Questions about your injuries?

[WalkThisWay]

Hello everyone!

I'm lucky enough to have stumbled upon this lovely forum, and am excited to be a part of the community.

My name is Ryan, and I'm just about to graduate from a Master of Physiotherapy program. I'm looking to start this thread to offer advice regarding injuries to the best of my ability over the net.

So, if you have any questions about your injuries, or have any nagging aches and pains, fire away!

Yours in health, hope and happiness,

Ryan
BKinH
M. Physiotherapy Candidate, 2012

[baldy]

Hi WalkThisWay, welcome to VF, have you thought about introducing yourself on the new members introduction thread? -> viewforum.php?f=11
Just helps people get to know you better.

Kind of worried about this thread, offering medical advice over the internet to people you have not met seems a little dangerous. How do you envisage it working, just chat about diagnosed injuries?

It certainly would be nice to have a physio to give opinions on things. For example I seem to have some patellar tendinitis in my left knee

[WalkThisWay]

Thanks for the friendly welcome!

You pretty much have it spot on. It's pretty much impossible to diagnose something over the internet, and it could lead to improper management.

I am looking more at helping people better understand their already diagnosed injuries, or to answer questions regarding treatments that they have been offered. Often time it is really difficult to find information about these things online, or they are not entirely understood when explained by a therapist.

I hope this helps clear things up. If you guys feel this isn't something that would be beneficial to the forum, no hard feelings would be held by me

[daveuk]

Hi there,
I have a long running shouler injury, which I have had an open anterior stabilisation to try to fix. Since then the shoulder has not dislocation, but regularly clunks and possibly subluxes(?).
The humeral head on this shoulder sits a lot further forward than on the other side, and I have tried just about everything, stretching pecs, foam roller, physio's, specialists, accupunture, release etc.
I have worked on back a lot and eased off chest, but it still doesn't work. The most recent physio I'v seen was just as puzzled as I am and pretty useless (information wise) to be honest.
So any help is appreciated, I am still working out a 3-5 days a week and don't intend to stop, but I need any advice possible. It seems like the condition only temporarily gets better - i.e for a couple of days max, then comes back. Other than that it feels unstable most of the time, though never fully comes out and I hope it never does again!
Have done the usual external rotation, scapular stabilisation exercises etc but doesn't seem to do much.
Please help!
Many thanks in advance

[WalkThisWay]

Hey Daveuk!

Thanks for the question, I can understand how frustrating that must be for you. From what you've said, it seems that you are doing everything right in terms of self management.

The shoulder is a pretty frustrating joint due to its relative instability because of the amount of movement it does. Most people look at it as a joint that is stabilised entirely by the rotator cuff muscles, and that is in a sense true, but this is more or less for dynamic stability such as during movement and exercise.

Seeing that your issue appears to be one that occurs even at rest, it may be a case that it isn't entirely the musculature that is causing your issue. The shoulder has plenty of structures that provide static stability, such as the actual capsule (Which I believe you had repaired anteriorally) and the glenohumeral ligaments. These structures may respond to stressors such as exercise(Bench pressing, sports etc) and repetitive tasks or posture by tightening up. Tight posterior structures are a major cause of the humerus sitting farther forward anteriorally.

May I ask if your physiotherapy treatment has consisted of any work stretching or releasing the posterior structures of your shoulder? This would involve actual hands on manual therapy techniques, as well as a stretching program. Additionally, have you had your posture assessed? Many people (Especially weight lifters) tend to have rounded shoulders, and even a slight bit of shoulder internal rotation can predispose to anterior translation of the humerus.

All the best!

Ryan

[wannalift]

Hi. Question/advice. I used to get a lot of groin pulls playing hockey. That stopped happening over the last 2 years and I actually haven't even played hockey in almost 3 months. What's happening now though is I am getting groin strains after doing RDLs. I will do a set of RDLs and after I do my last rep, I step forward to rack the weight and I get a really sharp pain as if I am getting a groin strain. Not an exercise i would expect a groin strain from and no other exercise does this to me including front squats, hang cleans, etc. After I feel the strain I do some deep stretches and it feels mostly better later that day. The next day it feels almost 100% better and I would say it is 100% better after two days or three days. This has happened 3 times over the last 6 weeks or so. Any thoughts?

[WalkThisWay]

Hey wannalift!

I would be pretty cautious with groin injuries, as they tend to have a high liklihood of becoming a chronic issue, especially if a "groin pull" as you described happened earlier in your life and wasn't adequately managed at the time.

If I were you, I would read up on 'Adductor Tendinopathy' and see if any of the symptoms seem to match what you are experiencing. Adductor is just another word for your groin muscles.

A good description of the condition is located at http://www.physioadvisor.com.au/1042655 ... y-phys.htm

The "causes of adductor tendonitis" subheading really nicely describes how these conditions can come on acutely (as in a pull or tear of the muscles), long term overuse, or as a result of a poorly managed injury to the groin in the past.

Tendinopathies like this have different levels of progression, with the mildest being a slight pain that goes away with warm up, and moving right through to debilitating pain that stays for the entire duration of the activity.

Hope this helps! Write again or PM me if you feel you need more info.

Cheers mate,

WTW

[NatB]

I have a stuffed left knee. I tore my medial meniscus and my ACL in 1999 and (despite being originally misdiagnosed and fobbed off by the wonderful NHS) had two sucessive operations in the following 18 months: an arthroscope in UK and then a (left) hamstring graft ACL reconstruction in Australia, which I found out following an MRI last year has failed completely.

Regardless of this (and the fact that I never fully regained the muscle mass especially to the hamstring) I have still managed to function pretty well and train daily. I run, do strength and conditioning, boxing and BJJ (at an MMA gym), pilates, yoga etc and a couple of weeks ago managed to climb 2 peaks in snowdon with no swelling or pain or any bad effects. And am training for Tough Mudder in November

I am still a lot weaker in the bad leg (single legged squats are a problem for example). The doctors are keen to do another operation (this time with an allograft) but I don't want one.

Simple fact is I don't trust them and don't want to give them another chance to hack away at me and for me to go through all the pain and rehab and it potentially fail again.

My question is, will I have problems later in life (such as osteoarthritis) that can significantly be reduced (not just slightly) by having the operation (given that for the last 13 years I have managed ok) and what are the chances of the operation failing anyway?

I guess what I am trying to work out is am I delaying the inevitable or can I survive just fine without and ACL from here on in? I really can't face another operation and year of rehab. However there are still things I would like to do (muay thai for example) that my knee is restricting me from.

Oh I am 55kg, 171cm tall 40 year old female in otherwise excellent health!

[WalkThisWay]

Heya Nat!

I can totally understand your frustration with the lack of success of your previous surgeries, and that rightly gives you justification to doubt the success of any further operations!

Regarding your question, I think the most important thing to consider is knee biomechanics following the type of injury that you have.

There are heaps of studies that show an altered pattern of movement in the knee joint following ACL rupture, and these alterations are what are likely to lead to further meniscal damage and articular cartilage damage. These changes in movement are further increased when the meniscus is involved. Also, looking at the stress of other knee ligaments after ACL rupture shows that the stress on the Medial Collateral Ligament may be up to 3 times higher in those without an ACL.

You definitely hear of people being able to function fine without ACLs and even competing in sport without them, but I would really question the long term effect it has on the knee joint because of what I mentioned above.

One of the biggest prognostic indicators for OA after ACL injury is the meniscus. People who have menisectomies or meniscal tears with their ACL rupture tend to have a much higher incidence of OA. ACL reconstruction has been shown through multiple studies to reduce the chance of additional meniscal damage.

Ultimately, you need to make the decision that is best for you. You're fit, healthy, and active and I take it that is something that will be the case for a long time (Especially since us vegans tend to live forever! Hehe). I would have a physio or sports doctor assess the laxity of your knee, and maybe investigate the degree of meniscus damage that you incurred. Be aware that you are at a higher risk for additional damage to the knee considering the types of activities that you like to do, and that further damage may increase your risk for OA.

Sorry for the novel! In terms of your questions, the studies are relatively divided on the difference in OA between conservative treatment and reconstruction, but considering your activity level and past meniscus injury, you may want to look into your surgical options. In terms of the graft failing, the protocols following knee surgery have changed pretty significantly in the past 13 years, as have the surgical options.

I have a few studies I can send you if you want to look at some literature yourself and prepare some questions to bring to any appointments if you decide to book them, just send me a message and let me know if you would like that.

All the best,

WTW

[NatB]

WTW thanks for the speedy and detailed reply!!!!

Well my osteo had a look and the knee isnt that lax but i cant jump. well i cant land as it wants to push out and just feels unstable. And I was watching myself in the mirror today doing squats and lunges and noticed how much my knee wobbles out to the side when i do this movement.

But how do you assess the medial meniscus damage? is that something that can be done from the MRI i had? and would most of the damage have already occured in the last 13 years or could i be doing a lot more from here on in?

I just really (emotionally) couldnt face being out of action for so long after the op. the gym and all the activites i do are such a huge part of my life right now i just couldnt bear to give them up! and yes as you said us vegans like to think we are invincible!! but on the flip side i dont want to be crippled when im older either.

thanks again for all your help!

[WalkThisWay]

Your surgery report (If you have it) would have details regarding how much of the meniscus was removed. And yes, you can certainly still be causing more damage to those structures in your knee the longer you go on. The meniscus is like a shock absorber, and it gets compressed and ground between the femur and the tibia. If there is move movement at this joint like there is in an ACL deficient knee (That wobblyness/unstable feeling you talk of), then you can imagine that the meniscus is taking more of that 'grinding'.

if you wanted to assess the current integrity of your meniscus, I'm sure you could get an MRI which is your most accurate diagnostic test that isn't invasive.

If your time away from the things you love is what is scaring you, you could consider LARS (Ligament Augmentation and Reconstruction System), which has a much shorter recovery time as it is a synthetic tissue, but there isn't any studies looking at prognosis in the long term with this surgery, which means we don't actually know if there is a greater chance of failure of the graft or of OA.

So again, it comes down to a personal choice. I can totally empathize with you about missing out on such important parts of your life. I would just consider the fact that you have a long life ahead of you, and with healthy joints, you can exercise and play jiu-jitsu for a very long time.

Let me know if you have any other questions

WTW

[NatB]

Thanks WTW. i had an MRI late last year. could a physio or a GP assess the damage for me from this?

[WalkThisWay]

Usually a scan will come with a report. If you don't have that, to get an accurate analysis, I would bring it to a specialist like a sports doctor, surgeon, or radiologist. They have a much better idea of how to assess exactly how much of the meniscus was removed or damaged.

Cheers!

WTW

[NatB]

OK thanks!!

[WalkThisWay]

Let me know how everything goes for you