Dr. Kyle: Torn ligament? Maybe not.

Knee pain can come in a variety of presentations. Whether from a sports injury, slip and fall, or out of the blue, no two knee injuries are completely alike. The extent to which tissues are damaged is specific to the patient’s genetics, lifestyle, trauma, and fitness level. A well-trained athlete may be quite high functioning even with a serious tear, while a mild injury may keep a very sedentary person out of commission for several months.

Often times I will hear “hey doc, I think I might have heard a pop and the inside of my knee really hurts!”. My first reaction is to suspect a ligament tear. Once examining the patient further however, orthopedic testing shows stable knee ligament testing, no swelling or redness, and no severe joint line tenderness. So what’s the deal?

Like most soft tissue injuries, ligaments can be damaged to varying degrees. In the clinical world, there are 3 grades of ligament tears. Grade 1 is mild ligament damage, grade 2 is moderate, and grade 3 is severe/ruptured ligament tear. Common symptoms of a complete tear include sudden onset of pain and severe swelling, joint instability, and impaired function. The truth is, disruption of tendon fibers can happen to varying degrees. Think of muscle strains and ligament sprains on a spectrum of structural damage from 0 to 100%. The higher percentage of damage, the longer time it will take to establish preinjury performance levels.

Fortunately, if ligament stability is determined to be adequate by a healthcare professional, a conservative trial of care will often resolve symptoms. Ligaments in the body have the natural ability to heal on their own. Healing consists of 3 distinct phases including the inflammatory phase, the reparative phase, and the remodelling phase. Simply put, fibrotic scaffolding will be laid down so newly formed collagen can connect the severed ends of the tear. It is important to seek proper medical attention so that rehabilitation can begin as soon as possible.

For injuries of this nature, treatment will often begin with controlled range of motion exercises. Other modalities such a laser and acupuncture are helpful for enhancing healing at this stage. As tensile strength of the ligament improves, the joint will be able to tolerate more load. Eventually strengthening exercises will be included into the plan of management and progressed with increasing difficulty.

So if you or someone you know is worried that their knee pain may need surgical intervention, make sure you get it assessed by a medical professional who specializes in musculoskeletal injuries. It may be quite reassuring to know that with the right tools and knowledge the body will be able to heal and adapt on its own.

For more information, please contact drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:
Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. Journal of biomechanics. 2006 Jan 1;39(1):1-20.

Dr. Kyle: Building Stronger Bones

When discussing bone health, we often talk about proper nutrition. Adequate vitamin D and calcium intake are usually recommended to enhance bone mineral density (BMD). What is not discussed as often is the role of exercise and weight training for increasing bone strength. A holistic approach looking at what we put IN our body as well as what we DO with our body is the key for building stronger bones.

As we age our body experiences several physiological changes. Our hormone levels change, muscle mass declines, and bones become less dense. Low bone density, otherwise known as osteopenia, increases our risk of fracture. Although we can bounce back from a slip or fall in our early years, a hip fracture in older individuals can have detrimental effects on quality of life. The good news is, there are important steps you can take to prevent or slow down the decline of BMD.

Research has demonstrated that healthy individuals and patients with osteoporosis can improve BMD with high-moderate impact activities and resistance training. A few examples of high impact exercises include step classes, jogging, and jumping jacks. Resistance or weight training on the other hand can include elastic band, pully, and free-weight based exercises. To put it simply, the more force you transmit through the bone, the more the bone will remodel and grow! Clinical judgment is needed to determine the intensity of force that each patient can tolerate.

Recent studies have found that high-intensity resistance training and impact training improves BMD and physical function in postmenopausal women. Low-intensity and light-resistance exercise programs are not enough to stimulate bone remodelling and improve BMD. Heavy multi-joint compound exercises such as squats and deadlifts induce extensive muscle recruitment and transmit greater force through the bones. In particular, these exercises will apply force through the lumbar spine and femoral neck, making them stronger and more resilient to fracture. Proper form and supervision are crucial when performing any high intensity or heavy loading activities.

Talk to a primary health care provider about your BMD and if an exercise program for developing BMD is right for you. Not only will exercise strengthen your bones, but it will have profound impacts on many other systems of the body as well. As always, if you have any question do not hesitate to contact me at drkyle@forwardhealth.ca or visit my Instagram page @drkylearam!

Reference:

Sinaki M. Exercise for patients with established osteoporosis. InNon-Pharmacological Management of Osteoporosis 2017 (pp. 75-96). Springer, Cham.

Mounsey A, Jones A, Tybout C. Does a formal exercise program in postmenopausal women decrease osteoporosis and fracture risk?. Evidence-Based Practice. 2019 Apr 1;22(4):29-31.

Dr. Kyle: Why You Should Use The Sauna

Everyone enjoys a day at the spa for some much-needed relaxation, but did you know that time spent in the sauna may actually increase muscle gains?

Originating in Finland, this traditional passive heat therapy is becoming increasing popular world-wide. Saunas are often used for the treatment of musculoskeletal pain as well as headaches. Recent evidence has suggested benefits for high-blood pressure, neurocognitive diseases and pulmonary conditions.

Emerging studies have found a protective effect for cardiovascular disease with regular sauna use for both men and women. It turns out, the more you use the sauna the better. More time spent sweating it out, the more health benefits!

Need any more reasons to hop in the sauna?

Sauna use has also been associated with increased net protein synthesis. This is why amenities such as saunas and steam rooms have become more common place in gym and fitness facilities. After your workout may be the best time to jump in the sauna and here’s why:

1. Intense short-term heat exposure stimulates the production of heat shock proteins that reduce muscle degeneration cause by oxidative stress.
2. Produce Growth hormone for increased lean muscle mass.
3. Increased NO (nitric oxide) availability to promote blood flow and circulation.
4. Decrease inflammatory pathway activity and free radical production.
5. Improve insulin sensitivity, allowing your body to utilize glucose more efficiently.
6. Enhance the production of BDNF (brain derived neurotropic factor) which synthesizes new brain cells.

Essentially, saunas stimulate the bodies autonomic nervous system in order to maintain a constant core body temperature in extreme heat. Short durations of heat stress induces adaptive mechanisms similar to exercise and have profound physiological effects.

It has also been found to help with anxiety, depression and improve parasympathetic function! Who doesn’t want a little extra mental clarity in their life.

For any questions or comments please email me at drkyle@forwardhealth.ca and be sure to follow my Instagram and Facebook page @drkylearam.

References:

Hussain, J., & Cohen, M. (2018). Clinical Effects of Regular Dry Sauna Bathing: A Systematic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 1857413. doi:10.1155/2018/1857413

Laukkanen, T., Kunutsor, S. K., Khan, H., Willeit, P., Zaccardi, F., & Laukkanen, J. A. (2018). Sauna bathing is associated with reduced cardiovascular mortality and improves risk prediction in men and women: a prospective cohort study. BMC medicine, 16(1), 219. doi:10.1186/s12916-018-1198-0

Dr. Kyle: Cracking Down on Low Back Pain

 

2 people with low back pain attempt 10 minutes of moderate exercise on an elliptical machine. One reports that the pain is better. The other reports that the pain is worse.

What’s the deal?

It turns out that one of the main predictors of stubborn low back pain is hip mobility. You may have heard of the term “hip hinge” before, and this refers to bending at the hips while keeping a neutral spine. Elliptical machines in particular work the gluteal muscles group and keep the spine relatively straight.

When restrictions in the hip develop, the body is unable to “hinge” properly and the low back folds forward to compensate. Over time this repetitive flexion of the lumbar spine causes accumulative stress that is linked to pain!

Could it be serious?

If the pain intensity does not change with alterations in posture, loads and movement, it may not be mechanical in nature. Some “red flags” that may indicate something more serious include:

• Bowel or bladder incontinence
• Numbness in the groin region
• Unexplained weight loss
• Low back pain with fever
• Progressive and constant low back pain

Once these red flags have been ruled out and your back pain has been deemed mechanical in nature, it’s time to develop a plan of management.

What to Do

The first step is to remove aggravating factors. If your back pain is worse bending forward, stop bending forward. If your back pain is worse bending back, stop bending back. To a point. The trick is to find that pain free range of motion and to work within it.

Train the hip hinge! A major part of the process is cueing patients to bend at the hips and not with the low back. This will keep the back straight and reduce shearing forces through the spine.

Next, we train the exercises or movements that take the pain away. For many this involves abdominal bracing to stabilize the spine. A few key exercises include:
• Modified curl up
• Bird dog
• Side plank

Fine Tuning

The final step is to develop strength and endurance. Try to include exercises that challenge one side of the body at a time. This includes lunges, suitcase carries, and one arm rows.

As always, consult the expertise of a registered healthcare professional before starting a strength and conditioning program. Check out my Instagram page @drkylearam for more videos of exercises to prevent low back pain. It’s time to get you out of pain and back on the elliptical!

Dr. Kyle: Can Changes in Weather Predict Pain?

 

 

I always thought my grandma was crazy when she’d say I can “feel” a storm coming as she’d rub her knees. To my surprise, her knees were often better at predicting the weather than our local news. How come?

It’s believed that changes in barometric pressure can lead to increases in musculoskeletal pain. In particular, for individuals suffering from osteoarthritis. But what’s surprising is most of the research is either inconclusive or there’s little evidence to support these claims.

After hearing a number of my patients describe similar changes in pain levels due to the changes in weather, I thought I’d take a further look at these claims.

In one survey by Von Mackensen et al., one to two thirds of patients with rheumatoid arthritis believed their symptoms were weather-sensitive (1).

Other studies found an increase in barometric pressure or a drop in ambient temperature are both associated with an increase in pain (2).

At first glance it appears there may in fact be some credible evidence to support this strange phenomenon, but why?

Joint Pain in Scuba Divers

Have you ever swam to the very bottom of a pool in the deep end and felt your ears pop? This sudden change in pressure is similar to what scuba divers experience but on a smaller scale.

Sudden changes in tissue gas tension surrounding the joints can cause fluid shifts and interference of joint lubrication. When divers go deep, their joints may hurt as there’s not as much fluid surrounding their joints. This becomes worse if severe osteoarthritis exists (3).

Why Your Joints Hurt More on Colder Days

Colder temperature and its association with increased pain is much easier to explain. We know that cold temperature reduces inflammatory markers, changes the viscosity of the fluid in our joints, and can decrease the strength and support of our muscles around joints (4). Patients tend to experience more severe joint pain during the cold winter months.

Show Me Your Search History and I’ll Diagnose Your Pain

I still recommend an in-person consultation but we’re close to this becoming a reality. A recent study found an association with local weather and rates of online searches for musculoskeletal pain symptoms.

Searches for arthritic related symptoms are significantly more common in climates closer to -5 degrees Celsius than 30 degrees Celsius. Although this doesn’t explain WHY osteoarthritic patients suffer more pain, it gives us a better idea of WHEN they experience worse symptoms and under WHAT conditions (5).

Well there you have it folks. There are still many uncertainties and unknowns on why joint pain increases when the temperature drops or pressure rises. But if you can sense the next snow storm or torrential downpour from your knees and not the news, you may be experiencing some underlying osteoarthritis.

1. Von Mackensen S, Hoeppe P, Maarouf A, Tourigny P, Nowak D.
Prevalence of weather sensitivity in Germany and Canada. Int J
Biometeorol. 2005;49(3):156-166.

2. McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K.
Effectiveness of glucosamine for symptoms of knee osteoarthritis:
results from an internet-based randomized double-blind controlled
trial. Am J Med. 2004;117(9):643-649.

3. Compression pains. In: US Navy Diving Manual. Revision 4 ed. Naval
Sea Systems Command; U.S. Government Printing. 1999:3-45.

4. Golde B. New clues into the etiology of osteoporosis: the effects of
prostaglandins (E2 and F2 alpha) on bone. Med Hypotheses. 1992;
38(2):125-131.

5. McAlindon T, Formica M, Schmid CH, Fletcher J. Changes in barometric pressure and ambient temperature influence osteoarthritis pain. The American journal of medicine. 2007 May 1;120(5):429-34.