Do I Need a Knee Brace?

Do I Need a Knee Brace?

A common misconception among folks with sore knees is that they should be able to locate and wear a knee brace that will immediately reduce their pain/discomfort.  Of course, having no knee pain would be an ideal result from a brace,  but not all knee braces are designed with pain relief at the forefront.

The primary functions of most of today’s knee braces are to provide support/stability to an unstable knee joint or to change the alignment of a particular less-than-ideally aligned component of the knee joint.   Improved support and alignment can reduce the chance of future degenerative joint changes.   AND – a potential bonus to wearing a knee brace is a reduction in pain.

Some knee braces are more likely than others to reduce knee pain.  For example, a brace with a solid hinge designed and worn to support the medial knee joint (for a torn medial collateral ligament), may also end up reducing medial knee joint pain.   Similarly, a brace that helps to change the position of an improperly tracking patella (knee cap) can also provide pain relief of the cartilage between the patella and the femur.  

Most common types of knee braces:

Patellar tracking brace:

Usually, a sleeve created of neoprene or a similar stretchy fabric

Two common options:

A.  one that changes the alignment of the patella by pulling it in a different direction (usually medially, for patellar femoral syndrome or patellar tendinitis)

B.  one with a buttress/reinforcement to hold the patella in place (for a dislocating/subluxing patella)

Ligament Brace

  • Provide support to the knee joint not provided by compromised ligaments
  • Choices are off-the-shelf (OTS) or custom (more expensive but better fit ensured)
  • Both OTS and custom can be constructed with a solid/hard shells or stays, increasing support by decreasing the potentially harmful movement that an unstable knee joint provides
  • A less expensive OTS option is a soft shell (often neoprene) sleeve with metal hinges
  • A wrap around style of OTS (versus a pull on sleeve) is often easier to get into position
  • Typically, you get what you pay for!

Osteoarthritis brace:

  • Often custom, but can be off-the-shelf
  • The only ones worth considering have solid/hard shells to effectively change the alignment of the lateral or medial knee joint
  • Designed to “unload” one side of the joint to decrease further degeneration (and potentially pain)

Compression sleeve

  • Tight fitting sleeve to offer general compression but mild stability of the joint
  • Can help diffuse swelling and increase confidence with mild support
  • often has reduced compression over patella to avoid articular cartilage irritation
  • The best ones offer medical grade (15-20 mmHg) compression and require a bit of effort to slip on

Since there are a variety of indications for a knee brace, health professionals need to have a solid understanding of the condition and symptoms of the individual requesting the brace.  The more information identified, the better the chance of providing the safest and most effective knee brace possible.

Think Twice Before You Ice!

Think Twice Before You Ice!

For over 40 years we have all been routinely treating injuries with ice. Yet, surprisingly, there is no scientific evidence to support the use of ice for tissue healing and recovery.  In fact, recent scientific research and clinical studies show that, not only is the application of ice ineffective in some cases, but it can also delay the healing of an injury.

A 2013 Journal of Strength and Conditioning Research article concludes that “these data suggest that topical cooling (icing), a commonly used clinical intervention, appears to not improve but rather delay recovery from eccentric exercise-induced muscle damage”.

Gabe Mirkin, the doctor who came up with the popular treatment acronym RICE in the late 1970s (rest, ice, compression, elevation) is backtracking and admits RICE was widely accepted without scientific validity.

According to Gary Reinl, the author of “Iced! The Illusionary Treatment Option”, icing does not reduce swelling or inflammation.  The lymphatic system is responsible for eliminating the “waste” in the tissues caused by inflammation.  It does this predominantly by muscle movement putting pressure on the one-way valves.  Ice inhibits this muscle pump and therefore does not reduce swelling.

When tissues are damaged, more blood arrives at the injury site and with it, inflammatory cells such as leukocytes and macrophages.  These cells rush to the damaged tissue to release proteins which clean up and heal the injured site.  This build up of fluid, or swelling at the site should be considered a positive reaction.  It allows the inflammatory process to progress, and prevents further injury (by increasing sensitivity to pain and restricting movement).  Healing is delayed by anything that temporarily blocks blood flow to the injury site – like certain medications and ICE.

We should not stand in the way of our body’s natural inflammatory response, which consists of a universally recognized 3 phase healing process.  Inflammation is the first phase followed by the tissue repair and tissue remodeling phases.  So if we stop inflammation, we are stopping the healing process.  Essentially there cannot be healing without inflammation.

Ice can still be used for temporary pain reduction and local numbness –  just be aware of its role in inflammation and swelling. Do your due diligence and then get on board with the huge industry-wide movement!

Our physiotherapists believe in keeping up to date with best practices and the most effective treatment strategies.  

Running as a minimalist

Running as a minimalist

Humans have been running for over 2 million years and when they first started running, they ran barefoot of course!

In Christopher McDougall’s book “Born to Run” he discusses various scientific studies about barefoot running and how we evolved into humans made for running. McDougall describes why running injuries familiar to us are unheard of in the Copper Canyon of Mexico where barefoot tribal folks run for hours on end.

It is clear from recent research that the modern running shoe has a significant impact on our bodies and our running mechanics.

When we run with modern cushioned shoes, we tend to land heavily on our heels, which increases the force at impact.  Conversely, when we run in bare feet we land more on the forefoot or mid foot and with more bend in the knees, both of which absorb the force of impact more efficiently.

The modern shoe also significantly reduces stride frequency and changes the contraction sequence of the leg and back muscles. Running with an increased stride frequency, or higher turnover rate of the feet, decreases the amount of force and time of each foot strike, which is believed to decrease the chance of repetitive type running injuries.

Many running experts are now recommending weekly training drills in bare feet to strengthen the intrinsic muscles of the foot and ankle, improve our proprioception (body’s awareness in space), thereby reducing the chances of running injuries.

Keep in mind that any changes in your training program must be gradual.  Extreme changes can cause an overload on your tissues and possibly an injury. Why not try taking off your shoes and baring your sole!

Should Kids Be Wearing Supportive Running Shoes?

Should Kids Be Wearing Supportive Running Shoes?

Runners, coaches, medical professionals, and now parents, are all realizing the benefits of allowing children to have proper natural foot motion.  According to the experts, parents should think twice before putting their kids in a pair of “good sturdy shoes.”  It seems that the smartest design that will ever be developed for injury free activity is the human foot itself.  Our feet are sensory organs that allow us to interact with our environment and to develop natural movement patterns. Studies suggest that shoes can interfere with that development. “Balance, stride length and stride width are all influenced by our ability to sense the surface we are landing on. The more “stuff ” between the foot and the ground the less ability we have to sense the landing surface.” says Paul Langer, D.P.M., chair of the American Academy of Podiatric Sports Medicine’s Shoe Committee.

Rob Conenello, D.P.M., international lecturer on podiatric sports medicine, advises putting children in the “most minimal shoe possible, and adding support if necessary.”The level of minimal that is possible will vary with the child and may vary as the child ages.”

RECOMMENDATIONS FOR PARENTS: (Jonathan Beverly, Running Times Magazine, April 2010)

1) Encourage kids to go barefoot whenever possible: in the house, yard, parks, on the beach.

2) Buy the most minimal shoes appropriate for your child. Look for shoes that are flat, with low heels, little cushioning, flexible in all directions, light weight with lots of toe room. In early development, a child’s foot is widest across the toes.

3) Ensure all of your kids’ shoes are running-friendly. Kids don’t change into running shoes to run, they do it naturally throughout the day.

4) Add support only if necessary. Get an evaluation from a physiotherapist or podiatrist if your child shows signs of needing structural support.

5) Allow and encourage kids to run more like they do when they are very little: short bursts that end when fatigued, with a relaxed stride, at a variety of paces.

6) Encourage kids to participate in a wide variety of physical activities that build strength and flexibility.

7) Help kids stay at an appropriate weight through diet and activity.

Given what we’re learning about how minimal shoes can be beneficial to an adult’s running technique, efficiency and injury prevention, it makes sense that we should be starting our kids off on the right foot.

Sue Underhill is a registered physiotherapist and owner of Maximum Physiotherapy. She offers running assessments using video analysis and treadmill running and gives technique and footwear advice.   To book a running assessment at Maximum call 705-444-3600.

Lengthen to Strengthen… (Eccentric Strength Training)

Lengthen to Strengthen… (Eccentric Strength Training)

When we have a sore muscle from physical activity, we assume the muscle must be tight and that we need to stretch it.  Often though, especially if we’ve been participating in a repetitive activity/sport for many years, a sore muscle may indicate a relative weakness in the muscle.

To recover from a muscle strain or to prevent one altogether, it’s important to strengthen your muscles “eccentrically”.

An eccentric muscle contraction occurs as the muscle fibres lengthen.  This happens when we do things such as lowering a weight by controlling it through a muscle’s full range of motion.  Eccentric training, often referred to as “negatives”, focuses on slowing down the elongation of the muscle.  This type of training allows for the greatest muscle forces at relatively low energy costs.

Many muscles cross two joints: hamstrings and hip flexors cross the hip and knee, the gastrocs cross the knee and ankle, and the long head of biceps crosses the shoulder and elbow.  So to strengthen these particular muscles, we need to look at the position of both joints to make sure the muscle is being contracted throughout its full length.   For example, to strengthen the bicep muscle eccentrically, lie on your back on a bench with your arm over the edge, and slowly lower a weight by extending the elbow and also extending the shoulder.

To get the biggest return on your investment, make sure to include eccentric strength training throughout a muscle’s full length.

Sue Underhill, Owner/Physiotherapist

Maximum Physiotherapy

Collingwood, On

Massage is for everyone

Massage is for everyone

Managing Stress with Massage Therapy

None of us are immune, at some point or another we will all find ourselves overwhelmed by what is being asked of us in our lives.  Stress comes in many forms and will affect all of us differently.  Our ability to cope with stress has been key to our survival as a species, but as our current lifestyle evolves, so does the way we perceive and deal with the stressors in it. These stressors have both mental and physical components.  They might include raising children, caring for ailing parents, living with an illness or injury ourselves, working one or more jobs, volunteering, helping friends, maintaining our homes and all the stuff we accumulate.  As the “to do” list grows and the amount of time or emotional ability to handle it does not, our stress level increases and we find ourselves living in a constant state of “fight or flight”.  Over time, if we do nothing to counteract high levels of on-going stress, we enter a state of chronic stress.  This can lead to negative, even life-threatening effects on our health including; soft tissue dysfunction, hypertension, depression and suppression of hormone glands.

Good news!  There is a way to manage the physical affects of stress on our bodies.  When we hold stress in our muscles, this is referred to as “tension holding”.   Some common areas we hold tension are, in our neck, face, jaw and scalp which manifest commonly as headaches.  Some other areas can be our shoulders, chest, abdominal and hip muscles.  Holding stress in these places will change the way we stand, manifesting in postural changes which can negatively affect the spinal column, spinal cord and peripheral nerves of the arms, legs, and neck. Tension holding can also lead to painful muscle spasms and trigger points. In short, tension holding leads to dysfunction and more physical strain.  Therapy through soft tissue massage has long been recognized as an effective way to reduce ‘tension holding’ and eliminate its negative effects.  This is true not only during treatment but, thanks to muscle memory, for days or even weeks to come.

 Therapeutic massage with a Registered Massage Therapist (RMT) positively softens the contractile tissues of the body but it goes beyond that, helping to heal and restore the psychological, immunological and neurological systems.  The benefit is to such a degree that massage therapy is now included in many workplace health insurance benefits and motor vehicle accident treatment plans.

Depending on the type of physical manifestations of stress, massage can be effective with more frequent treatments for a week or two, tapering as the individual reaches their treatment goals.  As a preventive, maintenance or wellness measure, massage is recommended in appropriate cases once per month for one hour.