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knees

Happy Halloween! Spooky Noises coming from your Knees?

“What are those cracks and noises coming from my knees? Is there something wrong??”

Our clients come in with this question all the time. They usually feel nervous and fearful that the noises they hear may indicate something more serious is going on within the joint. Is there damage occurring whenever they hear this sound? Do they need to avoid activities that provoke these symptoms? Will they need to rely on pain pills and surgeries in order to maintain their mobility if their joints deteriorate? 

Crepitus refers to these clicking, popping, and creaking sounds that a large portion of the population experience on a regular basis.  This phenomenon can occur at any joint, but is most commonly reported in the knees, shoulders, ankles, hips, and spine. 

Although these noises often don’t produce any pain, they can cause anxiety. Individuals start to develop their own beliefs about what is going on, and ultimately alter their behavior to avoid these cracking or popping sensations.

What causes these noises?

Many structural factors can contribute to joint noises.  Some of the most common are:

  • Tendons rubbing along bony prominences (bumps on bones)
  • Nitrogen bubbles popping due to pressure changes within the joint
  • Small labral or meniscus tears that get caught or pinched as we move

However, we don’t have the luxury of utilizing x-ray goggles during our examinations.  This means that we often cannot be certain of exactly which structures are creating these sounds.  What we do know is they aren’t a reason to be highly concerned as long as they aren’t associated with pain or swelling in the affected joint.  

How can I prevent it from getting worse?

The best way  to prevent these symptoms is to keep moving!! Motion is lotion. Regular movement throughout the day allows our joints to lubricate themselves, kind of like applying WD-40 to a creaky door hinge.  Additionally, it’s important to keep the muscles surrounding your knees strong and balanced. This helps to offload the forces through the joint, which limits “typical” wear and tear on cartilage and bony structures.

What if I’m noticing pain or inflammation in the joint that’s making these noises?

If you have a specifically noisy joint that’s also painful or swollen, it’s best to come in for a formal examination with a physical therapist – ideally someone who specializes in movement mechanics.  We train you in correct, healthy movement that both relieves your body of pain in the short term and protects it from further damage in the long term.

If finding the solution to your problem is something you’re interested in, you can come in for a free Discovery Session at our practice in Portsmouth, NH! All you have to do is fill out this brief form here and we’ll contact you. Discovery Sessions are great for people who want to talk with a specialist about what might be causing their problem, and we’ll help you figure out what the next best steps are.  Our goal is to give you all the information you need so that you can make the best decision for your health – without any obligation or commitment.

We also know not everyone is ready to commit to regular physical therapy appointments, and that’s why we offer free health and posture classes!  These events are for people in our community who want really valuable, expert information about movement, pain, and overall wellness. We know it’s confusing out there with all of the information floating around on Google and Facebook, and this is a valuable first step towards getting some answers for your problem.

Hopefully you found this information helpful, and the only thing scaring you this Halloween will be haunted houses instead of the noises coming from your joints!

PS – If you found this information helpful, please share this with a friend or on your Facebook feed.

Research shows MRI’s not reliable for back pain

One of the most popular questions and concerns I get from clients is whether or not they need an MRI for their back or neck problem. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI – right?

Not necessarily.

Here’s the problem. 

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine.  But what we now know from research is that all those findings on an MRI rarely correlate with what’s actually causing your pain. One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain.  Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Let me explain.

When it comes to neck and back problems, what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature.  That means that your problem has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration show up on an MRI. Disc degeneration and arthritis are normal parts of aging, but they often get blamed for problems they don’t actually cause. The best way to figure out a movement problem is with… well… movement! Not an MRI.

But how do you know that it’s a mechanical problem and not something more serious?

The easiest way to find out is to ask a physical therapist who specializes in the spine, and specifically in mechanical neck and back pain.  But one sign you can easily recognize on your own is to take note of how your pain behaves. Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain? When your pain is variable, it’s the best sign that your neck or back problem is “mechanical” in nature and due to a movement dysfunction. And that also means you don’t need surgery or any kind of procedure to fix it! In fact, a procedure or surgery could leave you feeling worse off than before.

So what’s the big deal about getting an MRI?  Isn’t it good just to be extra-cautious?

In theory – yes.  But here’s what actually happens.  MRI’s are super powerful and amazing tools.  Because of this, they see everything – including normal age-related changes like I mentioned just a moment ago. They also pick up things like bulging discs.

Research has also shown that around 60-70% of the population walk around with bulging discs and have no symptoms. Why?

Because a bulging disc only gives you trouble if you are moving or positioning yourself in an unbalanced way.

If an MRI picks this up, the news is often more devastating than it needs to be and the typical advice is to get an injection or surgery.  Neither of these procedures will fix your movement problem. And what typically happens is the bulge comes back, or appears somewhere else. This is why being “extra-cautious”, and over-prescribing MRI’s when it comes to back and neck pain, is not a good idea. The outcome is usually that people end up dealing with invasive procedures and surgeries they didn’t even need.  

If you’ve had a bad accident, fall, or trauma – then an MRI is a good idea.  But if you are dealing with chronic, long-standing aches and pains that have come and gone over the years and have recently gotten worse – there is a 70-80% chance that it is a movement problem that has finally caught up to you.  It’s best to see a movement expert for this. We know how to tell if the issue is something more serious. We can also send you to a doctor right away if necessary. But when you automatically assume that you need an MRI first, you end up spending a lot of money (the average cost of an MRI is $150,000, and you have to pay a portion of this), and the likelihood of getting prescribed an unnecessary surgery or procedure is much higher.

If this story sounds all too familiar, or you’ve been told that you must get an MRI for your neck or back problem – feel free to reach out to us and we can help you sort through fact vs fiction.  You could also come to our next “Ask the PT Night” on October 23rd and ask your questions then!

Setting Goals for the New Year: Part One – What to address FIRST?

New Year’s may still seem pretty far away, but if you plan on setting any resolutions or goals for 2019, you should start now. The earlier you set your goals, the more likely you are to achieve them. But choosing meaningful and positive goals is a process. That’s why we’re launching this four-part blog series to be your guide as we head into the end of 2018!

The first step is identifying what you want to change – FIRST.

A typical New Year’s resolution might be to lose weight or be more active. But before you can address those goals, it’s important to take a quick inventory of your body and identify obstacles that might get in the way.  The last thing you want is to get all excited about a goal, only to have those aspirations quickly deflated because you neglected to see the whole picture.

Let’s take the weight loss goal for example. Coming from a physical therapist’s point of view, that might mean asking yourself, “what hurts?” or “what has physically been bothering me?”  What are one or two things that could possibly get in your way of completing this goal?  Maybe your body is feeling great, you could still be struggling on other levels. It’s important to be honest with yourself and identify anything and everything that could be an obstacle to your goal. Once you can recognize and become aware of this issue, you have the opportunity to resolve it!

But how do you do that?  First, you have to get specific. For example, if you want to address your back pain in the New Year, so that you can be more active and lose weight in 2019, it’s not enough to simply say “I have a problem with back pain.”  When we get specific, we are able to take what may seem like a big, overwhelming problem – and turn it into bit size actionable chunks….

Start with focusing on the what, when, where, and why of the problem.

“Back pain” in itself is a general term. It’s more likely that instead of your entire back hurting at the same level all the time, you have a specific area (or areas) that hurts during specific activities. For instance, your “what” (the specific problem at hand) could be low back pain. The “when” could be in the evening after a long day on your feet. “Where” could be your living room when you’re trying to get up off the couch, or the golf course after a swing. “Why” could be a combination of factors that are causing you to experience the pain. For example, your body mechanics might be off to the point where it’s causing degradation of your vertebrae. Learning to move properly (for instance, with a physical therapist) would be a logical way to address that “why.”

Next, write down your focused description of the problem.

The simple act of writing something down will clarify and solidify your intentions. In this example, we started with the general statement “I have a problem with back pain.” We broke that down into parts, so that now you might say:

“I am experiencing severe low back pain. It typically occurs in the evenings after I’ve spent a long day on my feet, particularly when I’m moving from sitting to standing. This is likely a result of poor body mechanics, as I have never been instructed in proper movement to relieve back pain. This is the issue I intend to resolve so that I can be more active in 2019 and lose 20 lbs.”

Our next blog post will consider this series and discuss how to set a specific long term goal.

Stay tuned for this post coming out on 11/20! In the meantime, you may want to consider how physical therapy could help you in improving your overall health this upcoming New Year. You may not have a specific physical complaint like the one we described in this post, but working with a physical therapist can actually help you PREVENT these issues from arising later on! As we continue to age, it becomes more likely that we will experience back pain and numerous other issues. The great thing about PT is that it strengthens your body in all the right ways to guard against joint degeneration, stiffness, achiness, muscular weakness, and loss of balance (just to name a few benefits).

If you want to know if one of our specialists can help you, apply for one of our FREE Discovery Visits right here in Portsmouth!