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PrintIs the Outcome of ACL Surgery really better than Conservative Management?
If you have sustained an ACL ( Anterior Cruciate Ligament of the knee) tear and is considering an ACL surgery, you would find it useful to know more about the latest research discussion on ACL surgery versus Physical therapy management.
Bracing for Scoliosis
How many types of braces are available for scoliosis?
In general, there are 2 main types of braces: hard brace and soft brace.
Hard braces are made of thermoplastic. It has been the main brace prescribed over the last a few decades. Common types of hard braces are Boston’s, Charleston’s, and Milwaukie’s etc.
| Hard Brace | Soft Brace |
Like what its name suggests, it is hard and non-flexible, and wearing which limits movements of the spine. Hence it greatly affects one’s sports participation and causes significant comfort and tolerance issues. Additionally, hard brace is usually bulky and heavy, and shows under the clothes, it is not easily accepted by image-conscious teenage girls. Besides, it also creates much stiffness of the spine, weakness and tightness of the spine muscles.
Soft brace on the other hand, allows movement of the spine when worn. Therefore, the spine is much more mobile during and after the treatment, there is also much less muscle imbalance and joint stiffness of the spine.
Currently the only available soft brace for scoliosis is SpineCor brace. You can get more information on SpineCor brace by following this link: http://www.spinecorporation.com.
How different are the two types of braces? Is one definitely better than the other?
It’s hard to say which brace is definitely better than the other, they work on different principles. Hard braces are designed to hold against spine deformity statically, soft brace on the other hand, is designed to use dynamic force to target on bone deformity and muscle re-training and balancing.
Both hard and soft braces can be effective before the bones of the spine reach maturity, which is usually between 13-15 years old for girls and 15-17 years old for boys. Hard braces can be used for any types of scoliosis such as neuromuscular scoliosis, congenital scoliosis, and idiopathic scoliosis. SpineCor brace is designed for idiopathic scoliosis only.
Both braces need to be worn regularly throughout the day (16 hours per day). Soft braces are lighter and more comfortable to wear; it is more cosmetically acceptable as it can be well hidden under the clothes. It also allows better posture & muscle development, and is able to promote good mobility of the spine while correcting the curve. Hard braces are usually much heavier and hotter to wear and may result in a poorer compliance compared to soft braces.
For people who participate in sports like dancing, gymnast, running or badminton, soft brace is of a much more practical choice. Soft brace is also recommended for individuals who are more prone to skin problems or who are likely to have compliance issues.
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Knock Knees – Can I reverse it? (Part 2)
In the previous entry for Knock Knees, we discuss about the different types of knock knees and the contributing factors of it. Now, we will talk about the problems of this condition and ways we could get rid of it.
The Problems of this condition
The alignment of the knee joint in someone with knock knees is such that there is an increased force on the medial (inner) part of the knee joint. This can predispose the knee joint to osteoarthritis because of the increased loading on the medial compartment.
Symptoms from this may not even present within the knee joint, you may have ankle problems or hip problems as a result of having knock knees.
How do I get rid of it?
External aids:
1. Orthotics
The knee joint may appear to be misaligned if the foot is not biomechanically sound. This means that someone with a very pronated/inverted/flat feet may be at risk of developing a symptoms similar to someone with knock knees. Placing an insole or orthotics device may help correct the foot position, and indirectly the alignment of the knee joint.
2. Knee braces
These can help prompt correct alignment of the knee joint, but may create a degree of dependency.
3. Strengthening
A physiotherapist can design an exercise program to help strengthen weak muscles. By focussing on the specific muscles that require strengthening, you will put your body is a safe healthy direction, and will be able to train for all types of sporting challenges and limit your risk of injury.
4. Stretching
Stretching is an important component of knock knee reversal. When a joint has spent all it’s time in a misaligned position, certain structures will shorten and become stiff. Stiffness in the joints and muscles will make it very difficult to train and strengthen the area. A physiotherapist can assess the position of your knee, ascertain which structures are tight, and give you an appropriate stretching program.
Knock Knees – Can I reverse it? (Part 1)
Knock knees is a phenomenon where it appears as though your knees are at an inwards angle in relation to your feet. Most kids under the age of 6 appear to have knock knees, but grow out of it as their body shape changes. An adult with knock knees may or may not have pain – mostly depending on the severity.
In this article, we would discuss on the different types of knock knees and the contributing factors that may develop with this condition.
When discussing the reasons for knock knees, structure of the bones and joints must be assessed. Structural reasons for knock knees are not normally reversible, unless surgery is indicated. When it comes to the strength, control and stiffness of muscles that control the alignment of the knee, a full assessment must take place so that a corrective program can be enforced.
Structural reasons:
Genu varum: … Not Reversible
A structural deformity of the knee joint, causing the lower leg to be angled inwards and the upper thigh to be angles outwards, causing a bowing effect.
Tibial valgus: … Not Reversible
This is a deformity of the tibia.The bone angles outward towards the end furthest from the knee joint.
Coxa Varum: … Not Reversible
A deformity of the femur; the angle between the head and shaft of the femur is more acute, making the shaft of the femur angle inwards.
Q angle: … Not Reversible
This is the angle between the line of the femur, and the line of the mid patella – tibial tuberosity. A larger Q angle will mean more biomechanical problems within the knee joint.
Poor strength of:
Hip external rotators: … Reversible
- Gemellus inferior & superior
- Obturator internus & externus
- Quadratus femoris
- Piriformis
- Gluteus maximus
- Gluteus medius posterior fibers
- Sartorius
Weakness in these muscles will cause the femur to internally rotate causing an increased ‘knock knee’ effect.
Hip abductors: … Reversible
- Gluteus medius
- Gluteus minimus
- Tensor fasciae latae
- Sartorius
Without the strength of these muscles, the femur is more likely to adduct, increasing the knock knee appearance.
Quadriceps: … Reversible
- Rectus femoris
- Vastus medialis, lateralis & intermedius
Asymmetry in the strength of this muscle group may result in misalignment of the knee joint, giving the appearance of knock knees. Generally it will be the inner most compartment of this muscle that is weak.
Hamstrings: … Reversible
- Biceps Femoris
- Semitendinosis
- Semimembranosis
Similar to the quadriceps, asymmetry in the strength of this muscle group i.e. inner most compartments (semitendinosis and semimembranosis) may lead to this appearance.
Poor control of:
Hip External rotators: … Reversible
Hip abductors: … Reversible
Lumbo/pelvic muscles: … Reversible
If these muscles are not controlled well because they have poor activation or endurance, they muscles will not be able to hold the knee joint in a correct alignment constantly. In other words, the muscles will get tired, and they will not be doing their job.
Stiffness in the:
Hip: … Reversible
Tight muscles in the hip region may limit the range of motion available. If the joint is not moving correctly, the required muscles will not be able to work to correctly align the knee joint.
I have corkie (bruise)? What should I do?
Almost everybody experiences corkies or bruises during his lifetime. Some people are more prone to develop corkies than others. In many cases you don't have to worry about a corkie but it is important to know at which stage you should see a doctor.
What are Corkies?
Corkies are also known as bruise or contusion. They are a type of a relatively minor bleeding (hematoma) of your tissues in which small blood vessels are damaged after a trauma. Bruises can occur at different layers of the body and include skin, deeper tissue, muscles and bones. Most bruises happen after a fall, hitting an object or getting a hit during sports. In many cases it takes a while till you notice a corkie and you will not immediately feel the symptoms right after an incident. Typical areas for corkies are at the front of the thigh, shin, at the frontal pelvic bone (hip pointer or iliac crest) and on your forearms.
How do I know I have a corkie/bruise and what are the symptoms?
A corkie presents with the following symptoms:
- initially short severe pain during trauma (hit, fall as mentioned above)
- later the pain reduces and becomes more of a local tenderness
- swelling (not always)
- bleeding (hematoma- dark blue colored spot on the skin)
- pain during action /use
What are the contributing factors?
The size and shape of a bruise is influenced by several factors such as age, condition- color and type of tissue. Furthermore the location, striking force of a hit or blood disorders (coagulation problems) have an impact on the size and shape of a corkie.
What should I do when I have a corkie?
The treatment of light corkies includes:
- RICE (Rest, Ice, Compression, Elevation) to reduce pain and swelling
- painkillers
- soft stretching after a few days when the pain settled down
- after the inflammatory phase (3-5days) heat to loosen up tight muscles
When should I see a doctor?
You should see a doctor if you have a moderate-severe corkie/bruising. This is indicated if:
- you have severe pain and tenderness
- you develop a massive swelling
- movements of the affected area are very painful
- you have a big corkie without any explanation/reason
Note: If you have unexplained bruises which occur very frequently over a long period of time it is advisable to see a doctor to rule out skin or blood disorders (platelet or coagulation disorder). Furthermore unexplained bruising may also be a warning sign of child abuse, internal bleeding or other serious health problems. The usage of several drugs (e.g. steroids, blood thinners) can cause easier bruising.
How long does it take for the corkie to disappear?
Normally light bruises heal within 2-3 weeks. Depending on the severity and the individual healing process it can take longer. Deeper bruises take more time to heal.
Shoulder Anatomy Video
In this post, we will take a look at what are the structures in our shoulder.
What can be done for Scoliosis?
Must I have surgery if I have scoliosis?
No. Surgery is usually only indicated when the curve is bigger than 50 degrees, or is severely affecting one’s everyday activities or his / her quality of life. Majority of scoliosis cases do not require surgery. Surgery will only be considered when the curve continues to worsen in spite of bracing or exercises, and is progressing near or beyond 50 degrees.
The degrees of scoliosis curves are measured by Cobb’s angle.
One must be aware that there are complications with scoliosis surgery, such as stiff spine, spine muscle weakness and possible rods breakage. The spine will no longer grow again after scoliosis surgery, so if it is to be performed in growing children, it should be delayed as much as possible in order to preserve the growth of the developing spine.
What else can help control scoliosis besides surgery?
Besides surgery, the most common treatment is bracing and physiotherapy.
The purpose of using a brace is to control the progression of a curve, but not to eliminate it. Bracing is indicated when the scoliosis curve is between 25-40 degrees, and when the spine has not yet reached full maturity, which is usually between 13-15 years of age in girls, and 15-17 years in boys. In the case that though the curve is smaller than 25 degrees, but worsens more than 5 degrees within a period of 6 months, a brace is also recommended. To ensure the effectiveness of the brace, it needs to be worn 18-20 hours a day through the growing years.
Physiotherapy works to strengthen the weak muscles, to improve the flexibility of the shortened & tight tissues. It helps slow down the development of muscle imbalance and joint stiffness, and helps reduce back pain. It benefits individuals with scoliosis either are or are not on braces. The stiffer the curves are, the more strongly physiotherapy is recommended. Furthermore, physiotherapy enhances the correction achieved by braces during the bracing and after the brace is weaned off.
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