigue in prostate cancer patients⁴. Exercise and physical activity may contribute to preserving a patient’s capacity for independent living and protect against falls and fractures. Moreover, exercise is crucial component in the prevention and treatment of numerous chronic diseases such as obesity, cardiovascular disease, type II diabetes, and osteoporosis⁵.

Lymphedema of the lower extremities, penis and scrotum: It may be caused by lymphatic obstruction of the pelvic lymph nodes, surgery, local radiation in the pelvic areas, radial prostatectomy, etc. Lymphedema has been shown to be an, “independent predictor of decreased quality of life even when other predictive factors such as socioeconomic status, decreased range of motion and obesity are taken into account”⁶. That being said, exercise is an important part of lymphedema management, as non-fatiguing exercise may induce sufficient muscle contraction to reduce swelling. In addition, the tone of the sympathetic nervous system may be increased with aerobic exercise, causing the lymphatic system to pump more vigorously. Education concerning compression garments, manual lymphedema massage, as well as preventative and self-management techniques should also be incorporated into the treatment session⁶.

Urinary/bowel problems (i.e. accidental leakage, erectile dysfunction, etc.): Due to pelvic floor dysfunction, which can be caused by surgery (radial prostatectomy) & radiation therapy, among other things⁶. According to a clinical study published in 2014, physical therapy was shown to improve or fully restore continence⁷. In addition, a randomized control trial conducted in 2005 concluded that pelvic floor muscle exercises and biofeedback may, in fact, be an effective treatment for men with erectile dysfunction⁸. This was evidenced by the fact that at 3 months, the men in the intervention group showed significant mean increases in the erectile function domain of the International Index of Erectile Dysfunction, compared to the control group. Furthermore, similar benefits were seen in the men of the control arm after they had been transferred to active treatment after 3 months⁸.

If you have any questions or concerns regarding your prostate cancer, please consult your doctor. If you have any questions or concerns regarding the content of this blog post, you may contact me directly at infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The information contained on this blog is a resource for information. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding the role of physiotherapy in patients with prostate cancer, please consult your doctor or physiotherapist.

References

1. Prostate Cancer Canada. (2016). Prostate Cancer. Prostate Cancer Canada. Retrieved from: http://prostatecancer.ca/Prostate-Cancer/About-Prostate-Cancer/Prostate-Cancer

2. Cheung, A. S., Zajac, J. D., & Grossman, M. (2014). Muscle and bone effects of androgendeprivation therapy: current and emerging therapies. Endocrine-related cancer, 21(5), 371–394.

3. Keogh, J. W. L., & MacLeod, R. D. (2012). Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. Journal of Pain and Symptom Management, 43(1), 96–110.

4. Prostate Cancer UK. (2015). Advanced prostate cancer: Managing symptoms. Retrieved from http://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/advanced-protate-cancer-managing-symptoms

5. Gardner, J. R., Livingston, P. M., & Fraser, S. F. (2014). Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol, 23(4), 335–346.

6. National Cancer Institute. (2015). Prostate Cancer Treatment. National Institute of Health. Retrieved from http://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#section/_182

7. Rajkowska-Labon, E., BakuBa, S., Kucharzewski, M., & Sliwinski, Z. (2014). Efficacy of Physiotherapy for Urinary Incontinence following Prostate Cancer Surgery. Biomed Research Internatinal. Retrieved from: http://dx.doi.org/10.1155/2014/785263

8. Dorey, G., Speakman, M., Feneley, R., Swinkels, A., Dunn, C., & Ewings, P. (2005). Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice, 54, 819–825.

Photo Credit: Flickr

Early Signs of Knee Osteoarthritis¹

• Joint stiffness: usually present after long periods of not moving the knee joint. Stiffness is temporary, lasting 30 minutes or less.
• Joint swelling: Swelling may be visible at the knee joint, causing reduced range of motion.
• Joint pain: Pain is typically worse after physical activity or exercise, and decreases with rest. As the disease progresses, pain may be present with daily activities such as walking and going up and down the stairs.
• Crepitus: cracking sound that occurs when bending and extending the knee.

Risk Factors for the Development of Knee Osteoarthritis¹

• Obesity: Excess weight will extra stress on the weight-bearing joints of the body, including the knee joint. Losing weight will decrease the loading at these joints, and may prevent or delay the need for surgery in the future.
• Age: The likelihood of having knee osteoarthritis increases with age. It may begin at a younger age but is not detected because the person is not experiencing any symptoms at the time.
• Family history: There is a genetic component to the development of knee osteoarthritis.
• Previous joint injury: People who have experienced previous joint injury may have already experienced damage to the structures in or around the knee joint such as the cartilage, muscles or ligaments. This previous injury may render the knee joint less stable, altering the biomechanics at the knee joint. The latter will ultimately how the knee is loaded and may contribute to the development and/or progression of knee osteoarthritis.

Photo Credit: Flickr

How to Manage Your Knee Osteoarthritis¹ ⁵ ⁶

• Cardiovascular exercise: Performing regular aerobic exercise will keep the heart healthy and keep your weight under control. Other forms of exercise often suggested for patients with knee OA include Tai Chi and Yoga.
• Strengthening & Flexibility: Strengthening the knee joint will provide additional stability, providing protection for the knee joint. Ensuring optimal flexibility is important to maintain a full range of motion and to help reduce pain and stiffness at the knee joint.
• Heat: Will help relieve pain and stiffness by decreasing muscle spasms and tightness, improving range of motion at the knee joint.
• Cold/Ice pack: Will help relieve pain by controlling swelling and inflammation, which may be a limiting normal range of motion at the knee joint.
• Orthotics/knee braces: Help promote proper biomechanics at the knee joint. Knee braces also provide additional stability, providing further protection to the knee.
• Physiotherapy: A physiotherapist will be able to provide a variety of interventions based on your impairments, such as manual therapy to optimize joint range of motion, myofascial release to increase flexibility, exercise prescription to optimize strength and flexibility, and taping to promote proper biomechanics at the knee joint, among others.
• Protect your knees: Know when to take breaks. When exercising, make sure your joints are positioning correctly to ensure proper biomechanics. Avoid repetitive high-impact activities such as running. Cycling or aquaform is a great alternative. Lastly, the use of an assistive device such a cane or walker may be beneficial to further reduce loading at the knee joint.

When is Surgery Recommended?⁷

• Severe knee pain or stiffness that limits activities of daily living and transfers (standing up, walking, stairs, etc.)
• Moderate to severe knee pain at rest (day and/or night)
• Knee deformity (varus or valgus)
• Chronic knee inflammation that is not responsive to medical treatment
• Failure to respond to other medical treatments (anti-inflammatories, corticosteroids, lubricating injections, physical therapy, etc.)

If you have any questions or concerns regarding your knee osteoarthritis, please consult your doctor and/or physiotherapist. If you have any questions or concerns regarding the content of this blog post, you may contact me directly at infophysiotherapy10@gmail.com.

Did you enjoy the content of this post? If so, please share this post and comment below. Your feedback is greatly appreciated. Don’t forget to follow my blog for more updates!

___________________________________________________________________

DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The information contained on this blog is a resource for information. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding knee osteoarthritis, please consult your doctor or physiotherapist.

References

1. The Arthritis Society. (2015). Osteoarthritis: Causes, Symptoms and Treatments. The Arthritis Society. Retrieved from: https://arthritis.ca/getmedia/baab0788-483c-4494-9d40-630bc1d4a3e0/Osteoarthritis-Causes-Symptoms-and-Treatments.pdf?ext=.pdf

2. Osteoarthritis Research International. (2015). Standardization of Osteoarthritis Definitions. OARSI. Retrieved from: https://www.oarsi.org/research/standardization-osteoarthritis-definitions

3. Bombardier, C., Hawker, G., & Mosher, D. (2011). The Impact of Arthritis in Canada: Today and over the Next 30 years. Arthritis Alliance of Canada, 1–52.

4. Stafinski, T. & Menon, D. (2001). The Burden of Osteoarthritis in Canada: A Review of Current Literature. Institute of Health Economics, 1–20.

5. Page, C. J., Hinman, R.S., & Bennell K. L. (2011). Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, (14): 145–151.

6. Osteoarthritis Research International. Non-Surgical Management of Knee Osteoarthritis. OARSI. Retrieved from: https://www.oarsi.org/sites/default/files/library/2014/pdf/patientsumfinal.pdf

7. Foran, J. R. H. (2011). Total Knee Replacement. American Academy of Orthopaedic Surgeons. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00389