Posterior Knee Pain

October 6, 2021

We have previously discussed knee pain, including in the last issue when we discussed the injuries to the medial side of the knee. Today we discuss the final area of the knee, the posterior knee. 

Let us first look at the anatomy of the posterior knee.

If we consider all the anatomical structures on the posterior side of the knee, we will find there are 7 muscles, 4 ligaments, 3 bones, 4 bursas, 2 mensicus, and multiple arteries, veins and nerves. There are also three surfaces of bone  lined with cartilage. All of these structures are potential sources of pain and subject to injury.

The following are common causes of posterior knee pain:

  • Knee joint effusion

  • Baker’s Cyst

  • Referred pain (from lumbar spine, patellofemoral joint, or neural compression)

  • Biceps femoris tendinopathy

Less common causes of posterior knee pain:

  • Popliteus tendinopathy

  • Gastrocnemius tendinopathy

Rare causes of posterior knee pain, but not to be missed, would include Deep Vein Thrombosis, Claudication, and Posterior cruciate ligament sprain/tear.  If you ever have a hot, red, area behind the knee, swelling or discolouration that does not look normal, this warrants a trip to the emergency room.  Don’t delay what could be a vascular issue. 

As we have previously discussed tendinopathies and joint effusion can be the result of multiple different causes, we will only take a closer look at posterior knee pain from Baker’s Cysts and the different sources of Referred Pain.

Baker’s Cysts are fluid filled sacs that form in the posteromedial knee joint.  In adults, these cysts form as a result of chronic knee joint effusion, or excessive fluid, often from something else happening within the joint like a medial meniscus tear, ACL injury, cartilage degeneration or arthritis.  In some people, the cyst will spontaneously burst or become reabsorbed and in others the size may fluctuate, so at times they appear smaller or larger.  Due to the high association with other joint injuries/pathology, it is very important that the knee is fully assessed to look for these other potential knee joint injuries. 

Patients with a Baker’s Cyst will present with:

·         Palpable and sometimes tender mass in the posteromedial compartment of the knee

·         Decreased knee flexion

·         Pain on deep squats or kneeling

Diagnosis:

·         Can be made on ultrasound of the area and give the approximate size of the cyst, however ultrasound does not assess the structures of the internal knee, like the meniscus and cruciate ligaments well so further imaging will need to be done to find the source of the problem 

·         MRI is considered the gold standard for diagnosis, both of the cyst and the underlying causes

Conservative treatment would involve:

·         Addressing the underlying cause, i.e., if a medial meniscus tear is the cause of the excessive knee swelling, the torn meniscus needs to be addressed. 

·         Aspiration combined with a steroid injection may be used for temporary relief

·         Surgery to remove the cyst completely. Usually only done for very large and painful cysts. 

Keep in mind that although removal may help with the decreased knee flexion or may allow an athlete to perform, Baker’s cysts will likely reform until the underlying cause is addressed. 

Referred sources of posterior knee pain

When posterior knee pain is unable to be reproduced on examination, we need to look at other structures as a potential source for referred pain.  Often, patients with referred posterior knee pain, cannot isolate the pain to a particular structure.  There may be other sensations, like numbness/tingling or a deep ache. 

Structures which refer to the posterior knee:

·         Lumbar spine, usually nerve root irritation

·         Piriformis syndrome

·         Sciatic nerve entrapment at piriformis or hamstring

·         Muscular trigger point

Examination:

When a knee structure cannot be identified as the source of the pain, the examination should include lumbar spine range of motion, joint palpation and compression tests as well as, neural tensioning tests.  A very mild low back injury may present with leg pain, making the patient feel that only the knee is the source of the problem.  Neural tensioning tests tend to be very sensitive to reproducing pain.  In addition, the muscles of the buttocks and the posterior thigh need to be fully palpated looking for areas of tightness that may reproduce the pain. 

Treatment will then need to address the source of the problem.  If it is lumbar disc herniation, for example, treatment would include relieving compression on the nerve root, via chiropractic manipulation, exercise and pain management.  Once the pain is under control, then looking at making biomechanical changes, either through specific exercises or creating new movement patterns, can help to prevent further injury down the road.  Make sure to discuss with your healthcare provider options for treatment, regardless of the source of the problem. 

This sums up our series on knee pain.  Chiropractors can definitely diagnosis and treat most knee injuries and if we can’t treat it, we can help direct you to another professional that can.  If you have questions regarding knee pain or any health issues, please contact us at MMD Chiropractic Health Centre, 905.529.2911. 

 

 

Medial Knee Pain

April 12, 2021

In the last issue, we discussed the difference between Patellar tendinopathy vs Patellarfemoral pain.  This issue, we will continue to discuss knee injuries, but will focus on the medial side of the knee.  

Let us first look at the anatomy of the medial knee.  

If we consider all the anatomical structures on the medial side, or inside, of the knee, there are 9 muscles, 3 ligaments, 3 bones, 2 bursas, 1 mensicus, multiple arteries, veins and nerves and four surfaces lined with cartilage. All of ...


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Anterior knee pain: Patellofemoral Pain vs Patellar Tendinopathy

March 8, 2021

Anterior knee pain is a very common symptom in many musculoskeletal rehab or family practices.  In this article, we are going to look at the two most common conditions associated with anterior knee pain, Patellofemoral Pain (PFP) and Patellar Tendinopathy (PT) and address the differences in their respective symptoms and treatment options. 

The following chart shows a comparison of the clinical features of PFP vs PT.


Signs

Patellofemoral Pain

Patellar Tendinopat...


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We are Hiring!

February 7, 2021
We are currently looking for a Registered Massage Therapist and a Physiotherapist to join our team.  This is a difficult time in the world with the current pandemic.  Our clinic follows very stringent protocols for screening, cleaning and maintaining a high level of disinfection inorder to keep ourselves healthy, as well as our patients that are coming into our space. 

The successful candidate for massage therapy will be registered with CMTO and have atleast 2 years experience working in a cl...
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Staying Healthy at home: Part 3: Maintaining our Mental Health

February 3, 2021



In the past two issues of our Staying Healthy at Home series, we first discussed exercising from home with the equipment that is available to you.  In our last issue we discussed cutting the sugar from our diets to avoid insulin resistance and to cut down on the typical North American diet of high carbohydrate meals.  In this article, we will address our mental wellbeing. 

With the current pandemic situation we are limited in the activities we can do, people and family we can see and travel...


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Staying Healthy at home: Part 2: Cut the Sugar

January 12, 2021




In the last article, we talked about exercising at home and I provided ideas on how to do this with minimal equipment or items you likely already have at your disposal.  In this article, I want to address nutritional changes that you can make that only require small changes to your shopping lists and cooking habits.  In particular, I want to discuss reducing the sugar or carbohydrates in your diet as a starting point. 

A personal trainer that worked with us previously, had these little challen...
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Staying Health at home: Part 1 Exercise

December 8, 2020




We are not quite sure how much longer this pandemic is going to keep us out of the gyms, but it doesn’t mean we have to stop exercising.  There are several ways to exercise at home, we just have to be creative with what we have access to.  Here are some ideas of making the most of what you can do at home:

  • Safe space:  Ensure you have a space large enough for the length of your body with your arms out stretched in all directions.  Within this space, you can do many things to keep up your ca...

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Corrective Exercise: Part 3 in our Exercise and Movement series

April 15, 2020


unlock your potential and start moving vetter

In our last two newsletters we discussed both prehabilitation and then rehabilitation to help you make it through an injury.  Now let’s take a look at your overall motion and make sure you are moving well.  

There are many different screening methods that have been utilized during various medical evaluations, team tryouts, combines or sports training camps.  The evaluators of these screens take different information from them that may lead to a score of overall functioning, readiness t...


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Rehabilitation: Part 2 of our Exercise and Movement series

March 9, 2020

Rehabilitation - restoring back to normal after an injury


In our last article we discussed prehab and noted the difference with rehab.  To recap, by definition, Rehabilitation (according to Oxford dictionary) is "the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness".  Prehabilitation can be defined as "the process of care, initiated before surgery, whereby patients’ physical, nutritional, medical and mental conditions are strengthened while waiting for surgery in order ...


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Prehabilitation:  Part 1 of our Exercise and Movement series

February 12, 2020


Prehabilitation is a newer buzz word that is used often in the healthcare industry, in particular, more amoungst physical therapy providers like chiropractors, physiotherapists, occupational therapists, athletic therapists, massage therapists and some orthopedic surgeons.  By definition, Rehabilitation (according to Oxford dictionary) is "the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness".  Prehabilitation can be de...

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Common Fractures

December 29, 2019

The image above illustrates the various types of fractures that can occur.  The terms "Compound Fracture" is used to describe a fracture that breaks through the skin resulting in an open wound or also called an "Open fracture".  Many displaced fractures, meaning the two ends of the bone do not align, are Compound fractures.  The term "Simple fracture" refers to fractures that are "closed" or do not penetrate through the skin.  The terms in the image above are used to describe the fracture lin...

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How do I know if my low back pain is serious?

November 12, 2019



Believe it or not, this is not a common question.  Often, I find myself letting patients know the serious symptoms that may arise with a back injury so they are aware of what to look for.  I wonder sometimes if this scares people, but I know that in discussing this with patients they will be better prepared to recognize these symptoms and may not ignore the symptoms if and when they arise. 

One of the first signs or symptoms to look for is the presence of “saddle parathesia”.  This is n...


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What causes low back pain?

November 12, 2019

There are several sources of low back pain. 

To understand the symptoms of low back pain, we must be aware of all the anatomical structures and how they contribute to the movement of the spine.  These sources can be grouped into our “mechanical” sources of low back pain (LBP). 
There are other sources of LBP that tend to be secondary to another condition that we will also briefly discuss.  We will refer to this second group as “non-mechanical” sources. 

Mechanical Sources of Low Bac...


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Delayed Onset Muscle Soreness (DOMS)

November 7, 2019


When we use the term DOMS or Delayed Onset Muscle Soreness, we are referring to the post workout pain that tends to peak around the 24 to 48 hour mark.  We want to discuss the potential treatment for DOMS and recommendations for the prevention of this pain.  After reading a great, lengthy article on this subject by Paul Ingraham (painscience.com) , I will summarize some his points. 

How delayed is this muscle pain?  The muscle soreness can come on almost immediately post exercise, but tends ...

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Cold cream review

October 7, 2019
What is your cold cream of choice  for use on sore and ache muscles?  We had a fun little experiment on one of our Monday afternoon meetings where we each tried out the cold creams that either we sell in the clinic, or various other products that companies have sent samples to us to try out.  Here are the contenders:
Biofreeze


Fisocream


Motion Medicine

Medistik solid 46%


Medistick spray 22%

 
After testing all five on each of our forearms, we rated each on smell, coldness, absorption rate, and leng...

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Proper Backpack fitting

August 13, 2019

As we prepare for the back to school season, let us remind you of how a backpack should be worn.  Remember the weight should be 15% of your body weight if you are older than 12.  Younger than 12, the backpack should only be 10% of your body weight.  If you have a scale at home, it is really easy to see how much your bag weighs.  Simply pack your backpack up for school with all the items you normally take with you and place it on the scale.  These rules also apply for all the other types of ba...


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Camping in Pain: Choosing Your Sleep System

July 9, 2019

Camping is a wonderful, age old summer tradition for outdoorsy Canadians. Something about natural landscapes and outdoor activities being good for your health. A road block for a lot of people can be pain. We know from the science that restriction of activities due to pain can lead to co-occuring mental health disorders like depression.

But it doesn't have to be that way.

It can be possible to adapt to pain while still doing what you love or even trying something new. When it comes to camping, ...


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Is your bike ready for summer? Summer Bike Tune Up.

June 6, 2019




The weather has been... well ok we won't talk too much about the weather as it has been raining a fair bit in the last while but I swear it can't rain all the time and when you catch those sunny days you will want your bike to be in ready-to-ride condition. A lot of people bring their trusty steeds up out of the basement between April and June to drop off at the local bike shop for tune ups but the truth is, a lot of the bikes only need a few small and simple adjustments that can be done at h...

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Range of Motion Training

May 9, 2019

 There is always a lot of talk about specific exercises for certain injuries or rehab protocols for different muscle groups.  One theory that has emerged in the last few years looks at the reason why many injuries happen, and that theory revolves around having an inaccurate range of motion. 

 The dancer above would not be able to move the way she does if she did not have full ankle planter flexion and toe flexion, knee flexion, hip flexion and extension, spinal extension, shoulder flexion, abd...

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Acute care for your Temporal Mandibular Joint Pain and Dysfunction

April 9, 2019
We have previously discussed Temporal Mandibular Joint (TMJ) Pain and Dysfunction in more detail (click here for previous article).  In this article, we want to review some acute care procedures you can do at home to help care for this problem.  

Finding Your TMJ

First, lets remind ourselves how to accurately feel where your TMJ is on our skull.  If you place your hands on the side of your face, just in front of your ear, your hand should be right over your TMJ (see diagram below).  To test if ...
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Tabata Workouts

March 2, 2019


Most people have one of two relationships with cardiovascular exercise... tolerate or hate. It's hard to refute the benefits of cardiovascular exercise for heart health. If you are in the hate category, Tabatas might be the right fit for you. Tabata exercises were created by Dr. Izumi Tabata, who researched new approaches to training the Japanese Olympic speed skating team. He created a 4 minute cardio workout that involves 20 seconds of work and 10 seconds of rest for 8 cycles. His research ...

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Spotlight on Women's Cardiac Health

February 26, 2019

March 8 is International Women’s Day and we decided to focus our newsletter on women’s heart health, an understudied, under-diagnosed and under-treated health concern for women. Though there have been incredible improvements in cardiovascular mortality rates in women, heart disease is still the leading cause of mortality in women. Regardless of age, women tend to die more frequently within 1 year of their first heart attack (at 26% vs men at 19%), and within 5 years, at 47% vs men at 36%,...


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Welcome to the gun show!

February 11, 2019

You guessed it!  The guns we are referring to are the biceps.  In this article, we will discuss proper motion, common injuries, exercises and things not to do at the gym! 

The biceps brachii have two muscle bellies and attach the shoulder to the elbow.  For those that would like to know more specific anatomy, the short head, attaches to the coracoid process of the scapula and the long head attaches to the supra glenoid tubercle of the scapula.  Together, both muscle bellies come together to ...


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Gout: Recognizing, Risk Factors and Treatment

December 5, 2018

Gout is an inflammatory arthritis caused by excess uric acid in the bloodstream.  The symptoms of gout arise due to uric acid crystals that are deposited in the joints and the body’s response to them.  The pain is often so intense, anything touching the joint involved, including clothing or socks, causes extreme pain.  The most common joint affected is the big toe, with patients often commenting that even their bedsheet hurts the toe.  As this is a potentially destructive joint disease, it ...


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Fall 2018

October 16, 2018



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Does weather really affect our joints?

October 11, 2018


How many times have you heard the statements "My ankle hurts more when rain is coming"?  Or cold weather brings ache joints.  Often we have an influx of acute neck or low back pain during a "change in seasons" period.  Is there some validity to the theory that changes in weather can bring changes in joint pain sensitivity or even pathology to joints.  Let us take a look at some of the literature on this theory.  

If you search for "joint pain and weather" in Google, the first listed website th...
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Preparing for tryout season

September 4, 2018

Back to school is around the corner and that also means tryout time for school and out of school sports teams.  In my family, our baseball season is coming to an end, but within the first two weeks of school we have tryouts for next years baseball and basketball teams.  This can be a period of extreme stress for some, particularly if they are trying out for a new team with kids they don't know and coaches that may be very different from coaches they have had in the past.  Are their athletic s...


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Natural Bug Repellents

July 8, 2018


Last month I gathered together more information than any usual citizen should sift through and read about mosquitoes, ticks and bug spray. I wanted to better understand how these insects find us, and how well different repellents work and what the safety usage guidelines were for each of them. This is a condensed version of my findings because the whole thing worked out to be 5 pages! If you're interested to know all of it, let me know as it is the basis of my Natural Bug Repellent workshop! ...


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Patellar Tendonopathy

June 4, 2018

What it is

Patellar Tendinopathy, also known as patellar tendinosis, jumpers knee, or Landers knee is an overuse injury at the knee. There is no specific injury or trauma to cause it, but the repetitive motions over time result in the tendinopathy.


Suprapatellar vs Infrapatellar tendinopathy

Supra- or superior refers to   tendinopathy above the patella (knee bone). This area is also call the quadriceps tendon. This portion of the tendon connects the quadriceps muscle and the knee. Infra...


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Movement screening to prevent injury

June 4, 2018

Some of you may have experienced some new testing that I have done to assess how your body moves.  In the fall of 2017, I began studying a method to assess movement throughout the whole body.  The Selective Functional Movement Assessment, or SFMA, is a tool that takes a patient through a series of 10 movements.  These 10 movements are then classified as being normal functioning or dysfunctional.  This assessment tool is part of the Functional Movement System, which includes other screening te...


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