Non-Surgical ACL Treatment and Rehabilitation

Traditionally, the diagnosis of an ACL rupture has almost certainly meant surgery. The thoughts on this are slowly changing. There are multiple studies being conducted on the healing potential of an injured ACL. There are also almost no good studies that prove that surgery is actually better than a structured rehab program.

That being said, ACL reconstruction has potentially been done too easily and frequently in the past. The more recent thinking is to attempt a structured rehab program, assigned by a medical professional with the relevant knowledge, for 3 to 6 months and then re-evaluate the need for surgery. Some patients will still require surgery but a large percentage will be completely functional with some good rehab.

There are many factors that will contribute to the decision surgery vs non-surgical:

Concomitant injuries like other ligament injuries
Meniscal tears that cause locking or catching
Fractures
A very unstable knee

In the initial phase, the most important aspect is to get the patient as confident as possible in daily activities like standing up from a chair and sitting back down. Exercises, and their intensity, are then gradually increased as tolerated to the point where the patient has full lower limb strength and control.

The final decision is then made based on incidences of instability experienced by the patient once fully rehabbed.

Does the ACL heal?

Some studies have found that the ACL heals on its own, others have found it heals onto the PCL, and in some cases, it doesn’t.

Does it matter if my ACL heals or not?

In most cases, it will not make a difference if your ACL heals or not as most of the stability for your knee is dynamic. What this means is that most of the control or stability of your knee come from muscular control, strength and proprioception (balance). There are now many famous professional athletes playing their sports that choose not to have surgery. Some of them have healed ACLs and other not; but their lower control and strength is good enough that the ACL is less important.

Moral of the story:

It is worth a trial of non-surgical treatment following an ACL rupture prior to deciding on a surgical intervention.

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Running Injuries

Hips and Knees

Running Injuries

With the fall clock running down, many of us weekend warriors are being chased down by the injury bugs. Following a long, hot season of pounding the trails, it’s not uncommon for some aches to show to up. For both the avid year-round runners and the warm-weather aficionados, the mileage starts to add up. With the mileage comes various ailments to our hips, knees and ankles. This can be contributed to poor training habits, technical errors or the body just hates us. Regardless of the reason, the point of the fact is there is a broad spectrum as to why the body breaks down. Looking at it anatomically — and biomechanically — from a physiotherapist’s standpoint, two of the most common areas where a runner’s body can break down are the hips and the feet. This article will focus on the hips. The hip can be a cause of a variety of common injuries encountered by runners. These include patella-femoral syndrome, aka runner’s knee, IT band pain, or the dreaded plantar fasciitis. Weakness or imbalance in the muscles of the hip, or tightness of the hips, can change how the joints below your hips move. For the runners that have been told their knee and/or feet pain is due to flat feet, or over-pronation, it could very well be due to one of the above-mentioned reasons related to the hip. The hip is an important part of running as it is designed to take the bulk of the impact when we land, it is also responsible for generating the energy that moves us forward. Because humans are inherently designed to compensate for faulty systems in our bodies, we have become very good at using different body parts and movements to achieve the same goals. In running, when the hips aren’t doing their job, the muscles and joints below can take up the slack. Overtime, these systems can be overworked and this is when we can start getting achey joints, and chronic muscle and tendon injuries. With a physiotherapist, the initial assessment includes: comparison of both walking and running patterns (viewed from in front, behind, and from the side); strength assessment; lower extremity alignment; and education regarding the findings. A plan can then be put together that best fits with the runner’s goals, including activities aside from running. There is not a single solution, but let us work with you to find your stride.

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Hip Disorders: Osteoarthritis & Bursitis

Hips and Knees

Hip Disorders: Osteoarthritis & Bursitis

Our hip joints allow us to do an amazing number of things – walk on two legs, pivot, squat, even kick a ball. It is an engineering marvel to combine the stability required to balance the weight of the torso over a structure the size of a golf ball, with the substantial degree of mobility available. The high demands on the hip joints can, however, take their toll over a lifetime.

Osteoarthritis is the most common hip disorder affecting adults. Primary osteoarthritis (OA) has no recognizable cause, while secondary OA is thought to occur due to altered joint mechanics or following joint trauma. Obesity, excessive loading due to occupational or sport demands can contribute to breakdown of articular cartilage. There is likely a genetic component as well. Muscle imbalances around the hip are also predisposing factors, as shearing forces or high compression load will cause abnormal wear and tear. Alignment issues of the low back, pelvis and leg can also contribute to abnormal forces around the joint.

Muscle imbalances occur as a result of weak, tight, or inappropriately recruited muscles. Our neuro-muscular system can develop certain abnormal pathways of firing, creating suboptimal movement, and potential damage to joint structures. If these are retrained before the cartilage damage is severe, it can halt the progression and reduce the symptoms of arthritis.

One of the most important groups of muscles for maintaining optimal compression and centering the ball, (or head) of the femur in its socket are the Gluteal muscles on the lateral side of the hip. Core strength and balance are also very important components of optimal hip health.

A second common diagnosis of hip pain is trochanteric bursitis. The most prominent lateral point on the hip bone is called the greater trochanter. It was commonly thought that the bursa overlying this point was the most common local cause of lateral hip pain. However, in a recent study, using real-time ultrasound, 80% of patients with lateral hip pain did NOT have bursitis. 50% of the 877 patients studied had tendinosus of their gluteal muscles, ie. a degeneration of the deep hip rotators tendon’s collagen in response to overuse, occuring when other stabilizer muscles weaken. It is part of what has been labeled Greater Trochanteric Pain Syndrome (GTPS).

Symptoms of both OA and GTPS can be similar. Pain from OA is usually felt in one or more of the following areas: the groin (most common), over the greater trochanter, or down the front of the thigh and knee. Usually, arthritis pain is reported with or after activity, progressing to pain at night or at rest.

With GTPS, point tenderness is noted at or behind the greater trochanter, typically worse at night, especially when lying on the affected side. Lateral hip pain with repeated stair climbing and squatting is more likely due to GTPS.

Maintaining adequate strength and flexibility of the hip muscles is an important component of treatment and prevention of both hip osteoarthritis and trochanteric pain syndrome. Physiotherapists are trained to assess these disorders. They can prescribe individual exercise where deficits in strength, mobility and balance are noted.

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Hip Strengthening

Hips and Knees

Your Hips: The ‘Core’ of the Problem?

I think most of us by now have heard about the importance of strengthening your ‘core’. But did you know that the most important part of your core for preventing hip, knee, and ankle injuries are your hip muscles? Your hip muscles or ‘glutes’ are the largest group of muscles in your lower body and are a part of your core that are often much weaker than they should be.

So what exactly are the hip muscles responsible for? Strong hip muscles keep your spine, pelvis, knees and ankles in alignment. If your glute muscles aren’t strong enough your hips rotate and drop, your knees move inward and your feet flatten (pronation). All of these motions create more strain on the joints, ligaments and tendons of your lower body. This excessive strain often leads to injury and persistent pain. Achilles tendinosis, patellofemoral knee pain, iliotibial band (ITB) syndrome, and piriformis syndrome are all common injuries linked to weak hip muscles. Research is also showing that hip weakness is a major risk factor for non-contact ACL (knee ligament) injuries.

So why do our hip muscles become weak in the first place and what can we do about it? The latest research done by Dr. Powers who is a physiotherapist in Los Angeles, shows that our brains have only a very small area dedicated to controlling the hip muscles. It is unclear why this is the case but it may explain why the majority of us don’t naturally use our hip muscles during activities such as: running, walking and hiking. The good news is that the same research shows that exercise can change the way our brains work.

In the study, patients that took part in specific hip strengthening exercises, actually showed changes in brain function. The areas on the brain controlling the hip muscles became larger after only a week of exercise! This is important because the larger the area of your brain dedicated to a certain muscle group is, the easier it is to ‘turn on’ and strengthen that muscle. Keep in mind though, these strengthening exercises need to be done for a minimum of 3 months in order to get significant strength improvements in the muscle.

So if you suffer from ongoing hip, knee or ankle pain, strengthening your hips may be the key to getting over your injury problems. Visit your local physiotherapist and ask for an assessment on your hip strength. If your muscles are weak your physiotherapist will give you the proper home strengthening exercises to address the weakness. Through these exercises you can change your brain to help change your pain.

Graham Gillies, M.Sc.PT, CAFCI, FCAMPT, MCISc(MT), CGIMS

Graham Gillies is a registered Physiotherapist at Sun City Physiotherapy Winfield and is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS and acupuncture practitioner.

suncityphysiotherapy.com/our-team/the-winfield-team/graham-gillies/

Treatment Options for Hip Osteoarthritis

Hips and Knees, Physio Articles

Hip osteoarthritis is a common condition that involves the degeneration of the articular cartilage of the hip joint. If you have this condition and are noticing an increase in pain and a decrease in physical function you may be wondering what treatment options are available to you.

With osteoarthritis of the hip you may feel a constant ache localized to the groin and side of your hip and sometimes extending into the front of your thigh and knee. The hip often feels stiff, especially first thing in the morning when you get out of bed and it can make activities of daily living much more painful including standing, walking and stairs. It can also make it difficult to put your socks on, get into and out of your car and even get on and off of the toilet.

Stiffness, pain and having difficulty with many previously easy daily activities may lead you to want to do less physical activity. The trouble is, not moving will often lead to weakness, further stiffness and general deconditioning.

A physiotherapist can help design a treatment program with a focus on decreasing pain, increasing range of motion and flexibility, improving core stability, gaining muscle strength and endurance and improving general conditioning. Other functional goals often include improving walking pattern, speed and distance, ability to go up and down stairs without pain and better control going from sit to stand.

This is often accomplished through a combination of education, manual therapy and exercise. An exercise program is often extremely beneficial to help improve physical function and decrease pain. A physiotherapist is an excellent resource to put together a safe and effective home exercise program for you to perform daily at home or at your local gym. Also, if you enjoy swimming, bring this up with your physiotherapist as aquatic exercise is a great form of treatment for hip osteoarthritis.

Other possible physiotherapy treatments that may be effective for some individuals with arthritis of the hip include: acupuncture, massage, heat on the muscles around the hip, ice, TENS, supportive footwear and/or a gait aid such as a cane or walking poles. It is important to talk with your doctor about your arthritis to discuss other treatments that may be beneficial to help manage your symptoms. Certain medications may be helpful, but it is important to bring this up with your doctor to be sure they are appropriate for you. Also, if you are overweight, a weight management program can be extremely beneficial to decrease the stress on your joints. Since nutrition plays a crucial role in weight management, it is important to have this discussion with your doctor.

A small portion of individuals with hip osteoarthritis will eventually opt to have a total hip replacement. This is often the case when symptoms are progressively getting worse and significantly limiting activities of daily living. If you have had a total hip replacement a physiotherapist guided post-operative hip strengthening program is ideal in order to decrease pain, improve your hip function and return to your active lifestyle.

Iliopsoas Bursitis

Hips and Knees

Iliopsoas Bursitis

It’s a pain that no one wants to experience. It lives in the front of your hip and groin, and can radiate down the inside of the thigh to the knee. The hip and groin pain is noticeable with certain hip motions and activities. It’s called Iliopsoas bursitis, and you might have it.

Iliopspas bursitis is an inflammatory condition that involves the muscle and busra in the hip/groin region. It is often the result of repetitive hip flexion (bending) in activities such as running, dancing, track and field and gymnastics. People report having pain in the front of the hip and groin region that often radiates down the front or inner thigh all the way to the knee. Occasionally, a snapping or clicking is heard that may or may not be painful. The pain is made worse with extending the hip back, crossing the leg in front of the body, and twisting the leg inwards. Bringing the knee up to the chest can often produce a pinching sensation in the hip or groin.

The Iliopsoas bursa is the largest bursa of the 160 bursae found in the human body. A bursa is a fluid-filled sac that lies between a muscle and bony prominence. It is designed to reduce the friction and provide cushioning for the muscle as it glides over the bony prominence. Inflammation of the Iliopsoas bursa results when the overlying hip flexor muscle produces excessive pressure or friction on the bursa during movement. This increase in friction is often a result of tight hip flexors combined with repeated hip flexion, poor mechanics, or even direct trauma.

The amount of repeated hip flexion during running, dancing, gymnastics, and field events makes this a familiar condition for these athletes but it is also common among the recreational athlete too. What I tend to see, clinically with the recreational athlete who presents with Iliopsoas bursitis, is someone who typically has a seated job (desk job, driver, etc.) They spend the majority of their day in a seated position, which is the ideal position to promote hip flexor tightness (not to mention hamstring and calf tightness). Then, with their tight hip flexors, they go for a run or a long hike. The whole time the tight hip flexor is gliding over the underlying Iliopsoas bursa, creating excessive friction and inflammation. The end result in both cases is the same. Pain, decreased hip motion, decreased activity tolerance, and often tenderness to touch.

Treatment for Iliopsoas bursitis includes stopping the irritating activity, decreasing the inflammation with ice, using anti-inflammatory medication as directed, and seeing your Physiotherapist for assessment and treatment. Your Physiotherapist will determine the cause of the irritation to the bursa, rule out other possible diagnosis, and administer additional inflammatory reduction therapy (ultrasound and electrical stimulation). They will begin stretching exercises as soon as possible, and then appropriate strengthening exercises to minimize reoccurrence. If your injury was a result of improper mechanics, your Physiotherapist will also be able to help you identify and correct those factors.

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Robina Palmer, B.Sc.PT, CAFCI, Vestibular Therapist

Robina Palmer is a registered Physiotherapist and co-owner of Sun City Physiotherapy.

Robina is a graduate of University of British Columbia’s School of Rehabilitation Medicine. She has practiced in sports and orthopaedic rehabilitation in various clinical settings throughout the United States and Canada.

suncityphysiotherapy.com/our-team/the-downtown-kelowna-team/robina-palmer/

Non-Surgical ACL Treatment and Rehabilitation

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Running Injuries

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Hip Disorders: Osteoarthritis & Bursitis

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Iliopsoas Bursitis

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006