Knee Osteoarthritis

Knee pain in the middle to late decades of life is a common complaint amongst patients presenting to osteopathic clinics across the globe. Osteoarthritis (OA) is a common cause of knee pain in this age group of people. Research suggests approximately 654 million people aged 40 years and over were living with knee OA in 2020 around the world. This comes at an incredible cost to healthcare services worldwide, with figures in the billions of dollars!

What is osteoarthritis?

Osteoarthritis is just one of a number of forms of arthritis… Essentially a disease which affects the joints in our body. OA is the most common form of arthritis, with Rheumatoid Arthritis (RA) being the second most common form. This blog will focus on OA, a potentially debilitating disease that most commonly affects the weight-bearing joints of the body (i.e. the knees, hips and lumbar spine), but can affect any joint in the body where the joint surfaces are covered in cartilage.

The characteristics of OA include loss of the cartilage that covers the ends of bones that come together to form joints. The underlying and surrounding bone, as well as other joint structures (including joint capsules and other tissues) are also susceptible to degenerative changes that ultimately lead to poor functioning of a joint. The process usually occurs over a long period of time, often starting early in life (interestingly with little to no symptoms at all) and progressing into the latter years. The severity of the disease varies from person to person with some people only experiencing mild symptoms throughout their life. Other people experience more severe symptoms and may require joint replacement surgery as a last port of call to ensure they can continue to live their life as pain-free as possible.

Osteoarthritis of the knee can affect either of the two main joint components of the knee… The joint between the ends of the thighbone and the shin-bone (called the tibiofemoral joint), and the joint between the thigh-bone and the knee-cap (called the patella-femoral joint).

 

Risk factors

There are certain factors associated with higher rates of knee OA. These include:

  • Age: Rates of knee OA increase in the elderly
  • Obesity: Rates of knee OA increase with higher levels of obesity
  • Gender: Females slightly out-do the males with this one, being approximately 1.5 times more likely to develop it
  • Trauma: A trauma to the knee can increase your likelihood of developing knee OA
  • Smoking: Smoking is associated with higher rates of knee OA

 

Signs and symptoms

The signs and symptoms of knee OA include:

  • Pain
  • Stiffness
  • Swelling
  • Reduced range of motion
  • Difficulty performing functional movements including squatting and kneeling

 

Pain associated with tibiofemoral OA commonly affects the inside region of the knee first, where the two bones meet at the joint line. Patella-femoral related pain is often felt deep behind the kneecap. Pain will vary from one person to another, and the severity of pain does not necessarily relate to the severity of degeneration. Although if you speak to a person who is about to have a joint replacement surgery (i.e. their joint has degenerated to the point of needing a surgical intervention to keep the person functioning well), they will likely tell you that the pain is extremely debilitating.

Pain and stiffness are regularly felt first thing in the morning and late at night. OA tends to respond well to movement of the joints, and so people often find their pain and stiffness improves once they are up and moving, for it to return once their day has finished and they are relaxing at night.

 

Treatment

So, you’ve been diagnosed with knee OA. What to do? Call your osteo… Ta-dah!!!! Given we are experts in how the human body moves (we study human biomechanics at uni), we’re good at picking up how the body should and shouldn’t move. There are no magic pills for treating OA of the knee, and no practitioner can claim to treat the disease itself, as there is unfortunately no cure for OA. It is a progressive, degenerative disease, but there are ways of stunting the progression of this condition if the risk factors leading to its presence are attacked head on.

Poor movement resulting from daily postural repetitive strain, or an old injury that wasn’t treated to resolution is a big factor in the maintenance and development of OA in the knee. Poor movement or dysfunction occurring in the low back, hip or ankle can all lead to excessive load being placed through the knee joints, which can exacerbate the disease process. This is where we come in. We can watch you move during an assessment and work out what is causing the excessive loads through the knee and put a plan in place to improve range of motion and flexibility, strengthen muscles and return you to (hopefully) pain-free daily activities. We will use a combination of soft tissue manipulation, joint mobilization and progressive exercise programs to restore life to your body. Returning to efficient movement patterns after years of neglect, poor movement and a de-conditioned body part will take time, but with determination from both you and your practitioner, it can happen.

 

As previously mentioned, some cases of knee OA can end up requiring surgical intervention to replace either part of or the whole joint. The good news is, if you do have to go through this process, we have your back (well… in this case, your knee) and can help you through rehab and recovery. Many people who have a knee replacement return to full daily activities and live a long and pain-free life.

Knee pain? What are you waiting for? Call us today on (416) 546-4887 or book online to schedule your appointment.

 

References
1. Cui, A. et al. 2020. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 100587. 29-30. Available from: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2820%2930331-X

  1. Arthritis Australia. 2016. Counting the cost. [Online]. Available from: https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final-Counting-the-Costs_Part1_MAY2016.pdf. [Accessed 09 February 2021]
  2. Centres for Disease Control and Prevention. 2020. Cost statistics: The cost of arthritis in US adults. [Online]. Available from: https://www.cdc.gov/arthritis/data_statistics/cost.htm. [Accessed 09 February 2021]

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Approximately 2 million ankle ‘sprains’ (the word used to describe a ligament that has been over-stretched or torn) occur in the US every year alone, which gives you an idea of how many happen worldwide! Whilst many of these sprains occur in the sporting world, there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorized into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further than your trusty osteopath. Call us today on (416) 546-4887 or book online to book your appointment and begin treatment immediately.

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Spondylolisthesis

Spondylolisthesis is a spinal condition that in the sports world most commonly affects cricketers and gymnasts, but in reality, can affect anyone! Pronounced ‘spon-di-lo-lice-thee-sis’, it most commonly affects the lowest segments of the lower spine region.

What is spondylolisthesis?

Spondylolisthesis is the slipping forward of one vertebra on another. This most commonly occurs at the L5 segment (the lowest vertebrae in the lumbar spine), which slips forward on the S1 segment of the sacral bone. The runner up? L4, which is also a commonly affected area.

There are a few different causes of this condition, and so it has been classified into different types. There are five categories of spondylolisthesis. These are:

  1. Degenerative: Occurs due to degenerative changes to the spinal facet joints and discs
  2. Isthmic: Occurs due to a bone defect in a part of the vertebrae known as the ‘pars interarticularis’
  3. Traumatic: Occurs following a trauma that results in a fracture of either the spinal facet joints or pars interarticularis.
  4. Dysplastic: Occurs due to a developmental defect of the vertebrae which alters the direction of the spinal facet joints, leaving the segment(s) open to slippage in the area where they are partially held in place by the facet joints.
  5. Pathologic: Occurs secondary to a medical problem such as infection or cancer.

In theory, any process that leads to the weakening of the supportive structures of the spinal segments (i.e. the bones, ligaments, discs, muscles) can lead to abnormal movement of the spine.

 

Grades of spondylolisthesis

Spondylolisthesis is further classified based on the amount of slippage that has occurred:

  • Grade 1: Between 0-25% of the vertebral body has slipped forward on the vertebrae below
  • Grade 2: Between 25-50% has slipped forward
  • Grade 3: Between 50-75% has slipped forward
  • Grade 4: Over 75% of the vertebral body has slipped forward

The most commonly reported grade of this condition is grade one, accounting for approximately 75% of all cases.

 

Signs and symptoms

These vary depending on the cause, but can include any or all of the following:

  • Low back pain, including pain in the buttocks
  • Pain along the back of the thigh which rarely goes lower than the knee
  • Tight hamstring muscles
  • Changes in walking pattern
  • Pins and needles and/or numbness down the legs
  • Bowel and bladder dysfunction (in more severe cases)

If you come to us with low back and/or leg pain, we are trained to work out exactly what is going on based on your symptoms and medical history. We will ask you lots of questions to begin with to dwindle our list of potential diagnoses to just one or two. Then we’ll get you to move and through a thorough movement assessment, will be able to come to a specific diagnosis that we will work with you to treat.

Sometimes we may require the help of imaging to rule in or out spondylolisthesis, depending on the severity of symptoms and how much it is impacting your life. In these cases, we will send you off for an x-ray which can detect this issue.

 

Treatment

Most cases of spondylolisthesis can be managed conservatively, meaning non-surgical options are chosen over a surgical one. When this injury occurs, the instability of the particular spinal segment can lead to many of the signs and symptoms mentioned above. One of the main goals of treatment is to increase stability around the affected area and offload the forces that are acting on the injured area.

We will spend time educating you on the mechanics of the spine. If you understand what is happening to your spine, you will know how to protect it, without adding unnecessary stress to the area. We will also advise on appropriate footwear, as well as standing, seated and sleeping postures. Being obese or overweight is also a risk factor for developing, as well as maintaining this problem. If you need to lose weight, we can help you formulate a plan to get there.

Exercise to increase core stability, as well as flexibility of tight muscles is a very important part of therapy as this will reduce the need for external supports such as braces in the long term. And of course, not forgetting our wonderful hands which will get to work on your muscles and joints to reduce tension and tightness, while increasing range of motion. Our osteopaths can help you manage your spondylolisthesis.

All of the above treatments will help you to manage pain, increase function and get you back to work or sport or gardening… Whatever your goal is! Call us today on (416) 546-4887 or book online at beachealth.janeapp.com if you have low back pain, or even if you already have a diagnosis of spondylolisthesis, and we can help you formulate a recovery plan to get you on the road to better health.

 

References

  1. Chila, AG. et al. 2011. Foundations of Osteopathic Medicine. 3rd ed. Lippincott, Williams & Wilkins: Philadelphia
  2. Tenny, S. and Gillis, C. 2020. Spondylolisthesis. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Many sprains occur in the sporting world, but there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorised into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further, our team can help you get back and running. Our osteopaths can help with treatment and rehab, whilst our chiropodist can help out with alignment corrections and shoe recommendations. Call us today on (416) 546-4887 or book online at beachealth.janeapp.com to book your appointment and begin treatment immediately.

 

 

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Connective Tissue Disease

The human body is made up of trillions of cells. Recent findings suggest as many as 30 trillion cells combine to form the human body at any one time. That’s pretty much impossible to comprehend. But combine they do, and what beautiful forms we are! Have you ever thought how all those cells stay together so well? Well… Our intricate and amazing bodies contain special tissues (made up of proteins) known as ‘connective tissues’ (CTs), which act as a glue to hold everything together. Without connective tissue, we may just exist as one big blobby puddle on the floor!

As well as their glue-like property, CTs allow the tissues of the body to stretch and recoil… A little bit like an elastic band. Some common examples of proteins that make up the CTs in the body include ‘collagen’ and ‘elastin’ (you may have heard of these before). It is possible for a person to have a disease which directly affects the CTs of the body. Collectively these are known as connective tissues diseases (CTDs), or diseases of connective tissue. As connective tissue is found all over the body, nearly all of the body can be affected. CTDs may affect the skin, blood vessels, blood, muscles, fat, bones, cartilage, tendons, ligaments and other joint-related tissues. Even the eye can be affected!

Types of CTD

There are two main types of CTD… Genetic and autoimmune. We’ll explain what these mean:

Genetic: These types of diseases are inherited. This is usually because of a single mutated gene that is passed on from your parents to you.
Autoimmune: These types of diseases occur because your body’s defence system (aka the immune system) views the CTs as foreign and attacks them. This results in a painful, inflammation-driven condition where a person regularly experiences redness, heat, swelling and pain in specific parts of their body.

Genetic CTDs

Examples of genetic diseases of CT (with a little description of each) include:

Ehlers-Danlos syndrome: Affects the collagen in our body, resulting in excessively stretchy skin, hyper-mobile joints and abnormal scar tissue formation. There are over ten forms of this condition.
Marfans syndrome: Affects fibrillin (a protein) in the body, resulting in longer bones and thin and long fingers and toes. People with Marfans are usually very tall and slender.
Osteogenesis Imperfecta: Another condition that affects collagen, resulting in brittle bones, weak and thin skin, loose ligaments and a lower than average muscle mass.

Autoimmune CTDs

Examples of autoimmune diseases of CT include:

Rheumatoid arthritis (RA): The body attacks the membranes that hold the joints together resulting in pain, stiffness, degeneration and destruction of joints throughout the body. RA typically affects the small joints of the hands and feet.
Sjogren’s syndrome: A disease which typically leaves a person with an excessively dry mouth and eyes. People also regularly experience joint pain.
Systemic Lupus Erythematosis (SLE): A condition that causes inflammation of the skin, internal organs and joints. Other symptoms include mouth ulcers, heart, lung and kidney problems, hair loss and mental health issues.

It is useful to point out there are many other CTDs. Having one CTD means you are more likely to have other CTDs as well.

Treatment

So where does my osteo come into the equation? Being the holistic practitioners we are, we can help in many ways. People with CTDs regularly need help with joint range of motion, as well as an exercise program to help strengthen the body. Treatment and exercise need to be carefully planned out with CTDs, so having someone with experience to help you manage a potentially difficult condition is always handy. We can also help to educate you on what the diseases are, and how they affect you to ensure you have the correct self-help strategies in place.

Have you been diagnosed with a CTD? If so, get in touch today for an appointment. We’d love to be a part of your team!

 

References
1. Healthline. 2018. Diseases of connective tissue, from genetic to autoimmune. [Online]. Available from: https://www.healthline.com/health/connective-tissue-disease#types. [Accessed 16 Dec 2020]
2. Genetic and rare diseases information centre. 2014. Mixed connective tissue disease. [Online]. Available from: https://rarediseases.info.nih.gov/diseases/7051/mixed-connective-tissue-disease. [Accessed 16 Dec 2020]
3. Science Direct. 2019. Connective tissue disease. [Online]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/connective-tissue-disease. [Accessed 16 Dec 2020]
4. Healthline. 2018. How many cells are in the human body? Fast facts. [Online]. Available from: https://www.healthline.com/health/number-of-cells-in-body. [Accessed 16 Dec 2020]

Gluteal Tendinopathy

Have you recently started to experience pain at the side of your hip? With the turn of the new year now behind us, maybe you’re embracing your new healthy lifestyle and have been going for a solid run several times a week to shift some of those festive kilos… Or it might just be that you’re getting a bit older, hitting the middle decades of life, and you’ve had a nagging hip for a while. There are a few structures in and around the hip that can lead to pain felt at the very outer aspect of it. Problems in the low back, the hip joint itself, and soft tissues that surround the joint can all be viable culprits.

Common culprits in the running and middle-aged populations are the tendons of the gluteal muscles. These muscles are responsible for movement at the hip (outwards, backwards and forwards) and stability of the pelvis and hip during movement. There are three gluteal muscles or ‘glutes’. The deepest muscle is the gluteus minimus, followed by gluteus medius, and finally gluteus maximus (which is the largest and most superficial of all three). Where the gluteus medius and minimus tendons wrap around the bony outer part of the hip and insert into the bone, are the areas most commonly associated with disease leading to pain in the outer hip.

Tendon disease

There are a few terms that can describe a diseased tendon. An acutely inflamed tendon is known as ‘tendinitis’, where ‘itis‘ means inflammation occurring at the tissue. A tendon which is chronically diseased (i.e. long-standing pain that may have been present for several weeks, months or years without the presence of inflammation), is known as ‘tendinopathy’. Historically the term ‘tendinosis’ was used to describe a chronic tendon problem, but tendinopathy is now the favoured term. The important thing is to think of a tendon problem sitting somewhere on a continuum between acutely inflamed and chronically degenerated and/or torn.

Let’s take our aforementioned population, a middle-aged female (females are more affected by this issue than males), who runs. What typically happens is they will start to run with the full intent of bettering themselves. Due to poor running technique, the tendon becomes overloaded and after a few weeks or months… Bang! Inflammation, pain, can barely walk! Once the initial pain settles and movement resumes, they start to run again. If they haven’t corrected the problem that underlies the initial acute episode, the problem compounds itself. The body will compensate, and further excessive load and compression are placed on the tendons and other surrounding structures. This might go on for a while with the hip grumbling from time to time. Eventually, the changes that have occurred to the tendon tissue result in widespread degeneration and derangement of the tendon fibres and you are left with a tendon incapable of dealing with the high loads required to do something like running. If left untreated, the tendon eventually tears and leaves you with a very unhappy and less mobile hip.

Signs and symptoms

The signs and symptoms of a gluteus medius and/or gluteus minimus tendinopathy include any or all of the following:

• Pain felt on the outside of your hip
• Pain that radiates down the thigh to the knee
• Pain that is worse before and after exercise
• Pain that improves initially with exercise (depending where on the disease process you are)
• Pain when lying on the affected side
• Difficulty walking up stairs or hills
• Difficulty standing on one leg (on the affected side)

Treatment

Your first port of call is to temporarily cease the activity that is aggravating your hip, and ring your osteo (ahem… 416-546-4887). This will help to de-load the injured tendon, and give you relief knowing soon you will be in the hands of an expert who is going to guide you through your recovery journey. We will assess your movement from top to bottom and work out where the root cause of your problem is. This is what osteopaths are great at doing. We look beyond the pain, take a picture of your whole life (occupation, hobbies, family life, etc…) and work out all of the contributing factors, so we can put a comprehensive plan in place to rid you of your problem forever.

For a gluteal tendon problem to occur in the first place, there will likely be mechanical issues to correct in the spine and/or lower limb (from the foot up). We do this with a combination of:

• Hands-on therapy to soothe your pain and improve muscle and joint health
• Re-training of poor movements into more efficient movements
• Strengthening exercises for the muscles / tendons
• Alterations to your daily life which may be contributing to your issue (i.e. increasing particular activities, decreasing aggravating activities, changing a work posture)

Over time, treatment will aim to progressively strengthen the gluteal tendons, so they are capable of withstanding greater loads again. Combined with correction of poor, inefficient movements, this will also decrease the compressive forces acting on the tissues in and around the hip, leaving you with greater strength and more flexibility.

We will be with you every step of the way. A gluteal tendinopathy doesn’t mean you have to give up running. We might need to change focus for a short period during rehab, but our goal will be to get you back to your pre-injury state… with a little extra in the tank so you’re not back with us for the same issue within two months.

Hip pain, was it? No problem. We got this! Contact us

Cranial Osteopathy and Cranio-sacral therapy

Our Osteopathic Manual Practitioners at Beachealth have completed a 5 year double degree university program at Victoria University in Australia for Osteopathy. This qualifies them to practice osteopathy and in Australia under the title of Doctor. The basic training of cranial osteopathic technique is given during the medical degree, but some Osteopaths specialize at post graduate level.

In the 1970’s Cranio-Sacral therapy embraced these osteopathic techniques. However, most Cranio-Sacral Therapists are not Osteopaths, and not all therapists have a background in anatomy, physiology, pathology, diagnosis and biomechanics. Therefore they are unable to offer a valid working diagnosis which is essential prior to application of treatment.