Health July 29, 2008

Joint Mechanics

So you try to convince yourself that the painful “pop” you just felt in your knee while trying to knock one out of the park is just a minor strain. But the amount of swelling you’re experiencing, coupled with a buckling feeling as you walk, have you questioning your self-diagnosis.

Great, you think, now what?

Knee problems accounted for 19 million visits to physicians’ offices in 2003, says orthopedic surgeon Glen Shapiro, M.D., FAAOS, of Hailey Sports Medicine & Orthopedics, making it the most common reason for visiting an orthopedic surgeon. Almost 14 million people were seen that same year for a shoulder problem.

Your knee joint is made up of bone, cartilage, ligaments and fluid, with muscles and tendons allowing the knee to move normally. Dr. Shapiro is convinced that training and conditioning need to be a year-round endeavor as “strong knees are safe knees.”

Flexibility and strengthening exercises for the hamstrings and quadriceps muscles need to be a regular part of any conditioning program. A physical therapist can teach an athlete proper leg and trunk posture during “cutting” movements (quick lateral motions required in soccer, basketball, etc.) as well as proper footfall and landing techniques to avoid hyperextension injuries.

In case of injury, the first steps in treating any acute injury include anti-inflammatory medication, rest, ice and, if possible, compression and elevation (RICE).
As a physical therapist (PT), I also encourage people to use crutches or a cane to avoid secondary strains of the back, hip or calf that result from limping. Isometric muscle setting helps maintain the “mind-muscle” connection and prevents excessive atrophy, while gentle range of motion aids circulation and prevents loss of mobility.

Since Idaho is a direct access state (meaning that a physician’s referral is not necessary to receive physical therapy treatment), I also encourage people to consult with a PT as soon as possible. We’re trained to perform tests to determine the structure at fault and can immediately begin rehab. Any red flags that suggest the need for referral to an orthopedic surgeon will also be obvious to a well-trained PT. >>>


Anterior cruciate ligament (ACL) tears are probably the most commonly known knee injury requiring surgical repair.

Tony Buoncristiani, M.D., of Sawtooth Orthopedics & Sports Medicine, explains that ACL surgery “is currently experiencing a ‘rebirth’ whereby two ‘bundles’ of tissue associated with the ACL are being reconstructed via a ‘double-bundle’ technique to provide more stability and improve outcome. This is especially important for those individuals who participate in rotationally demanding sports (i.e., skiing, hockey, football, soccer, basketball, etc.)”

Some people may find temporary pain relief from homeopathic remedies, acupuncture or foot reflexology, but as a PT, I find that the underlying mechanical injury also needs to be addressed to achieve lasting improvement.

Rehab involves techniques that improve blood flow to the tendons, since they receive only about 16 percent of the flow received by the muscles. I also use massage to relieve trigger points and tightness in the shoulder blade muscles, and mobilization to the joints of the shoulder and neck/upper back, since they too strongly influence mechanics. Rehab exercises are different from what someone would do with standard gym equipment, because PTs help athletes train movements and muscle groups together in a way that will mimic the demands placed on the shoulder during a specific sport.

If conservative treatment fails, surgery may be indicated. According to Dr. Buoncristiani, rotator tears are predominantly being repaired arthroscopically, with new techniques being used to restore the original anatomical attachment of the rotator cuff via a “double-row.” Of course, as with many orthopedic problems, corrective surgery is just the first step in the healing process. A rehabilitation program and strict adherence to the program is crucial to recovery. Dr Shapiro states that, “Most patients have a hard time accepting that it will be six to nine months after a rotator cuff reconstruction before they’re able do things that require power from the shoulder muscles. You just can’t rush Mother Nature.”

This article appears in the Winter 2008 Issue of Sun Valley Magazine.