DR. RUSSELL SCHIERLING
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CHRONIC KNEE PAIN? SURGERY PROBABLY NOT THE BEST SOLUTION

7/22/2016

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CHRONIC KNEE PAIN?
SURGERY NOT USUALLY THE BEST ANSWER

Knee Pain Solutions
Knee Pain Cure
"The benefits of knee repair procedures in older adults for painful arthritic knee or torn meniscus are short-lived and “inconsequential” compared with the potential harms. Older patients who have knee pain but do not have osteoarthritis - a chronic disease of the joint cartilage and bone - should not be recommended the procedure."  Sabriya Rice from Modern Healthcare
According to the CDC's National Center for Health Statistics, there are 719,000 total knee replacements done each year in the United States.  And this doesn't count the millions of arthroscopies (scopes) that doctors do.  In light of what science has revealed over the past decade, this is way too many surgically-repaired knees.  And here's the thing; the medical community knows this but still continues these surgeries unabated.  My goal is to help you halt --- or at least dramatically slow down --- your current knee problem before it gets to that point.  It's not like any of this is new information.

Back in September of 2008, the New England Journal of Medicine published twin studies showing the same thing ---- that there are way too many knee arthroscopies taking place here in the US.  The two categories that these unnecessary surgeries were taking place in?  OSTEOARTHRITIS (Degenerative Arthritis) and MENISCUS TEARS.  The most prestigious journal for orthopedic surgeons (Journal of Bone and Joint Surgery) followed this up in 2011 with Increase in Outpatient Knee Arthroscopy in the United States: A Comparison of National Surveys of Ambulatory Surgery....  This study showed that knee scopes in America were, "more than twofold higher than in England or Ontario, Canada, in 2006. Our study found that nearly half of the knee arthroscopic procedures were performed for meniscal tears."  And now this....

This month's issue of the British Medical Journal (Exercise Therapy Versus arthroscopic Partial Meniscectomy for Degenerative Meniscal Tear in Middle Aged Patients) agreed.   The authors started the ball rolling by saying that in the middle-aged population (average age, 49.5 --- exactly my age), "most meniscal tears are degenerative and might be regarded as the first sign of osteoarthritis".  What should this statement lead you to ask?  It should leave you wondering if it is possible to prevent --- or even reverse --- arthritis symptoms or meniscus tears.  We'll get there, but first I want to discuss a sentence found in this study.

The authors state that, "Considering the large amount of surgery performed worldwide, and the inconsequential short term additional pain relief seen from surgery in addition to exercise, randomised controlled trials are needed to explore the comparative treatment effect of partial meniscectomy alone with supervised exercise therapy alone."  Did you catch that?  The pain relief from knee surgery is "inconsequential".   They backed this statement up by citing a significant number of similar studies showing that arthroscopic surgery on knees for arthritis or meniscal tears does not work well --- a fact I have noted in my clinic for decades.  Here is what was done in this particular study.

"In the exercise group, 61% of participants completed the exercise therapy program (25 sessions on average) with satisfactory or excellent compliance.   19% in the exercise group crossed over to receive surgical treatment between three and 16 months. Of these, approximately half had completed at least 19 exercise sessions.   Owing to persistent knee pain and catching of the knee 3% in the meniscectomy group were reoperated on, and one participant who had crossed over underwent another operation six months after the primary operation."

The surgical group underwent PHYSICAL THERAPY but not a strengthening protocol per se.  Thus, when comparing groups of people who received knee scopes to those who underwent strengthening protocols only, we saw that, "No clinically relevant difference was found between the two groups at two years.  Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option."

But make no mistake about it, it wasn't all champagne and roses for either group of participants in this study --- surgical or strengthening alone.  Here's the proof that you are better off preventing  arthritis that trying to do something about it after the fact.

"From baseline to the two year follow-up, 23% of the participants in each group experienced pain, swelling, instability, stiffness, or decreased range of motion in the index knee that was serious enough to seek consultation. Similar symptoms in the opposite knee were experienced by 21% of participants in the exercise group and 14% in the meniscectomy group."

This is an important study because it shows yet again that exercise is virtually indistinguishable from arthrosocpy for the two most common knee problems.  Why is this such a big deal to grasp?  Firstly, because we know that the incidence of KNEE PROBLEMS is literally exploding here in America (HERE).  And secondly, STUDIES HAVE REVEALED that if you have your knee scoped (even if there is no surgery done), your chances of developing arthritis skyrocket after only one year.  Fortunately for most of you with knee problems / pain, there's a better solution.

Are you interested in getting your knee(s) better without dangerous or invasive procedures or products?  There are large numbers of practitioners of all sorts who are selling knee pain relief with huge up-front case fees.   Want to hear something really cool?  Most of you can do these protocols on your own.  The doubly cool thing is that it won't really cost you anything other than some time, energy, and effort.  Follow the blueprint found in THIS POST to see how most of you can solve your own knee pain.  Always remember; not making changes until they are forced to is the typical way that the practice of medicine works, and why the "BEST EVIDENCE" is either not followed or anything but.
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EXPLODING INCIDENCE OF KNEE PAIN / KNEE ARTHRITIS IN THE UNITED STATES

6/29/2015

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THE GROWING PROBLEM OF KNEE PAIN

knee arthritis
knee osteoarthritis
knee pain
"Recent Center for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of pain from the various causes......   For U.S. adults reporting pain, causes include knee pain (19.5%)"  From the American Academy of Pain Management's Facts and Figures on Pain.

A new study (Annual Incidence of Knee Symptoms and Four Knee Osteoarthritis Outcomes in the Johnston County Osteoarthritis Project) from the official journal of the American College of Rheumatology (Arthritis Care and Research) sheds some light on the explosive manner in which KNEE PAIN and arthritis are increasing in America. 

Johnston County, North Carolina, with a population of around 175,000 is not too far from the Raleigh / Durham / Chapel Hill metro area, and has been home to an ongoing study on Osteoarthritis (OA), otherwise known as DEGENERATIVE ARTHRITIS or DJD since 1991.  After specifically looking at arthritis of the knee, the authors concluded that, "The annual onset of knee symptoms and four OA outcomes in Johnston County was high, and may preview the future of knee OA in the US."   This itself begs the question of how many people are being diagnosed with new cases of knee pain / knee arthritis each year in Johnston County?  Try 5.6% of the population on for size (the CDC's website says it is 3.5%).

Of course the authors said that this, "underscores the urgency of clinical and public health collaborations that reduce risk factors for, and manage the impact of, these outcomes."  Other than being older (over 75) one of the top risk factors for knee pain was, as you might guess, OBESITY / OVERWEIGHT.  Is this a problem in North Carolina?  Here is what a collaboration between the government and private sector (Eat Smart, Move More NC) says.   "In North Carolina, two-thirds of all adults (65.7%) are overweight or obese, and North Carolina ranks 5th worst in the US for childhood obesity."  It's almost guaranteed that these figures are too low, as a brand new study (Prevalence of Overweight and Obesity in the United States, 2007-2012) published one week ago today in JAMA Internal Medicine, revealed how severely we have been underestimating / under-calculating America's weight problems.

It's interesting, but even though every article or study I see talks about the nature of our national poor health issues as related to our burgeoning waistlines --- calling for more money to be spent on education, physical activity, better diet, etc (see the first red sentence in the previous paragraph) ---- the problem continues to grow, with every study being worse than the study that came out before it.   Unfortunately, many doctors are taking advantage of this --- and not only with unnecessary surgeries (HERE or HERE).

Doctors of all kinds are advertising solutions for Chronic Knee Pain and Obesity, not to mention DEPRESSION, INFERTILITY, TYPE II DIABETES, NEUROPATHY, FIBROMYALGIA, and a myriad of others (just look at the ads in the newspapers of any large city).   Because most health problems and pain syndromes are based on INFLAMMATION, these health problems are not only related to each other, but have common origins.  HERE are some examples of solutions that you can have free of charge.   Although there are some knee-specific exercises and protocols you may need to do in order to solve your specific knee problem, following this program (with your doctor's permission) will help you with any number of health problems and pain syndromes you may be dealing with, and help get you off the DANGEROUS DRUGS you are continually advised to take.
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CHRONIC PAIN SOLUTIONS FOR LONG DISTANCE PATIENTS

4/3/2015

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SOLVING CHRONIC PAIN IN OUT-OF-STATE AND INTERNATIONAL PATIENTS

Picture Morton Buildings
Morton Buildings Ref# 3948
On this "Good Friday" I just want to say that I am grateful to God, who has blessed my practice beyond measure.  This decade has seen an explosion in the numbers of patients that come from all over the world to get help for their various CHRONIC PAIN SYNDROMES.   They come because for many, riding the MEDICAL MERRY-GO-ROUND has all but completely stolen their hope of recovering their ability to live and function normally --- without pain.  My desire is to not only give people hope, but to be a part of helping them get their lives back.

When it comes to health, Steve is a motivated individual.  He just happens to be in a situation that many of us are likewise dealing with --- an accumulation of injuries caused by years of who-knows-what; sports, hunting in rugged terrain, work, etc, etc, etc.   Today I received this unsolicited email from Steve, who has given me permission to share it with my readers.   Although you may not know Steve, many of you have heard of his family's business --- particularly if you farm for a living --- Morton Buildings.  If I'm not mistaken, they are the biggest manufacturers of metal barns (many of which double as homes) in the United States, and are located in Morton, Illinois.

Just over two weeks ago, I struggled in pain to get my luggage into my motel room prior to our appointment the following day. Especially the three to four steps down the stairs to the parking lot. This contrasts greatly to yesterday evening when I finished a two mile brisk walk punctuated with some short distance sprinting.  After stretching, my knee felt better than it has in 7 months since the injury/aggravation.  It is an understatement to say that I am thrilled to be able to get outdoors and walk/ run for a change.  Most importantly, I have noticed gradual improvement in function on a daily basis.

At this point, I have started to do single leg exercise drills to restore muscle strength and balance to the affected leg
[HAMSTRINGS / HIP FLEXORS AND QUADS / BUTTOCKS].  When I do feel discomfort, a stretching session relieves 90 percent of that discomfort.  I still feel some tightness under the knee cap when I descend stair steps but the improvement has been significant.  I will say that the ratio of pain relief per dollar spent makes my time spent coming to your clinic one of the best values in pain management I have ever experienced. 

This was all accomplished during a two week period that I drove approximately 3,000 miles in a small company car, which usually exacerbates the pain and healing process.  To say the least, I am very pleased about the results that you have helped me to achieve in my frustrating search to get back to 100%.  I have some referrals that will be coming your way in the coming weeks.

I look forward to the progress that I will make over the coming weeks and keep you in the loop.  Thanks, Stephen Fischer


If you have watched any of our VIDEO TESTIMONIALS, you may have already figured out that I'm on a mission.  I have a laser-like focus in finding the root of your CHRONIC PAIN, and destroying it (thus, the name of my website).  There are few things more satisfying than putting a GOLD BRICK in a patient's hands, and telling them it's theirs --- for keeps.  I had a blast getting to know Steve as I worked on him, and look forward to our next visit.  Because if everything goes as planned, I'll treat him early and then we'll spend the rest of the day RIDING OUR MOTORCYCLES IN ARKANSAS.

For those of you interested in what I do here in the office, THIS PAGE will answer virtually any question you can come up with.

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KNEE SURGERY CAUSES KNEE ARTHRITIS

12/13/2014

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DOES KNEE SURGERY CAUSE KNEE ARTHRITIS?
SEEMS SO

Chronic Knee Pain
"The meniscus is needed to distribute the body weight across the knee. Without the meniscus the body weight is distributed unevenly on the femur and tibia possibly leading to early arthritis to the knee joint.  The tear of meniscus is among the most common knee injuries."    - From Wikipedia's definition of "Unhappy Triad".  The Unhappy Triad is essentially a "blown knee".

"There have been several trials now, including this one, where surgeons have examined whether meniscal tear surgery accomplishes anything, basically, and the answer through all those studies is no, it doesn't."   - Dr. David Felson, professor of medicine and public health at Boston University, being quoted for the December 26, 2013 issue of WebMD.  The article itself (Study Questions Value of Common Knee Surgery Procedure to Repair a Torn Meniscus Worked No Better than a Fake One to Ease Lingering Pain) was written by Brenda Goodman


"Knee Arthroscopy for Osteoarthritis:  With this procedure, a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscus, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee."  - From an article in the August issue of AARP by called Four Surgeries to Avoid by Karen Cheney.  Stick around and I will show you that Cheney's second sentence is patently false.


"I have said repeatedly that surgery to trim cartilage in the knee is worthless. I have seen many patients who have had cartilage removed by surgeons for an average charge of $5000 and then they must have a knee replacement several years later. The surgeon must know about the harm he is doing because he has to see his patients for followup, when many of them require knee replacement surgery."  - Dr. Gabe Mirkin (MD) from his May 29, 2013 article Arthroscopic Knee Surgery is Usually Useless


"If the meniscus or menisci are removed then the cartilage is more vulnerable and starts to rub together.  This can create a ‘bone on bone’ situation over time and more arthritis sets into the knee joint. Meniscus tissue in the knee does not grow back so it is NOT advisable to ‘clean it out’ because over time removing  part or all of the meniscus creates more problems in the knee joint."    - Dr Alexandria Schnee from her April 24, 2013 article, Physical Therapy is As Beneficial As Knee Surgery for A Torn Meniscus; Study Finds


A recent article by an impressive array of orthopedic surgeons and sports doctors on Medscape's Emedicine site (Meniscus Injuries) revealed that, "Conservative treatment should be attempted in all but the most severe cases."  But why?  After all, surgeries for torn meniscus are exceedingly common (about three quarter million per year), and we all know people --- particularly if you are an athlete --- who have had this surgery.  Unfortunately, the more we learn about surgical repairs of torn meniscus, the more scared we should be of this surgery.

A recent study was presented at the annual meeting of
Radiological Society of North America called
Meniscal Surgery Markedly Increases Risk for Incident Osteoarthritis and Cartilage Loss in the Following Year.  The very name of this study begs the question of just how markedly is "markedly"?  It seems that physicians looked at a group of 354 patients who had been radiologically diagnosed with torn meniscus and then divided into a surgical and non-surgical group, discovering that not only did the surgical group not do so well, but that they had a high probability of developing an arthritic knee.  Listen to what Ed Susman said the other day in an article written for MedPage Today (
Knee Surgery Linked to Higher OA Risk).


"During the previous year, about 4% of the patients in the study underwent knee surgery. All of the 31 knees that showed evidence of osteoarthritis came from the group of patients that had undergone meniscus surgery -- 31 of 354 patients. Of the 354 patients who did not have surgery for their meniscus tears, none developed osteoarthritis.  "We found that in a group of patients without osteoarthritis, all knees that developed osteoarthritis within 1 year were among those patients who had meniscus surgery," he [Frank Roemer, MD, researcher associate professor of radiology at Boston University School of Medicine] said. "We also observed that the risk for cartilage loss was much higher in patients who had knee surgery compared with those who had meniscus damage but did not have surgery." 


The knee's meniscus is the the flimsy cartilage "cup" that sits on the top portion of the bones of the lower leg.  The meniscus provides structural integrity to the knee when it is mechanically stressed, twisted, or torqued.   It's purpose is to disseminate the friction that builds between the upper part of the knee joint (the femur) and the lower portion (the tibia).

Blood flow to all cartilaginous structures is poor, and the meniscus is no different.  In similar fashion to the spinal disc, it is considered to be "avascular" --- no blood supply.  If you look at the picture to the left, you will notice where these cup-like meniscus attach (at the center of the knee between the two bony bumps known as condyles).  Because they are not attached at the portions of the knee farthest from the midline, these areas can get over-twisted and tear --- particularly at the narrow portion of the medial meniscus where the meniscus is thinner.   Most of the time when doctors tell patients that they have torn a knee cartilage, what they really mean is that they have torn a meniscus.

SOME MORE REASONS TO AVOID MENISCUS SURGERY


  • Just one short year ago in the December 26 issue of the New England Journal of Medicine (Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear), we saw what happened when patients who had dealt with knee pain caused by a torn meniscus for at least three months, but did not have knee arthritis, volunteered for a "new" knee procedure.  Once in the operating room, the surgeon would open an envelope which told them whether to do a real surgery or sham (a fake one).  The fakes were done with real knives and real stitches to create real holes in the knees and real scars.   The study's conclusions?  "There were no significant between-group differences...   The outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure."

  • And who could forget the study done back in 2008?  Research that was published in that September's issue of the New England Journal of Medicine (A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee), led the authors to conclude that, "Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy".

  • Four years before that, back in 2002, NEJM published yet another study on a similar topic (A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee).  The study, done at Baylor University's College of Medicine, concluded that,  "In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure."  On top of this, an article from PlaceboEffect.com called Arthroscopic Surgery – Just a Placebo Effect? had some interesting things to say about this study.

"Amazingly, patients who received the surgery experienced exactly the same improvement as those receiving just the incisions - about 50% of patients in both the placebo and surgical group experienced relief overtime. Some of those who experienced relief from the placebo surgery were able to participate in physical activities they hadn’t been able to participate in for years. The renowned arthroscopic surgeon who performed the surgery, Dr. Bruce Moseley, said afterwards, “My skill as a surgeon had no benefit on these patients. The entire benefit of surgery for osteoarthritis of the knee was down to the placebo effect.” The study, which took 10 years to perform and was carefully designed by teams of researchers, rocked the medical world. The researchers conducting the study recommended that doctors no longer perform a surgery they had long considered useful because the effects – while extremely beneficial – were all placebo effects."

What are my recommendations for someone struggling with knee problems.  Of course it depends on what kind of knee problem it is (HERE, and HERE are a couple of common ones that we deal with here at the clinic).  But for the most part there are some hard and fast rules that make any sort of knee treatment far more effective than it otherwise would have been.

  • CONTROL YOUR WEIGHT:  This is a no-brainer.  If you are OVERWEIGHT OR OBESE, your odds of developing chronic knee problems (including ARTHRITIS) skyrockets as you are forced to deal with the increasing amounts of mechanical stress on the knee(s).  Figure out what it takes to LOSE WEIGHT and get busy.
  • EXERCISE:  There is an old saying in the field of medicine; "motion is lotion".  You've also heard the old cliches "Use it or lose it" and "Move it or lose it".  Because, as I stated earlier, cartilage is an "avascular" tissue that has little or no blood supply, the only way it gets oxygen, nutrients, and water into its cells, while moving waste products out, is via movement (joint motion).  If the knee is not moving properly, it's deteriorating.  The key is in performing exercises that don't repetitively stress the knee such as running on hard surfaces.  More information HERE.
  • CONTROL INFLAMMATION:  This is probably the most important bullet point on the list.  If you are not sure what INFLAMMATION is, make sure to click the link.  If you know what INFLAMMATION is, but aren't sure how to resolve it, click the link.  HERE is how I would advise you to deal with almost any problem you are dealing with, including knee problems.  Oh; and don't leave out the PGFO ---- it is massively anti-inflammatory.
  • DON'T LEAVE OUT THE COLD LASER:  Cold Laser Therapy is a viable solution for a wide array of health-related problems --- including arthritis.  Find out why by going HERE. 

According to stats from the peer-reviewed literature, currently 70 million Americans are dealing with some degree of arthritis of the knee, and nearly half of all Americans will develop arthritis of the knee in their lifetimes --- with the majority by far being women (Journal of Arthritis Care & Research).  It's time to take the bull by the horns and realize that surgery is not the option that your doctor led you to believe it was.   The truth is, when it comes to knee surgery, EVIDENCE-BASED MEDICINE might not be quite as "evidence-based" as we have been led to believe. 

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WHAT IS PATELLOFEMORAL SYNDROME?

1/20/2014

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PATELLO-FEMORAL SYNDROME
WHAT IT IS AND HOW TO DEAL WITH IT EFFECTIVELY?

Patellofemoral Syndrome
BruceBlaus
Patello-Femoral Syndrome
BruceBlaus
"Consensus is lacking regarding the cause and treatment of the syndrome.  Many theories have been proposed to explain the etiology of patellofemoral pain. These include biomechanical, muscular and overuse theories. In general, the literature and clinical experience suggest that the etiology of patellofemoral pain syndrome is multifactorial."    Dr Mark S. Juhn of Seattle's University of Washington School of Medicine from an article published for the November 1999 issue of the American Family Physician (Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment).

"Historically, clinicians have used a myriad of interventions, many of which have little, if any, supporting evidence."  Drs. Lori Bolga and Michelle Boling from 2011's An Update for the Conservative Management of Patellofemoral Pain Syndrome: A Systematic Review of the Literature from 2000 to 2010


As I continue our series on THE MOST COMMON PROBLEMS I SEE at Schierling Chiropractic, LLC, today we will tackle a very common problem --- something most frequently called "Patellofemoral Syndrome".

Depending on whose research you believe, the number one or number two reason that people visit "Sports Physicians" is Palellofemoral Syndrome (aka Patellar Tracking Syndrome, Chontromalacia Patella, and several others).  The quote at the top of the page was written over 15 years ago, and comes from a paper that is still widely considered to be the definitive word on the topic.  The pain itself is found most commonly in the front of the knee and is thought to arise from contact between the underside of the patella (knee-cap) and the thigh bone (femur).  It occurs most often in younger female athletes, although it is commonly found in runners of all ages (male as well), basketball players, as well as athletes from various other sports.

Although there are a wide array of treatment options for this problem, the "gold standard" involves various exercises to strengthen the quadriceps (front thigh muscles).  My goal today is to show you why this is not necessarily always the best or only option --- particularly if you are one of those who may have been told that a Lateral Release Surgery is your only option.
Let me first say that many of those I see diagnosed with Patellar Tracking Syndrome actually have some form of TENDINOSIS (it is important to understand the difference BETWEEN TENDINITIS AND TENDINOSIS).  This Tendinosis can occur in several different places (click on image at left) and my be a concurrent problem, or may mean the person was misdiagnosed.  Just understand that when we talk about Tendinosis of the knee, this can be in the form of Quadriceps Tendinosis or Patellar Tendon Tendinosis (HERE -- named according to the specific tendon it's found in).  Sometimes, this can be confused with OSGOOD SCHLATTER SYNDROME --- particularly in a child or youth who has not yet developed the large "Tibial Tubercle".

As you might imagine, most sources will tell you that Patellofemoral Syndrome is caused by weak quadriceps (front thigh muscles).  I am personally not convinced that this is always the case.  In fact, I would say that this assessment is often times blatantly incorrect. 

I see a lot of people with Patellar Tracking Syndrome and more often than not, find the opposite to be true (weak hamstrings being overpowered by the quads, which are --- or at least should be --- the strongest muscle group in the body).  This is particularly true in athletes.  In most athletes (particularly those who are well-trained or weight lifters) the quadriceps are significantly stronger than the hamstrings.  Not only that, but when people train their legs in the weight room, most of the common exercises for legs (squats, hack squats, presses on the leg sled, leg extensions) mostly or entirely work the quadriceps.  In fact, other than maybe doing some hamstrings curls, I find that many athletes are doing very little for their hamstrings. 

Below is a video of Jennifer that was shot three days ago.  Although I had treated Jennifer for Patellofemoral Syndrome over a decade ago, it only took one treatment to solve a (severe) knee problem that she had dealt with for five years.  I do not actually remember doing this treatment, but when I recently suggested that she might have Fasical Adhesions in her neck, she reminded me of the Fascial Adhesions that she had in her knee.  I told her that I would be doing an article on that particular problem on Monday, so she agreed to do a video for us (thanks Jennifer!).
Besides the quadriceps strengthening exercises, one of the most common methods of treating people with with Patellar Tracking Syndrome involves the use of NSAIDS.  As you might guess, I am not a big fan.  And as for CORTICOSTEROID INJECTIONS; because the cartilage surface of the underside of the knee may already be 'soft' (Chondromalacia Patella), the last conceivable thing you would ever want to put into the knee is something that is likely to make it softer or degenerative, which is exactly what Corticosteroids do.

Symptoms of Patellofemoral Syndrome include pain in and around the knee.  This is because, according to a 2009 article by Tom Plamodon, "The cause of pain and dysfunction often results from abnormal forces (e.g. increased pull of the lateral quadricep retinaculum with acute or chronic lateral PF subluxation / dislocation)".  In light of the fact that this is the medical community's current thought process on this matter, this is an important statement to understand.  And in order to grasp it, you'll first have to understand what a RETINACULUM is.  A Retinaculum (often referred to as an APNONEUROSIS) is simply a very wide, flattened or thin, fascia-like tendon.  Listen to Wikipedia's definition of a common treatment for Patellar Tracking Syndrome; the Lateral Release.
"A Lateral Release Surgery (also called a "Lateral Retinacular Release") is a surgical procedure to release tight capsular structures (lateral retinaculum) on the outer aspect (lateral aspect) of the kneecap (patella). This is usually performed because of knee pain related to the kneecap being pulled over to the outer (lateral) side and not being able to run properly in the center of the groove of the femur bone as the knee bends and straightens."
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I want you to look at the picture to the right (the muscle in red is the vastus medialis) and think about something for a moment.  If, as Dr. Plamodon above says, the lateral quadricep retinaculum has an "increased pull", we need to ask ourselves why.  Although we are almost always told that this is due to a weakness in the vastus medialis (the muscle on the inside front of the lower thigh opposite the vastus lateralis), I find that this is often not the case --- or at least it does not tell the entire story.  Instead, the problem is that there is very often ADHESED FASCIA (retinaculum) in and around the area of the vastus lateralis.  This area of adhesion can encompass the lower ITB as well.  What causes this?  Although I am not certain, I would speculate that it has to do with the fact that FASCIA can be broken down and scarred by either chronic repetition (i.e. running) or traumatic injuries --- both being exceedingly common in athletes.

Although strengthening of the quadriceps usually solves this particular pain, it can actually worsen the imbalance between the quadriceps and the hamstrings.  It was not that long ago that I read an article talking about the incredible increase in the numbers of cases of non-contact knee ruptures seen in today's athletes --- particularly female athletes.  The authors touted the fact that the number one cause of non-tramatic ACL ruptures in the female population, the quads were overpowering the hamstrings. 

For more information about PATELLO-FEMORAL SYNDROME and how to avoid a "Lateral Release" surgery, just take a few minutes to click and read the link.  You may want to look at our COLD LASER PAGE as well.

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I Have Become my Knee

2/10/2012

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"I HAVE BECOME MY KNEE"

Chronic Pain
Becky Stern
I'll never forget the first time I heard a patient make a statement like this; "I have become my knee". I totally understood what he was saying.  "Joe" had come to me for chronic knee pain due to an old high school football injury.  Although he was much younger than me, he had already had five knee surgeries, and was struggling with terrible pain in his ITB.  He was hoping to avoid a total knee replacement, but unfortunately, he had no cartilage left and there was little I could do. 

Joe explained to me that after he HURT HIS KNEE and had surgery, the CHRONIC PAIN and DYSFUNCTION had set in, and nothing that any of his doctors did could relieve it more than temporarily.  He went on to say that his knee was all he thought about any more. When people would see him on the street, it was not, "Morning Joe; how you doing?"  It was, "Morning Joe.  How's the knee?"  I can relate to this.  Not only on a personal level (an old foot / hip injury), but because of what my patients tell me ---- over and over and over again.  I just had a woman come to me for a Chronic Pain issue who said she recently caused a minor automobile accident because she was thinking about her hip.  It was, as the old Willie Nelson song goes, always on her mind.  And what does thinking about your pain all day do to the brain?  It's a no-brainer ---- it destroys it!


BRAIN ATROPHY LINKED TO CHRONIC PAIN
A patient recently told me that he thought that his chronic pain was making him, "dumber".  I was not surprised.  For years neuroscientists have known that Chronic Pain causes brain atrophy (shrinkage) which, on a brain scan, is indistinguishable from atrophy found in ALZHEIMER'S DISEASE or Dementia.  More recently the Journal of Neuroscience reported on a study from McGill University's Research Center stating, "The longer the individual has had Fibromyalgia [Chronic Pain], the greater the gray matter loss, with each year of fibromyalgia [Chronic Pain] being equivalent to 9.5 times the loss in normal aging".  Think about it for a moment. Every single year you live with FIBROMYALGIA (or other Chronic Pain Syndromes) is the equivalent of nearly 10 times the brain loss seen in the normal aging process.  Re-read this paragraph until the urgency of your situation sinks in!

I was married in 1996.  Soon after, I avulsed my ankle playing basketball with my Bible Study group.  This was not the first time I had injured my ankle in such fashion.  Then in 1998 I started having pain in the bottom of the foot that was not PLANTAR FASCIITIS.  Although Shawn of XTREME FOOTWERKS, gave me my life back a few years ago, I lived with Chronic Pain for over a decade.  Although I never did take pain meds, I did everything else that I could possibly do to help control the pain and keep it at a manageable level.  At one point I told my wife that I was ready to have the foot amputated.  So, when someone tells me, "I have become my pain," I get it.

Maybe that's why I have a laser-like focus on helping those who live with Chronic Pain get their lives back.  I've been there. I've lived it.  I have walked in their shoes ----- and I know how miserable it really is.  But beyond simply empathizing with them, I have made it my life's mission to do something about it.   No, I cannot help every person who suffers with Chronic Pain.  But if your problem is being caused by adhesion and restriction of the elastic, collagen-based connective tissues (FASCIAL ADHESIONS and / or TENDINOPATHIES / TENDINOSIS), there is a good chance that I can help you.  If you have given up hope, simply take a few minutes to view our VIDEO TESTIMONIAL PAGE.  I have always said that there is someone out there who can help you with your problem; it's just a matter of finding them.  My goal is to be 'that someone' to as many people as possible.

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    Russell Schierling

    Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic.  He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since.  He and his wife Amy have four children (three daughters and a son).

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