|
July-August, 1999
KNEE PAIN??
IT MAY BE CHONDROMALACIA!!
Chondromalacia is a common knee problem, affecting the underside of the knee cap. Normally the surface under the patella is lined with a tough, smooth tissue known as hyaline cartilage. The groove at the distal end of the femur is also lined with hyaline cartilage providing a smooth surface for the patella to track in during flexing and extending of the knee. However patellas affected with chondromalacia, have varying degrees of softening, pitting and increased wear of the cartilage. These irregularities create increased friction, which lead to pain and continued degeneration. For the patient suffering from chondromalacia, activities such as squating, kneeling descending and ascending stairs can often become too painfull to manage. However, in many cases, sufferers do not experience any symptoms.
The Causes
Besides involvement in an automobile accident, there are many different causes of chondromalacia of the patella. For example in some cases, the patella does not track or glide normally and thus causes surrounding cartilage to wear abnormally and prematurely. In other cases, the patella dislocates from the knee and slips out of place partially or completely. Often the degenaration of chondromalacia begins without any precipitating injury or trauma. But despite the cause, patients must work in harmony with their physical therapist and physician in a treatment schedule.
The Treatment
Physical therapy treatment focuses on restoring proper tracking to the patella. This includes strengthening of the vastus medialis, specifically the oblique fibers and stretching of the muscles around the knee cap. Patients can also learn selfmobilization techniques that will work to correct a patella that rides too high. In addition to these measures, the physical therapist may tape the patella to maintain the kneecap in the proper position and decrease the grinding with active movement. For people sufferring from chondromalacia, the modification of aggravating activities is critical to reducing pain and boosting recovery. For exampIe, patients should avoid repetitive climbing, squating, running, hiking, strenuous bicycle riding and weight lifting. Activities that require a bent or flexed knee can promote aggravation and problems for the patient. In most cases, physicians recommend an antiinflamatory drug to reduce pain and inflamation to the knee.
In some instances, doctors may recommend the sergical treatment of chondromalacia with the arthroscopic debridement of the damaged cartilage. This procedure can restore a smooth surface to the cartilage.
Other surgical procedures may be performed to release the tightned structures and realign the kneecap. While most cases can be handled through physical therapy treatment, it is important for patients to recognize that the condition cannot regenerate mhyaline cartilage. But through appropriate treatment and potential surgical care the patients can manage their condition.
A HANDS-ON APPROACH
FOR EFFECTIVE
"ELBOW" TREATMENT
"No, I don't have a tennis elhow - I've never even played the game!". As most people might know (or not), is this not true?
The term 'tennis elbow' is a catchall term for most non-specific injuries affecting the wrist-extensor group of muscles on the outside of the elbow.
Being a janitor, superintendent or doorman on Park Avenue can give you a 'tennis elbow'! Doing a 40 hour week of clerical work on Wall street can give you a 'tennis elbow'.
So called conditions, including the 'infamous neighbor', the 'golfer's elbow', which commonly affects the inside of the elbow, are as common as allergies in New York (and everywhere in the world). What is truly amazing is that proper education to the successful management of this condition is under emphasized.
It falls in the category of repetitive strain injury. Other conditions in this category includes 'shin splints, carpal tunnel syndrome, De Quervain's tendonitis, Achilles tendonitis etc. All of these have been and will be successfully treated by skilled manual therapists in the field of Physical Therapy.
It is strongly believed and clinically proven by various clinicians, such as Dr. James Cyriax of the UK, for decades now that a hands-on, manual approach is the key to the successful treatment of tennis elbows. In addition to medical intervention such as non-steroidal anti-inflammatory drugs (NSAID) and home treatments including ice treatment, it is skilled soft tissue mobilization, selective manipulation and a well instructed therapeutic exercise regime that has the long lasting results. Correct application of ultrasound therapy, in conjuction with a recommended NSAID ointment, assists the therapist in speedy recoveries.
Proper evaluation, manual treatment and management of your elbow by your physical therapist are vital steps to take towards a pain free or nuisance free daily life. It is important to have either your 'tennis elbow' or 'golfer's elbow' evaluated by a skilled physical therapist soon, seeing that the British Open golf starts soon as well as the US Open Tennis... you do want to handle the TV remote control without pain, right....??!!! |
