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Plica issue

 
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Plica issue - November 22, 2015 10:25:19 AM   
LBDPT

 

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Ok, yet another injury. Was running an easy 10 miles, having done a 10 mile race the week before and a half marathon 2weeks before that with no issues. This was after 2 months off bc of left foot plantar fasciitis. Feet started to hurt, had used different running shoes, kept going, felt pull in right proximal gastroc muscle, walked home. Calf pull, treated with ice, meds, sleeve, twisted knee while treating babies in a side sit position. I am a pediatric and Ortho pt. Dx 2 weeks later by Ortho of irritated plica, given injection, helped for two days. Symptoms pain medial to patella with walking and running. Advice?
Bethpt
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RE: Plica issue - November 23, 2015 5:58:52 AM   
ginger

 

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plica schmica Beth, you have a back problem. L3 ( medial knee ) and L5 ( calf and foot ), you need someone with decent hands to do some CM . Good luck.

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Geoff Fisher
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(in reply to LBDPT)
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RE: Plica issue - November 24, 2015 7:36:18 AM   
LBDPT

 

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Ginger, not disagreeing. Please come to New Jersey.

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RE: Plica issue - November 25, 2015 6:21:45 AM   
ginger

 

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I've never been to continental USA Beth, bit worried about your gun crime stats, bigfoot and the price of coffee ( decent coffee also hard to find so I'm told). Apart from which I'ts summer here and not there. I'll come up with some better excuses , gimme time.

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Geoff Fisher
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RE: Plica issue - November 27, 2015 11:42:25 AM   
jesspt

 

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Uh, plica? What?

Any reason why this can't just be patellofemoral pain?

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Jess Brown, PT
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RE: Plica issue - November 28, 2015 1:13:48 PM   
Tom Reeves DPT ATC

 

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Plicae are irritated by the same things that irritate patella-femoral syndrome. pinching things laterally or stretching things medially, its all because of inadequate control of the pronation of the foot, bad shoes, tight ITB, tight gastrocs, tight soleus, silly exercise habits, or leg length discrepancies. Most likely more than one of the above making the knee do what it doesn't like to do.

Every thing is from the spine, right Geoff?

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RE: Plica issue - November 28, 2015 9:11:25 PM   
Chocco

 

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Pain with walking/running.What about squatting/stairs?

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RE: Plica issue - November 29, 2015 12:05:21 AM   
LBDPT

 

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Chocco, squats with weights fine, crawling fine (pediatric PT, lots of crawling), hurts with walking. Not a patella femoral type pain, medial to patella, hurts with deep pressure also. Thanks, Beth

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RE: Plica issue - November 29, 2015 12:09:53 AM   
LBDPT

 

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Knee pain started after severe, brief pain while in side sit , knee was flexed and internally rotated, went to move ankle which was fixed in sneaker, had calf sleeve on also, felt sharp pain in knee, next day knee pain, has lessened but still bad. That's why I thought meniscus or acl, no swelling at all. Ortho feels I pinched and irritated pli a.

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RE: Plica issue - November 29, 2015 4:44:35 AM   
ginger

 

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Most MSK things yes Tom. One cannot adduce the prospect of local nociception giving rise to pain until or unless the stronger likelihood of a referred event from the spine has been thoroughly and exhaustively eliminated. In most cases of non
traumatic medial knee pain the spine will be the primary source of that nociception. In this case made the more likely by the presence of similarly produced (L5 in the case of the calf) other referred events .

< Message edited by ginger -- November 29, 2015 4:45:42 AM >


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Geoff Fisher
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RE: Plica issue - November 30, 2015 9:04:44 AM   
Tom Reeves DPT ATC

 

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sometimes knee pain is just that, knee pain. local inflammation is the best way to get the brain's attention.
I would rule out the local before moving to the central. Thousands of microtraumas that exceed the local tissue's ability to cope is traumatic, and causes inflammation.

< Message edited by Tom Reeves DPT ATC -- November 30, 2015 9:08:25 AM >

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RE: Plica issue - December 1, 2015 4:31:56 AM   
ginger

 

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Which, unfortunately , is the backwards way that leads to the incorrect diagnosis of huge numbers of referred events each day, leading not just to a delay in appropriate treatment, but often to the inappropriate and often multiple surgeries that plague unwary health consumers everywhere.
Assuming a local cause first doesn't make neurological sense .
Every day , with almost every new patient I see, the same reports of useless and time wasting applications of this same wrong thinking coming through my door. I have entirely given up attempting to script a response to the question " why didn't they/he/she know?" that allows any escape from the obvious ,
" they had absolutely no f*****g idea."

< Message edited by ginger -- December 1, 2015 4:34:23 AM >


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Geoff Fisher
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South Melbourne

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RE: Plica issue - December 14, 2015 8:43:51 AM   
Tom Reeves DPT ATC

 

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so if you bash your medial knee on the floor playing basketball and your knee hurts and it persists beyond 2-3 days. You mobilize the spine? could it not be a local inflammation that requires local management?

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RE: Plica issue - December 14, 2015 10:03:01 PM   
ginger

 

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Yes Tom , is the short answer, it certainly could be a local drama related directly to trauma.
The point I make here is that when pain is persistant, wether related to trauma or not, a non local source ( the vertebral spine with protective behaviour) must be considered.
As we know , all pain is a product of the brain. That product is highly variable under various conditions both internal and external.
There is NO DIFFERENCE in a referred pain to a local pain. I say again no difference in the pain, because all pain arises from the same place. one cannot determine on the basis of pain alone, the source of whatever nociception may have given rise to that pain( presuming there is one). An experience of pain is just that.
There are however various hints and common traits that suggest referred pain. In the case of our very own Beth, she has several . The one I mentioned is the calf tightness, an L5 issue and a common feature of mild sciatic irritation.
the other is the onset of pain with running distance. SPB increases with fatigue.
I maintain that until or unless a thorough consideration of the spine is done, whereby the presence or absence of clinicaly relevant SPB has been established or ruled out, then any diagnosis of pain considered local only will be wrong most of the time.

< Message edited by ginger -- December 14, 2015 10:04:29 PM >


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Geoff Fisher
Physiotherapist
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(in reply to Tom Reeves DPT ATC)
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