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How to treat PFS runner's knee

Patellofemoral pain constitutes a quarter of the injuries to the knee.  Kneecap pain can be both debilitating and frustrating; prolonged pain can limit physical activity and cause those suffering from it to abandon their recreational and sporting activities. 

Patellofemoral pain usually manifests as a gradual onset of pain around the edge or underneath the kneecap during physical activities.  Common activities such as descending hills or stairs, squatting, running, or sitting for long periods of time can all aggravate the pain and cause soreness. 

How your knee works

patellofemoral pain image from http://www.moveforwardpt.com/The knee joint is made up of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap).  The patellofemoral joint refers to the kneecap and the groove (trochlea) in the femur in which the patella sits.  The four muscles of the quadriceps all attach to the patella.  The patella is a sesamoid bone (the bone is embedded within the tendon) and it plays a crucial role in the function of the leg by lengthening the lever arm of the muscles and tendons of the quad to maximize power and function and by acting as a shield to protect the knee from direct trauma.  The cartilage covering the kneecap within the knee joint acts as a shock absorber, protecting the underlying bone from stress.  With running and jumping, the knee (and its overlying cartilage) can experience forces up to 8 times bodyweight.  The cartilage itself does not have a nerve supply, but the bone underneath has an extensive nerve supply and these nerves become painful when the cartilage is not functioning properly to pad and protect the bone.

In patellofemoral syndrome, or PFS (also known as runner’s knee), the cartilage undersurface of the patella become angry, inflamed, irritated, and the kneecap hurts.

How to treat PFS or runner’s knee

  1. Loosen things up.  Use a foam roller to roll out the quad muscle and the illiotibial (IT) band.  These tissues all hook into the kneecap and can contribute to pain when they are tight.
     
  2. Make things stronger.   In the early recovery period (the first several weeks when you are just starting out on your recovery journey) ....

Tips for reducing hot flashes for women with breast cancer

Hot flashes are the most common complaint from women going through menopause. And for women who are breast cancer patients, the problem is often more acute. Surgery, chemotherapy and estrogen blocking medications can bring on hot flashes or make them worse if you already have them. And for women who must discontinue hormone replacement therapy, the instant onset of hot flashes and night sweats can severely impact quality of life.

Fortunately, there are several strategies you can easily and safely employ to decrease the severity and frequency of hot flashes and night sweats. Everything I recommend here is non-estrogenic so while it is generally safe for breast cancer patients and survivors, you should always check with your oncologist before trying any new supplement.

First, a few notes on diet. I recently had a patient who stopped eating refined sugars for general health reasons, and her hot flashes nearly disappeared. Your mileage may vary on this one but there are clear health benefits from lowering sugar intake, so it may be worth a try. You might also try ...

MS Research Update: How reliable are biomarkers measured by multiple providers?

Mobility issues secondary to strength, balance, and walking problems affect up to 80 percent of people with multiple sclerosis (MS). Providers and therapists use a variety of scales and tools to measure the extent of these issues such as:

 

  • The Berg Balance Scale (BBS) is a measure of balance that uses a 14-item scale and is scored based upon the results 0-56.
  • The 6-minute walk (6MW) is a measure of walking endurance.
  • Handheld Dynamometry (HHD) is a way to quantify manual muscle strength testing.

 

There is a lot of emerging research about “MS biomarkers,” which are values that look for ways to predict how patients will do in the future. The above tests are “physical biomarkers” of patient performance that may be able to be used as measures of disease state and change over time.

 

Often patients and clinicians are left wondering how accurate the results of these tests are. For instance, if provider A performs a functional test on a patient, will provider B get the same results if administering the same test to the same patient?

Current Exercise Concepts for People with Parkinson’s Disease

Research over the last several years has shown the positive benefits of exercise for people with Parkinson’s disease. Participants in physical therapy exercise programs demonstrate improved reaction time and balance, increased endurance and augmented strength. These gains in function can result in decreased falling, more energy to get around the home or community, and ultimately a better quality of life.

 

Evidence also points to HOW you exercise as an important variable in slowing the disease process. Concepts such as neural priming, movement visualization, whole body exercise, and intensity of practice all contribute to functional gains for people with PD.

 

Come to Swedish/Issaquah on April 22 to hear about these concepts AND get a chance to practice these exercises in class. The event is FREE. Please...

Exercise and cancer

There is plenty of research—and it is increasing every day—showing that exercise is beneficial for cancer survivors, whether during or after treatment. In a recent study published in the Journal of Pain and Symptom Management, Dr. Andrea Cheville, an onco-physiatrist (cancer rehabilitation physician) and colleagues at Mayo Clinic interviewed 20 patients with advanced lung cancer about exercise, its relationship to their symptoms, and the role of their oncology team in counseling them about exercise (video). Not surprisingly, participants considered their usual everyday activities as "exercise". While important in helping to maintain function, everyday activities generally do not reach the threshold to help maintain or improve overall fitness. In Dr. Cheville’s study, exercise was defined as "a systematic way of stressing the body to increase flexibility, stamina, and strength.”

Systematic and regular exercise causes biochemical changes in the body, not unlike medicine. The route of administration however, is different. You can't take an "exercise pill", you have to actively participate. The changes that exercise brings are beneficial. For example, exercise can help reduce fatigue. While this may seem counterintuitive, especially while living with cancer, taking it easy can actually increase fatigue. This is because the body becomes "deconditioned"—the less the body does, the less it can do. Add the fatiguing effect of chemotherapy, and you have a recipe for reduced whole body strength and fitness. Enjoyable and regular exercise is a powerful antidote to the fatiguing impact of cancer and treatment.

In our cancer rehabilitation programs, we often hear survivors express fear that exercise might cause physical harm. Some of the participants in Dr. Cheville's study expressed a similar concern. When exercise is done with a good understanding of what is too much, what is too little, and how to modulate its intensity during cycles of treatment, exercise not only enhances physical and mental well-being, but also helps to reduce symptoms related to cancer and its treatment. In addition to fatigue, these symptoms include shortness of breath, pain, insomnia, malaise and reduced endurance.

The study showed...

Eliminating your risk for stroke

In the clinic, we work with stroke patients and their families to help them understand the risk of having a second stroke and what they can do to reduce their risk. Lifestyle and medical conditions determine your risk for a first, or second, stroke.

  • Do you have high blood pressure and/or high cholesterol?
  • Do you have diabetes?
  • Have you been diagnosed with atrial fibrillation?
  • Do you smoke?
  • Are you overweight?
  • Do you avoid exercise?
  • Has a close relative had a stroke?

If you answered yes to any of those questions, you’re at greater risk for having a stroke. If you’ve already had a stroke, your “yes” answers mean you’re more likely to have another one.

Your lifestyle can help you avoid a first or second stroke. And, because family history is a stroke risk factor, your entire family can benefit from a healthy way of life. Pledge to help each other stick to a routine that includes:

  • No smoking
  • Healthy eating
  • Regular exercise
  • Taking medications are directed
  • Losing weight if you are overweight or obese
  • Drinking alcohol only in moderation
  • Taking low-dose aspirin or a similar medicine (if recommended by your doctor)
  • Managing your blood sugar if you have diabetes.

Exercising in the heat

Even though regular exercise is important for cardiovascular health, exercising in hot weather can lead to heat exhaustion or even heat stroke. These conditions result from the production of excess body heat, overwhelming the body’s capacity for heat release and raising the core body temperature.

What you should know:

The signs and symptoms of heat exhaustion include:

  • heavy sweating
  • fatigue
  • headache
  • pale and clammy skin
  • thirst
  • increased heart rate
  • dizziness or fainting
  • nausea and vomiting
  • muscle and abdominal cramps
  • elevated temperature.

What is heat stroke?

Heat stroke occurs when the core body temperature exceeds 104 degrees F, accompanied by seizure or coma. The primary cause of heat exhaustion and stroke is dehydration with inadequate fluid and electrolyte repletion. Those with the following risk factors are particularly prone to heat exhaustion and stroke: extreme young or old, pregnancy, chronic illness (in particular cardiac or respiratory diseases), alcohol consumption, extreme physical exertion, and certain medications.

So how do I exercise in the heat?

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