Archive for the 'knee pain' Category

Consultant Q&A with Mr Fares Haddad- leading knee and hip surgeon

Published on September 2, 2010 in Ankle and Knee, Arthritis, Orthopaedic Surgery, Uncategorized and knee pain. 0 Comments Tags: , , , , , .

Mr Fares Haddad- leading knee and hip surgeon

Considering having hip or knee surgery?  Make sure you read my interview with top London knee and hip surgeon Mr Fares Haddad.  During Consultant Q&A I ask Fares questions that are on my patients’ minds about his field of hip and knee surgery. If you want to know about latest advances, “lubricating” injections for the knee and more, then please read on.

At BOOST PHYSIO we’ve enjoyed rehabilitating many of Fares’ patients over the years following hip and knee operations and I’ve also had the benefit of watching Fares perform various knee operations-hence we highly recommend him to our patients. If you want to read Fares’ impressive biography and CV follow this link to his website, but in brief Fares Haddad is a Hip and Knee Reconstructive Surgeon at University College Hospitals, The Princess Grace Hospital and the Wellington Hospital.  He is Divisional Clinical Director of Surgical Specialties at UCH, and Director of the Institute of Sport, Exercise and Health at University College London.  Clearly an expert in his field!

Q: Fares, you are well known for being one of a few surgeons to perform key hole surgery for hip problems. Which patients do you find benefit the most from this procedure?
A:  Hip arthroscopy is a procedure that has expanded dramatically over the last ten years. The indications have become much clearer. The most successful interventions are in cases where there are isolated labral tears or when patients present in the early phases of femorocetabular impingement (FAI) before the joint is irrevocably damaged. FAI is a condition where the bones of the hip joint develop in such a way that the patient can function relatively normally, and often very athletically, but where abnormal contact between the femur and pelvis damages the hip. These are typically in sporting individuals who either suffer an acute injury, the labral tear, or get the insidious onset of symptoms through activity such as running, cycling or football. Plain x-ray imaging and MRI scan gives us most of the information we need although CT scanning is occasionally necessary to look at the bony anatomy. By dealing with the primary bony impingement as well as the problems within joint we decrease symptoms and hopefully also prevent recurrence and further progression of the problem in future. 

Q:  What does the future hold for technological developments in treatments for arthritic hip and knee joints?
A:  The management of early arthritis of the hip and knee is progressing at an impressive rate. Technical developments will focus in the first instance on prevention thus by replacing the damaged menisci and the damaged joint surface and injured ligaments. The new work on partial resurfacing of joints with novel materials such as Oxinium is very exciting. New work also on customising joint replacement will change the face of the management of arthritis giving us joint replacements that are much more functional and geared to high end activity such as sports. 
 
Q:  Which sports do you believe are suitable for patients following total hip replacement surgery?
A:  Following a hip replacement operation, we encourage our patients to get back to normal day to day activity within 6 weeks. All non impact sports such as long distance walking, gym exercises, swimming, doubles tennis and golf are encouraged. It is perfectly feasible for patients to play singles tennis or indeed in certain circumstances squash and many of our patients do get back to running but it is important for the patients to realise that there is a tension between the amount of impact activity that they do and the wear that they will cause to their new joint. 

Q:  How effective do you find “lubricating” injections are for arthritic knees?

A:  Our experience of the Hyaluronic acid lubricating injections for knee and hip arthritis has been mixed. There are some patients who have an extremely good response that lasts up to six months. There are others who do not respond at all. It is very difficult to predict. My personal experience is that those patients have dry knees without effusions tend to respond better to Hyaluronic acid therapy whereas those with effusions can respond to aspiration and injection but do so for a shorter period of time.  These are nevertheless interesting therapies which we must continue to pursue both in our athletic population when we often use them after surgery and also in the arthritic population.

I hope that you have found this Consultant Q&A interesting, if you wish to discuss any issues regarding your hip or knee condition with myself or one of my physios, please do not hesitate to contact us, you can call the clinic in Hendon, NW London on 020 82017788 or email us at info@boostphysio.com 

The BOOST Blogger- Steven Berkman

Regards… The Boost Blogger, Steven Berkman

Cryocuff cold compression therapy

Published on July 21, 2010 in Ankle and Knee, elite sports injuries, knee pain and sports injuries. 0 Comments Tags: , , .

The Cryocuff is a fantastic bit of physiotherapy equipment we’ve invested in at BOOST PHYSIO. Cryocuff is a cold-compression therapy system that is ideal for treating knee, ankle and foot swelling and pain.

We tend to use it most often post-operatively. For example following total knee replacement, ACL reconstruction surgery, key hole surgery to the knee and post-meniscectomy. For ankle injuries we use Cryocuff to bring down swelling after torn ligaments, fractures and surgery (eg following bunion surgery, achilles tendon repair surgery etc).

What exactly is the Cryocuff system? There are various garments used for the different body parts- ie ankle, knee etc. These are applied by your physiotherapist to the affected area and the the garment is filled with iced water! As the garment fills with the iced water it begins to compress the affected area.

You should be familiar with the acronym RICE which is used in physiotherapy treatment and injury management: Rest, Ice, Compression, Elevation. Cryocuff treatment forms a crucial part of the ice and compression of the RICE regime.

Boost Physio in Hendon will apply and use this treatment when appropriate.

Do you KNEEd help?

Published on June 29, 2010 in Uncategorized and knee pain. 0 Comments Tags: , , , , , , .

England football captain Rio Ferdinand may have missed the whole Fifa 2010 Football World Cup because of his knee injury, but you don’t have to be an international footballer to have trouble with your knees.  In this blog I take a look at the range of knee problems affecting different age groups.

Osteoarthritis (“wear and tear”) of the knee affects 1/3 of people aged 63 and over, often causing knee pain, difficulty rising from a chair and climbing stairs.  But knee pain is also not unique to older people- in fact there are many knee problems that are common in adolescents and teenagers, not to mention the knee problems that beset the athlete and sportsperson.  Knee problems are one of the most common conditions that we treat at BOOST PHYSIO, let’s take a look at the type of knee problems that affect different age groups and how we treat them.

Active adolescent children (aged 10-14) complaining of knee pain at the front of the knee below the knee cap are often affected by Osgood Schlatters Disease.  X-rays will confirm the diagnosis for this condition, but are often not

Diagram of Osgood Schlatters Disease

needed as the clinical examination can be enough to make the diagnosis.   There will usually be a tender, enlarged area at the tibial tuberosity (this is the bump between the knee cap and the top of the shin bone), where the quadriceps muscle tendon attaches to the shin bone and pulls on the not yet fused tibial tuberosity.  The ratio of boys to girls affected by this condition is 7:1.  A Finnish study showed a frequency of 13% of adolescent athletes had Osgood Schlatters. 

At BOOST PHYSIO our treatment programme for Osgood Schlatters involves decreasing of physical activity to allow the inflammatory reaction to subside, a programme of stretches to the knee muscles to assist in the muscle length and ensure that range of movement of the knee is maintained.  Most importantly carefully guiding the adolescent back to sport with a graded programme.

Teenagers with knee pain are often affected by anterior knee pain.  Anterior knee pain is often also called Chondromalacia Patella or Pattela femoral pain syndrome.  Anterior knee pain by contrast to Osgood Schlatters is much more common amongst girls than boys.  This prevalence amongst girls is partly due to the wider female pelvis which leads to an increased likelihood of knock knees (technically called genu valgus).  Pain is usually at the front of the knee underneath the kneecap (patella) and is worse climbing stairs.  Anterior knee pain is caused by poor alignment of the patella largely due the mechanics of the patient’s knees (often knock kneed and flat footed) which leads to maltracking of the patella causing excessive pressure under the patella.  In severe cases this will roughen the cartilage surfaces under the knee cap. 

Example of severe maltracking of the patella

We treat anterior knee pain by always tackling the root of the problem first which is normally the biomechanics of the legs.  BOOST PHYSIO often recommends orthotics (inner-soles) to correct foot and knee position and always gives corrective exercises to deal with muscle-imbalances at the knees focussing on strengthening the vastus medialis portion of the quadriceps thigh muscle which helps to re-align the patella. We often also use special strapping techniques to off-load the patella and re-educate the muscles around the patella.  Often “hands on” work is also needed to loosen tight structures around the patella. 

Knee problems in people in their 20s-50s are often related to an injury or trauma and are often sports related. Whether it is the Sunday footballer with a torn meniscus (cartilage of the knee) or a runner with a tendonitis problem we assess all these patients very carefully with specific tests to accurately identify the nature of the injury.   These knee problems can be challenging to deal with as tissue healing is slower in people over 20 and indeed sometimes the damaged tissue cannot repair itself at all.  While the majority of our patients with sports injuries to the knee are treated successfully with physiotherapy a small number need the help of a knee surgeon and we make sure that our patients receive the appropriate advice and care in this regard.  For those who do require surgery we work very hard on their rehab programme aiming to regain full strength and flexibility as soon as possible.

Over 60s suffering with knee pain can often be due to osteoarthritis of the knee which can also cause stiffness and often swelling of the knee.  While surgery can be a very effective solution for many of these patients, most will respond very well to a programme of physiotherapy focusing on strengthening the leg muscles to off-load the knee joint and work to improve the flexibility of the knee.  Both these elements lead to decreases in pain levels and improvements in functional ability.

If you would like to discuss your knee problem and have a thorough physiotherapy assessment and examination please do call us on 020 82017788 to arrange an appointment or visit our website www.boostphysio.com for more information.