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Re: Patella Tendonosis or 'Something Else'?
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Re: Patella Tendonosis or 'Something Else'? - June 29, 2006 5:36:00 PM
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ginger
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From: Melbourne Victoria
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Lovely rant proud, I would have offered a bit of the same but for my eyes mysteriously rolling upwards each time I mutter CS...T, bugger, there they go again.
Pete, a successful PT in private practice will have had numerous occasions to relate to those who come with more than the average amount of treatment information. I treat several physios and medicos myself, so need to be ready for the incisive questions. I would not be put off by being capable of asking questions and demanding answers , either here or in the company of anyone you choose to treat you.
Wish you well.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Patella Tendonosis or 'Something Else'? - June 29, 2006 6:46:00 PM
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TLB
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Proud,
What a great post I really couldn't agree more. Ginger, I have something for you. In my clinic we had 2 different PT's pt's come in with dx of achilles tendonitis, nothing in the subjective or objective indicated AT. When asked about back issues both said yes and a little mob here and there the AC resolved in 3 Rx. I think there's something to this neuromodulation type of treatment, how's that case study going?
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Todd
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Re: Patella Tendonosis or 'Something Else'? - June 29, 2006 8:49:00 PM
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nari
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From: Australia
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Proud,
I agree up to a point - EBP was invented to prevent funny PTs and doctors amongst others doing whatever they wished. Fine as that goes, as long as it doesn't blind PTs' ability to think and understand; to some extent it does.
Feldenkrais is considered 'fringe' but he recognised the importance of the brain and although it was not described as neuromodulation his techniques did just that.
When patients come in with so-called adhesive capsulitis and it is resolved within a couple of weeks with neural mobs (well, to acknowledge Ginger, maybe some spronging on ZPJs)and other neuromodulatory methods...well, I find it hard to understand why PTs are so resistant and prefer long timeframes of graded exercising and passive techniques....but maybe in the future...
Pete,
Any good therapist with a solid background of knowledge and understanding of physiology, would not mind at all if you went in with questions and suggestions. If he/she does mind, then it does not seem a bright idea to continue with them.
Nari
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Re: Patella Tendonosis or 'Something Else'? - June 29, 2006 9:19:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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bloody marvelous
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Patella Tendonosis or 'Something Else'? - June 30, 2006 8:37:00 AM
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proud
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Nari,
Wait a second. How does following EBM limit a clinicians ability to "think"???
Quite the opposite in my opinion.
The more I learn about what the evidence tells me, the more I am forced to think even harder!
I just do not know where this notion that EBM limits our ability to think. If by "limiting our ability to think" you mean limits our ability to "make stuff up"...then that's alright with me.
And neuromodulation as you mentioned, can be supported with EBM...
On a secondary note: To those of you who do CST and claim "whatever...it works". May I propose that in all likelihood you were treating an indivdual with hidden( or not hidden) psyco-social issues...somehow through the wonderful placebo effect, interrupted the pain cycle for a short while? However did absolutely nothing to rehabilitate the client.
In fact, by "floating your hands around" like some crazy snake oil clinician, you may have delayed the appropriate treatment the client required( CBT, appropriate referal to a specialist, exercise etc).
Sure they left your clinic claiming to feel better...but what is the long term outcome?
It's unethical treatment in my opinion.
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Re: Patella Tendonosis or 'Something Else'? - July 2, 2006 2:57:00 PM
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ginger
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From: Melbourne Victoria
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Nari, spronging, thats cute, I'm keeping that. I can see it on my brass plaque now.LOL.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Patella Tendonosis or 'Something Else'? - July 2, 2006 5:06:00 PM
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nari
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Proud
There have been articles about the downside of EBP in the BMJ, and other sites, but regretfully I have not kept them in core storage.
I am sure it is good for keeping out weird practices, whatever they may be; but the point I want to make is this - if EBP involves practising only what has been deemed solid 'evidence', the chance are, science being what it is, it will all change in a few years as knowledge increases. There is no such thing as a truth, only a theory, which is why EBP simply presents as guidelines.
If one works from a solid basis of knowledge and not airyfairy stuff with no physiological basis, it is much harder work; whereas it is easy to fall into thinking: Method X has been studied to be more effective for conditions A,B,C than method Y or Z (plus or minus variables), therefore for these conditions I will use only method X. No thinking required.
I am not saying at all this is what you do - I am thinking of PTs who are only too happy to follow a few studies and not think about questioning their consistent relevance to patients in the clinic. Science exists to be questioned; not followed blindly. That is the pitfall; and so many studies fail to take into account the human factor variables.
Ginger - you like? It's free.
Nari
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Re: Patella Tendonosis or 'Something Else'? - July 3, 2006 3:21:00 AM
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JLS_PT_OCS
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I can't add much to Nari's last post -- except to make sure to point out that Feldenkrais treatment is very well supported in the biofeedback, relaxation, and CBT literature.
Lack of outcome studies alone doesn't make something "non EBP". It's the theoretical foundation upon which it stands and the practitioner's approach which matters.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Patella Tendonosis or 'Something Else'? - July 5, 2006 4:20:00 AM
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Pete.
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Thanks very much for the replies and suggestions. I went back to my physio this morning and asked about L3,L4 passive mobilisations. He worked his way up and down my spine with his thumbs (for a couple of minutes) and stretched my back, which he said was 'tight'. He doesn't appear to be a fan of passive mobilisations, and short of printing off Ginger's instructions on how to do them, I didn't really know what to say about that. He seems to be concerned that the pain hasn't responded at all after 3 sessions of friction massage.
By the way, the pain came back after the Craniosacral Therapy session.
I'm really at a loss with this knee. Can I do a quick recap in case any one has seen something like this before and has any suggestions:
- Pain has been going on for over 5 weeks. Before it flared up I was getting more discomfort after exercising. It marginally improved after a couple of weeks then plateaued.
- pain most days, for most of the day. Every few days it will diminish to just being uncomfortable for a day, then flare up again.
- worse at night, to the point where it wakes me up. It's 3-4 out of 10.
- there was a very clear focus to the pain yesterday and last night: at the top outside corner of the patella, just where it meets the femur. I also have a bump ('traction osteophyte'? on the patella around that spot). During the night the pain move around to be more medial and a general ache. There's never a sharp pain, just a strong ache.
- The knee may be very slightly warmer than the other, good, knee.
- The VMO on the bad knee seems to have some kind of firing problem: slower and sort of awkward, it sometimes feels like I have to concentrate on it to make it fire when the knee is bent, whereas the vastus lateralis fires earlier and stronger: the contrast with my good knee is quite apparent.
- I'm currently doing a daily workout of 5 x 30 seconds of quad stretches, 15 slow eccentric squats on an incline board, 3 x10 leg raises with ankle weights. I think that these exercises may aggravate it (it's fine doing the exercises, but there is soreness later). Mind you, even driving the car or walking up stairs seems to set it off.
-There's hardly any tenderness on palpation around the patella or patella tendon. Just some discomfort at a particular spot on the tendon when doing friction massage. The physio doesn't think I have chondromalacia because (a) the cartilage was 'pristine' when I had an arthroscopic plica removal last September (b) he can't feel any crepitus.
I still have questions:
1. Does this sound like patella tendonosis?
2. What else could it be? Could there be two things going on at once? I'm just wondering about something unusual like bipartite patella (the pain flared up suddenly in the night after doing crossed legs hip stretches).
3. Should I keep doing the quads stretches and strengthening exercises even if they aggravate the knee? I read that Jason Silvernail fixed his tendonosis by exercising into pain with heavy weights. I'm just a bit wary of that because I'm not sure that what I have is just tendonosis (or even tendonosis at all)
I guess that I'm really hoping that someone on here will be able to say 'yup, seen this before lots of times, and this is how to fix it'. I will try to get a second opinion from other physios in my city, but I figure there's a wealth of experience on this forum.
Thanks very much
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 5, 2006 5:05:00 AM
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PTupdate.com
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At this point, I'd chill with the exercises, wear a neoprene sleeve for support/reminder, and use ice 10 minutes out of every 30, and start NSAID's if no health issues. Once calmed down, and you can sleep, then you can begin the program. Not sure if tendinosis from what you are describing, but could be a ton of other thigns, from chondral irritation of the patellar cartilage, synovitis, infrapatellar bursal irritation, and on and on. You've got a "hot" knee and just need to take care of that problem..don't put the cart before the horse.
Duffy
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John M. Duffy, PT
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www.PTupdate.com
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Re: Patella Tendonosis or 'Something Else'? - July 5, 2006 5:18:00 AM
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Pete.
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Thanks Duffy! I'll lay off the knee and get icing. Any recommendations re which neoprene sleeve to buy, or are they all basically the same?
Cheers
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 5, 2006 5:19:00 AM
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PTupdate.com
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Just go to a sporting good store and get something around 15 bucks with patellar cut out, and p erhaps a sewn in donut pad. It's more for the reminder "hey, I've got a f-ked up knee and should not be doing that"
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Patella Tendonosis or 'Something Else'? - July 5, 2006 5:35:00 AM
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Pete.
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Thanks - I don't need much reminding at the moment, but I take your point: once I have a relatively good day I tend to get a bit gung-ho.....
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Re: Patella Tendonosis or 'Something Else'? - July 6, 2006 4:11:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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Pete, I do understand your frustration with having only a cursory attempt at fixing your referred knee pain . I can only urge you to either explain the method more carefully to your PT , or find yourself an Aussi trained physio.
best of luck.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Patella Tendonosis or 'Something Else'? - July 7, 2006 3:10:00 AM
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Pete.
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Thanks Ginger - any ideas on how to locate an Aussie trained therapist? Is there something specific I could ask when contacting them by phone? I know that there are some McConnell trained physios in London, but that is 150 miles away. I' m going to see another physio on Monday for a second opinion.
Cheers
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 7, 2006 9:11:00 AM
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Pete.
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Thanks Ginger - any ideas on how to locate an Aussie trained therapist? Is there something specific I could ask when contacting them by phone? I know that there are some McConnell trained physios in London, but that is 150 miles away. I' m going to see another physio on Monday for a second opinion.
Cheers
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 7, 2006 9:13:00 AM
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Pete.
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Thanks Ginger - any ideas on how to locate an Aussie trained therapist? Is there something specific I could ask when contacting them by phone? I know that there are some McConnell trained physios in London, but that is 150 miles away. I' m going to see another physio on Monday for a second opinion.
Cheers
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 7, 2006 9:17:00 AM
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Pete.
Posts: 25
Joined: June 25, 2006
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Thanks Ginger - any ideas on how to locate an Aussie trained therapist? Is there something specific I could ask when contacting them by phone? I know that there are some McConnell trained physios in London, but that is 150 miles away. I' m going to see another physio on Monday for a second opinion.
Cheers
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 7, 2006 10:35:00 AM
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Pete.
Posts: 25
Joined: June 25, 2006
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Thanks Ginger - any ideas on how to locate an Aussie trained therapist? Is there something specific I could ask when contacting them by phone? I know that there are some McConnell trained physios in London, but that is 150 miles away. I' m going to see another physio on Monday for a second opinion.
Cheers
Pete
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Re: Patella Tendonosis or 'Something Else'? - July 7, 2006 11:11:00 AM
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nari
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From: Australia
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Pete,
I agree that exercising is often more nociceptive (irritating) than helpful. Your system is telling you that, by the appearance of pain after finishing the routines. This is chronic-type pain, rather than acute local pain, which would occur during exercises, as well as afterwards.
I don't think the pain is anything to do with your knee, and if the second PT does not think "away" from the knee, then you are a bit stuck.
Resting it, as Duffy suggests, sounds the best way for now.
Pain occurs when the brain figures there are threats to the body's safety (that is a long story..and a wonderful one) and putting it into a soft brace might just reduce that threat.
No exercising - just normal every day activity.
"Normalise" your day as much as you can. I would not recommend McConnel at this point, because of the rigorous exercises involved.
But try this:
Put a piece of tape, any sort of tape, about 4" long, somewhere around the knee, anywhere you like. Don't pull it tight, just place it somewhere near the patella, above it or below (NOT over it) with your knee bent about 45 degrees. That's all.
If you feel a bit of a difference after an hour or so, try another strip in a different place.
If you react to tape, buy the most hypoallergic tape you can find -the chemist can help there.
This has worked well for pain resolution in a lot of patients. Worth a try.
Leave it there, until it falls off. Let us know the outcome after a few days.
Nari
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