Running: All You Knee-d to Know

by Kate Marconi, PT

Running is one of the most popular forms of exercise in the United States, with over 60 million people participating in some way. Each year the number of running events, from 5Ks to marathons, increases due to popularity. The majority of people begin running to improve their health, but many runners have also been told that they’re ruining their knees or that they should stop when they get older to avoid arthritis.  

So will running ruin your knees? A study by Lo et al. (2018) looked into just that, following individuals over the age of 50 with current osteoarthritis in their knees. Their findings were clear: through over 48 months of regular running, none of the individuals had worsening osteoarthritis, increased knee pain, or new onset of knee pain.

Here's what we do know about injury prevention in running:

• There is a significant correlation between glute medius weakness and knee pain in runners (Wilson et al. 2011) (Dierks et al. 2008)
• Running 1-3 times per week with cross training has less incidence of injury and an equal cardiovascular benefit as those that run 5 times per week (Yeung et al. 2001)  
• Stretching and proper shoes had less of an effect on injury prevention compared to strengthening and adjustment of training schedule (Yeung et al. 2001) 

Whether you’re a new or seasoned runner, you should be doing regular strengthening exercises for your glute medius. But where to start? Stastny et al (2016) looked into hundreds of exercises and measured which had the most glute medius activity that would be most beneficial for runners. Below are a few to start with:

Side plank with hip abduction: Position yourself in a side plank with your elbow under your shoulder. Feet can be stacked, one in front of the other, or bottom knee can be bent on the ground for support. Take the top leg and keeping your toes forward, raise it keeping it in line with your bottom leg. Don’t let the top leg come forward and work on keeping your hips slightly forward.

 

 

 

 

 

Clamshell with foot elevation: Lay on your side with your knees bent to about 45 degrees. Roll your hip forward, then keeping your feet together raise both feet. Then lift your knees open and closed, keep your feet raised and your hip forward. Add a band above your knees for a challenge!

Single leg squat: Standing on the edge of a step, sit back into your heel and complete a squat by moving your hips back. Your knee should stay in line with your ankle. Tap the floor with your heel and return up focusing on keeping your weight in your heel.

 

 

 

 

Contralateral lunge: Holding a weight in the opposite hand, step forward into a lunge. Make sure you keep your knee above your ankle. Push off your heel to return back to standing.

If you’re a new runner getting started or a runner with knee pain and you’re unsure of where to start, you can always ask a physical therapist! Our therapists are always happy to offer their expert opinions to help you continue your running journey.

 

 

 Bibliography  

Dierks, Tracy A. “Proximal and Distal Influences on Hip and Knee Kinematics in Runners with Patellofemoral Pain during a Prolonged Run.” Journal of Orthopaedic & Sports Physical Therapy, vol. 38, no. 8, 2008, pp. 448–56. 

Lo, Grace H., et al. “Running Does Not Increase Symptoms or Structural Progression in People with Knee Osteoarthritis: Data from the Osteoarthritis Initiative.” Clinical Rheumatology, vol. 37, no. 9, Sept. 2018, pp. 2497–504. DOI.org (Crossref), https://doi.org/10.1007/s10067-018-4121-3. 

St
astny, Petr, et al. “Strengthening the Gluteus Medius Using Various Bodyweight and Resistance Exercises.” Strength & Conditioning Journal, vol. 38, no. 3, June 2016, pp. 91–101. DOI.org (Crossref), https://doi.org/10.1519/SSC.0000000000000221. 

Willson, John D., et al. “Gluteal Muscle Activation during Running in Females with and without Patellofemoral Pain Syndrome.” Clinical Biomechanics, vol. 26, no. 7, Aug. 2011, pp. 735–40. ScienceDirect, https://doi.org/10.1016/j.clinbiomech.2011.02.012. 

Yeung, E. W. “A Systematic Review of Interventions to Prevent Lower Limb Soft Tissue Running Injuries.” British Journal of Sports Medicine, vol. 35, no. 6, Dec. 2001, pp. 383–89. DOI.org (Crossref), https://doi.org/10.1136/bjsm.35.6.383.

 

We Turned 10!

by Sally Fansler PT

Is there anything more gratifying than knowing you’ve made a difference in someone else’s life? Honestly, we can’t think of anything, which is good news because it confirms we’re still in the right industry!

For the past 10 years, the staff at Lakeshore Physical Therapy has strived to provide one-on-one physical therapy care to our patients with a unique individualized approach. What we discovered was that this business model was equally positive for our patients and for us. With extra treatment time in each visit, successful communication and listening fosters a solid base to build on for our care.

Lakeshore PT is thankful to the Chicago community for 10 years of doing what we love to do!

What is the Pelvic Floor?

by Meg Crowley, PT

If you feel you've seen more and more articles referencing the pelvic floor, you're not imagining it - this group of muscles has been talked about recently on everything from local news stations to Buzzfeed. But you may have wondered: what exactly does the pelvic floor do? What does it look like? Why is it so important?

The pelvic floor is a bowl-shaped group of muscles located at the base of your pelvis (hip bones). These muscles have 5 main functions:

• 
  To help support internal organs 
• To control bowel and bladder function
  
• To aid in sexual function and pleasure 
• To provide stability to trunk and low back 
• To help with circulation of blood and fluid from lower legs back to torso 

As you can see, these muscles are in charge of making sure a lot of everyday function continues smoothly! Like any other group of muscles, however, the pelvic floor can be weak, overly tight, or a combination of both. This can create a variety of symptoms, of which these are some of the most common:

• Leaking of urine or stool
• Sensation of heaviness while doing higher level activities such as jumping or squatting
• Pain with sex
• Frequent urination (>6-8 times per day)
• Chronic pain in hips or low back that has not been attributed to something else

Physical therapy can help with the above-noted symptoms and many others. Therapists must undergo advanced training in order to effectively assess and treat this area of the body. In an evaluation, the therapist looks at how the patient moves and breathes and assesses the patient's strength, mobility and balance. If necessary - and with the patient’s consent - there may also be an internal assessment component in order to better assess the strength, coordination, endurance and mobility of the pelvic floor. This is something your therapist will discuss thoroughly with you beforehand and you both should decide together if this is the best option for you and your case. 

Though some of these issues may feel taboo to discuss, if you are experiencing symptoms of pelvic floor dysfunction, you are not alone in this! Please reach out if you have any questions, or if you are experiencing any of the symptoms noted above.

Getting into Gear for Cycling

by Lauren Sweeney, Office Manager

Whether you do it for recreation or for transportation – or both – cycling is a low-impact exercise that can be as fun as it is beneficial. I realize that as someone who bikes a minimum of 72 miles per week I might be biased, but the science backs me up: according to several studies, commuting via bike for at least 30 minutes, 5 days per week, reduces the number of sick days employees take. Studies have also linked cycling with decreased likelihood in death from cancer and cardiovascular disease. And there’s no wrong time to start: a study in the Journal of the American Heart Association followed two groups of commuters in their 40s – one who began cycling to work and one who continued to use passive modes of transportation – and found that, after 10 years, the cyclists had lower incidence of hypertension and hyperglycemia than did their bus- and train-bound counterparts.

However, all those health benefits don’t mean much if you injure yourself on the road! Here are some great stretches to keep those cycling muscles in top condition.

Shoulder External Rotation with Band: Hold elbows at your side, squeeze your shoulder blades together. Keeping that position slowly rotate hands out from each other. Should feel back of shoulders (rotator cuff muscles) and muscles between shoulder blades (middle trapezius and rhomboid muscles) working.

 

 

Standing Quad Stretch: Standing up tall and squeezing shoulder blades back, pull ankle toward back of hip. Should feel stretch on front of thigh (quadriceps muscle).

 

 

 

 

  

Doorway Pec Stretch: Standing up stall, squeeze shoulder blades back, put one foot in front
of the other and slowly lean forward until a stretch is felt in front of shoulders (pectoralis muscle).

The pec and quad stretches will help offset the crouched cycling body position, and the shoulder external rotation with band promotes keeping the shoulder blades back for optimal positioning.

 

 

 

 Some other tips:

• Make sure your grip on the handlebars is firm but relaxed. Change hand positions often and remember to keep your wrists straight. 
• Keep elbows slightly flexed to reduce shoulder strain. 
• Make sure your seat is properly adjusted to reduce knee strain. Most cycling shops offer custom fittings and can help you find the right height.

If you have other concerns about your body before you start cycling, you can always ask a physical therapist! Our therapists are always happy to offer their expert opinions to ensure that your ride is smooth and pain-free.

 References:

Ingrid J M Hendriksen, Monique Simons, Francisca Galindo Garre, Vincent H Hildebrandt. The association between commuter cycling and sickness absence. Prev Med. 2010 Aug;51(2):132-5.

Anders Grøntved, Robert W. Koivula, Ingegerd Johansson, et al. Bicycling to Work and Primordial Prevention of Cardiovascular Risk: A Cohort Study Among Swedish Men and Women. Journal of the American Heart Association. 31 October 2016; 5:e004413.

When Can Physical Therapy Prevent Surgery?

by Sally Fansler, PT

While more than 1.5 million orthopedic surgeries are performed in the U.S. each year, current research is showing that surgery might not be needed as often as previously thought. According to a recent review an estimated 10% to 20% of surgeries might not be necessary and in some specialties - such orthopedics - that number could be higher. One of the most common reasons for unnecessary surgery is that conservative options simply are not tried first. For musculoskeletal problems like joint pain, sprains, and strains, seeing a physical therapist before a surgeon can help keep patients out of the operating room and get them back to their daily lives sooner. Studies have shown that physical therapy is just as good - if not better - than surgery for a multitude of conditions, and it carries far less risk. We've compiled some research here as to the benefits of seeking physical therapy first for common orthopedic problems. 

Rotator Cuff Tears 

The rotator cuff is a group of muscles and tendons that surround the shoulder joint and provide strength and stability. When one of the rotator cuff muscles is frayed or damaged, it is considered a partial tear, whereas a complete tear is more severe and can actually pull the tendon from the attachment on the bone. Tears happen over time from normal wear and tear, or they can happen traumatically with a fall or strain. 

Small- to medium-sized tears typically respond quite well to physical therapy. A 2016 review of medical literature noted that conservative PT treatment for rotator cuff tears is effective in 73-80% of patients. While this efficacy rate depends on the age and medical history of the patient, the location of the tear, and the severity of the tear, more often than not surgery can be avoided (though in the case of a massive rotator cuff tear or a retracted tendon, the positive response to physical therapy may be reduced).

Meniscal Tears 

One of the most common knee injuries, meniscal tears are typically caused by an activity that twists the knee, and often occur when underlying osteoarthritis is present. An estimated 460,000 patients in the United States get surgery each year to fix tears in this C-shaped piece of cartilage, which acts like a cushion for the knee joint. 

Researchers are currently studying the effectiveness of surgery versus physical therapy in those patients with meniscal tears and knee arthritis. In a study of 351 patients who were 45 years and older with meniscal tears and osteoarthritis, half received physical therapy while the other half underwent surgery. The research did not find any significant differences after 6 months in those who received physical therapy alone and those who had surgery. Additionally, a 2017 literature review found that arthroscopic surgery for degenerative knee disease (including arthritis and meniscal tears) did not give lasting pain relief or improved function. Often, physical therapy is the optimal place to start to address this common knee injury.

Low Back Pain 

One type of back pain, called spinal stenosis, is a degenerative disease that causes narrowing of the space in the spinal canal. This narrowing creates pressure on spinal nerves and can become increasingly painful. Spinal stenosis is sometimes treated with surgery, but physical therapy often works just as well and comes with fewer unwanted complications than surgery, according to a study published in Annals of Internal Medicine in 2015. 

 Degenerative disk disease is also a common cause of back pain and has been studied extensively. Disk patients are sometimes treated with a surgical spinal fusion. However, a 2013 study found no major difference in outcomes between patients who had surgery for degenerative disk disease and those who chose physical therapy instead. 

Physical therapy can't fix every problem, and for some patients, surgery really is the best choice. However, the research continues to demonstrate that surgery is not a cure-all, and in fact is sometimes a very expensive and risky placebo. In many cases, physical therapy is the place to start - and for some, it's the only treatment necessary. 

 

References: 

Peter Edwards, Allan Wang. "Exercise Rehabilitation in the Non-Operative Management of Rotator Cuff Tears: A Review of the Literature". Pubmed Central (PMC), 2021.

"Surgery Versus Physical Therapy For A Meniscal Tear And Osteoarthritis". Vol 369, no. 7, 2013, pp. 683-683. Massachusetts Medical Society, doi:10.1056/nejmx130035. 

Siemieniuk, Reed A C et al. "Arthroscopic Surgery For Degenerative Knee Arthritis And Meniscal Tears: A Clinical Practice Guideline". BMJ, 2017, p. j1982. BMJ, doi:10.1136/bmj.j1982. 

Kuhn, John E. et al. "Effectiveness Of Physical Therapy In Treating Atraumatic Full-Thickness Rotator Cuff Tears: A Multicenter Prospective Cohort Study". Journal Of Shoulder And Elbow Surgery, vol 22, no. 10, 2013, pp. 1371-1379. Elsevier BV, doi:10.1016/j.jse.2013.01.026. 

Barrer, Steven J. "Surgery Versus Nonsurgical Treatment Of Lumbar Spinal Stenosis". Annals Of Internal Medicine, vol 163, no. 5, 2015, p. 396. American College Of Physicians, doi:10.7326/l15-5129.