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Readers Question: Noisy knees

When I squat, my left knee makes all kinds of noise. And not once, but really a series in a row. It does not really hurt, but I’m worried. And it’s just not a nice sound. Do you have any idea what this can be?

– Menno

Mark Chen, Physiotherapist

Sounds in joints are very common and exist in various forms, for example, there’s “snaps”,”pops” and “cracks”. Sometimes they are a one-time thing but they can also be constant, as you describe in your question. I can immediately reassure you; 90% of all knees crack, and as long as there is no pain, there is no clinical value. This rule of thumb applies to all sounds joints make.

The knee is a bit special when it comes to sound-making and that is mainly due to the kneecap. Visualise the kneecap as a kind of boat, which lies in the bony groove of the upper leg. There’s cartilage between the kneecap and the femur for smooth movement.

If both surfaces are smooth, there would probably never be any sounds. But that’s not how it works for most people. There are countless factors that determine how our knee is loaded and how the cartilage is stressed as a result. Think of sports, work (for example road workers) and footwear. These factors allow the structure to adjust. A “rippled” structure of your cartilage is very normal, but it does provide a bit more friction when there is a lot of pressure on the kneecap. For example, in squatting.

If you still worry after this explanation, there are ways to change the direction of your kneecap. As long as you do not experience pain, however, you do not need to take any action as far as I am concerned. Ask around in your own environment who else has noisy knees and you will be surprised. And in Dutch, we have a saying that would translate to something like this:

“creaky cars go the longest” , let’s hope that applies to your knees as well!

 

 

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Readers Question: Groin Pain

I play soccer and fitness, but during training I often suffer from pain in the groin. Two years ago, my left groin was strained and I started exercising a little bit too soon. Now I have a lot of problems with my right groin during and after training. I find it very annoying during exercise, but also in daily life. Do you have tips?

-Stephan

 

Mark Chen, physiotherapist

You’re partly answering your question yourself. You started training too early. We are all bound to certain laws of nature when it comes to repairing damage in the movement system. This recovery takes place in a number of phases and is time-bound. There are a number of things you can do to speed up the recovery, but speeding it up is not possible. But slowing down is!

It seems that this happened to you. If you have suffered damage to your muscle fibers, they must fully recover before they are able to be stressed at the same level again. Especially in sports like football, where the entire lower body is heavily loaded. Starting your training too early can ensure that your injuries are maintained or worsened. Time to reduce the load and practice patience.

Visit a physiotherapist and have your groin checked. This way you can exclude that damage is still present and make an estimate for how much you can stress the area at this time. Often there are also ways to take pressure off parts of your body during activity. Think of athletic tape for example. These are the brightly colored pieces of tape that you see often nowadays, with football players, runners and even swimmers to support peak effort. Sometimes this can help you to train without your groin being constantly overloaded.

Good luck!

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5 Questions about Athletic Tape

The sports enthusiast is probably already familiar with it: the colored tape that decorates the calves, thighs or arms of (top) athletes. This so-called medical tape is also being used more and more by non-athletes. Why?

Physical therapist Mark Chen explains it.

1. What is medical taping?

“Medical taping is the collective name for taping with the characteristic, brightly colored, elastic tape. There are many different brands (Curetape, Kinesiotape, X-tape) that are all similar in appearance and function.

The founder of medical taping is the Japanese Kenzo Kase. In the seventies, Kase was already a well-known name in chiropractic and acupuncture. His main point is that physical exercise and muscle activity are necessary to prevent or cure physical problems.

The stiff tape that was available at that time and was used mostly to restrict the freedom of movement of a muscle or joint did not have this effect. Kase, therefore, looked for a tape was more like human skin. In this way, you can improve the physical functions and support injured muscles and joints, without restricting the body’s movement possibilities.

Thus, after years, Medical tape was put on the market. In the last ten years, Medical tape has also gained a lot of popularity in Europe and more and more physiotherapists are becoming skilled in medical taping. ”

2. What kind of injuries medical taping suitable for?

“Medical tape can be used for many different types of injuries.bApplications of the tape are nowadays mainly seen in the sports world. In case of problems in the musculoskeletal system, the tape is often used to support joints or to influence muscles to increase or decrease the load on that structure.

The tape can also be used for posture correction, swelling reduction, pain reduction and improving skin condition for example with scar tissue. Medical taping is extremely versatile. Not all therapists are trained to apply all aspects of the tape, so ask your practitioner for the possibilities. ”

3. What kind of tape is used?

“With medical taping, the tape is used that has the same elasticity as the skin, is very thin and sticks well, it is ventilating, skin-friendly, moisture-resistant and anti-allergic, but it is advisable to apply the tape to a dry, clean, hair-free surfaces.

There are several brands of tape and the type used will differ per therapist. I myself have experience with one type of tape (Cure Tape), so it is difficult to give an objective opinion about which is best. It is ultimately a matter of which tape works best for you.

4. Can you do everything ‘while taped’?

“Depending on the technique and the skin of the client, the tape can last between four and ten days, during which time you can do everything with it: exercise, showering and even swimming! The tape breathes and transports moisture, so it causes no mushy skin under the tape. Of course, intensive use shortens the lifespan of the tape. ”

5. Can you also apply medical taping yourself?

“Yes, it is certainly possible to tape yourself.” Depending on the problem, location and technique, it is sometimes useful to tape yourself (learn with a physiotherapist), which gives you more freedom, especially if you have to be taped regularly. this reduces the number of treatments that you need with a physiotherapist as well.

Nowadays there are even pre-packaged, custom-cut packages for sale at some sports stores. They provide enough tape for self-taping once with an explanation in text and illustration. However, I would advise you to buy a roll of tape and find a certified therapist to teach you how to do it. It guarantees a professional approach and is cost-efficient.

Help me with this

Readers Questions: Preventative Physiotherapy

“I regularly suffer from back pain. Does it make sense to visit a physiotherapist every month just for maintenance? Can I prevent problems this way?”

-Francine

Mark Chen, Physiotherapist

Maintenance based treatment is certainly a possibility. Your physical therapist can ensure that your muscle tension remains under control, the joints maintain a good mobility and he/she can prescribe exercises.

Still, it is better in my opinion to take a good look at why you regularly suffer from your back. The spine is perhaps the most complex part of our mechanical system and almost everyone gets to deal with back problems sometime in their life. Often a lot can be explained from your lifestyle. Sitting a lot, for example, is a factor that is often overlooked, but has a major influence on the functioning and health of the spine.

Changes in pulling forces

The constant shortening of the hip-flexors changes the strength-length ratio of the muscles around the hips and the pelvis. These have a direct influence on how you move. This “strength-length ratio” acts as a tug of war between the muscles. Constantly, both teams work equally hard to keep everything balanced. Sitting a lot, lifting it incorrectly, a one-sided load during hobby or sport (tennis, darts, golf) can ensure that one of the “teams” gets an extra player, which destabilizes the balance.

“Weak Spine”

Of course there can be many other causes. For example, I get to see clients with a “weak back” a lot. I myself am rather concerned about that term because it suggests that it is something that can not be fixed. Time and time again I’m struck by how little control we have over our spine. And we have use it for so many things!

To return to your question: It is worthwhile to visit a physiotherapist for maintenance , but don’t go just for a massage or a manipulation. Look further. Dig deeper. Exercise and aim to get stronger.

Try to put together the pieces of the puzzle that cause your back problems and look for a long-term solution together with the physical therapist and/or personal trainer.

 

Help me out!
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Reader Question: Swimming for Arthritis ?

I have osteoarthritis throughout my body. My neck, shoulders and right hip are the worst. Which sport can I practice? I would like to swim, is this possible?
– Lida

 

Mark Chen, physiotherapist:

Osteoarthritis means that the quantity and sometimes quality of the cartilage is reduced. We also call it ‘wear-and-tear’. This is a normal phenomenon and sooner or later we will all experience it. It can cause pain symptoms but it doesn’t have to. The cartilage acts as a shock absorb-er. The joints can start to hurt if there is too much pressure on the amount of cartilage.

Swimming is therefore often an obvious choice; in the water you only weigh about 20 percent of your weight ‘on the dry’. So it is a very friendly way of moving for your joints. In addition, you also use almost all muscles while swimming. It provides a good blood circulation and improves the endurance of the strength-supplying muscles. Swimming can also ensures a quick improvement of the cardio-vascular system! Swimmers are among the fittest athletes in the sports world.

There are, however, a number of side notes to make. Posture and technique are important during swimming. Especially the neck can sometimes suffer severely. Take for example the breaststroke, which is popular with many swimmers. Take a good look and you will see many people swimming with an unnatural position of the neck. Almost as if the head is forced to be kept above water. If there is wear and tear at the vertebrae where this “kink” exists, it could cause more complaints instead of less.

The same applies to the shoulder. A considerable amount of movement is needed to make a nice stroke and sometimes osteoarthritis is accompanied by clear limitations in mobility.

Swimming is a nice and friendly sport for the body, but I recommend to look at the above factors. Any physical limitations can be picked up and possibly treated by a physiotherapist possibly in combination with a swimming instructor.

 

Good luck!

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30 Second Posture test

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Episode 1: 30 Second posture test

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5 Questions about Cupping

  1. What is Cupping?

    Cupping involves the usages of glass/wood/silicone cups that are used to create a vacuum on the body. Depending on the chosen method, these will either stay in place for 5-15 minutes (traditional cupping)
    or moved around the area (Gliding). There is also a less well-known version called “Wet Cupping”, with which small cuts are made before the cups are applied. During this version, the cups will be filled with blood from the client. Needless to say proper hygiene and qualification of the therapist are of extra concern with this method.

  2. What are the benefits of Cupping?

    There are multiple benefits from cupping. The most well known reasons to use cupping is to speed up muscle recovery after workouts. This was very commonly seen in the last year’s Olympics, where multiple athletes were seen walking around with the typical marks from a cupping treatment. Because cupping is very non-invasive and doesn’t cause much side effects, it’s a very common choice for athletes after competition or training.Aside from the physical effects, Cupping is very well known for it’s soothing effects on the central nervous system. For this reason, the treatment is often chosen as a pain reliever or to fight stress in general.

  3. How does Cupping feel?

    A lot of my clients describe it as a “reverse massage”. This makes sense since instead of being compressed, the skin and connective tissue is being pulled up and decompressed. Traditional cupping, depending on the amount of vacuum and duration of the treatment can be a bit uncomfortable, whereas gliding is typically experienced as very relaxing. Your therapist is supposed to monitor how you feel during the session and adjust when necessary.

  4. What do the colors mean?

    The skin can show different reactions to Cupping, and each has a meaning as you can see below in the picture. Sometimes Cupping is used as an “assessment”, to get an idea of what’s going on in the area underneath the skin. If area’s display moderate or sever stagnation, these points are often focused on more during follow up treatments. Usually we see these markings become less and less noticeable as the client starts to react to treatment.

  5. Where can I experience Cupping?

    In Asia, Cupping is a very common treatment method and is used to support the body while fighting disease and therefore is very easy to find. When choosing this option, make sure the hygiene standard is good enough since dirty cups can cause infection.
    Also, in most of these establishments there is no underlying physiological knowledge. If you want to get cupping done for specific problems or body parts, it is best to find a Physiotherapist that is also educated in Cupping.

 

Of course, feel free to contact me if you’d like to experience a session!

 

 

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Myths busted: Is your spine “Out of Alignment?”

So many time clients with spine issues tell me the following:

“I’ve had this in the past and my spine was out, so it had to be put back in place”.
Usually, they refer to a manual therapist or chiropractor that did that for them.

I believe this needs to be addressed since it’s simply not true and it can create problems which I’ll explain.

But first let me point out that the spine is a very strong and robust structure. It cannot simply be pushed into and out of alignment by quick thrust. If that would be the case, Rugby players and MMA fighters would be in serious trouble after nearly every match.
Also, in Australia, recently some students tried to take apart an SI joint. It took them more than an hour, 2 students, a hammer and lots of sweat to do it. There’s a small chance that if that’s the case, a microsecond and a quick thrust will provide any structural change.

As a matter of fact :

“No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal, this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.” 

Why is this misconception a problem?

Saying that a client’s spine “is out” creates two problems in my opinion:

  1. dependency on the practitioner or technique used to “correct” the problem.  It’s the practitioners duty to inform the client correctly and in my opinion, and provide information and/tools to empower the client to take manage or restore their own bodies’ function. We as health professionals can and should help this process but dependency on us should be avoided.
  2. False beliefs about a structural “dysfunction” of the spine. Saying something is “out of place” and “needs to be adjusted” creates the idea that there is something wrong with the spine. The next time a client deals with pain, a logical consequence would be to think “my spine is out again”, which will result in thinking that manipulation is needed to fix the problem.

Both of these issues can be avoided simply by not using these terms anymore. Spinal manipulations definitely have clinical value but we should aim to provide information that is accurate and beneficial to the clients beliefs, aside from just treating them.

The Epidemiology of low back pain. (Hoy D1Brooks PBlyth FBuchbinder R.)