Knees are the most operated joint of the body. The knee joint consists of the 3 joints around the knee. The tibio-femoral joint, the patellofemoral joint and along the outer side the tibio-fibular joint. There are ligaments, meniscus and multiple bursae (cushion sacs, protecting over wearing of muscles) around this joint. Many of these could refer pain.

Examination of the knee needs to include all these structures and also sources of referred pain, such as the lumbar spine and muscular referral. Ranges at the joints above and below are also very important aspects of assessment and treatment.

Treatment often involves mobilisation, strengthening, stretching, soft tissue techniques, taping and electrotherapy along the required areas. As mentioned above dealing with the cause of the injury could very well reduce pain and also deal with the cause of the injury in the first place.

In recent studies, injuries such a meniscal tear if not accompanied with locking could have a good outcome with physiotherapy and also be comparable to a surgical outcome.

Walking is an easy leisure activity. My aim with this blog is to suggest a few bio mechanical aspects that could optimize walking.

If we consider walking from the ground upwards, we come across the foot as the first point of contact. It is essential to have good mobility in the multiple joints there.

When we walk we should have a nice smooth transition of weight from the heel to the toe. It is also important to not favor either side while walking. Most of this control comes from the core control of the trunk and the gluteal muscles. These God given strategies allow the human body to translate forward and not collapse with each step.

The ability to maintain a slight bend without full locking the knee and the hip needs to translate well forwards and backwards for optimal function.

When we consider the trunk the weight of the body needs to the centered and not either forwards or backwards. The rest of the upper body would follow  this centering. A good arm swing to maintain good rotation of the thoracic spine and shoulder is also essential. Relaxed shoulders and a stable head posture would add on to the optimization of our gait pattern.

From a bio mechanical perspective it is important to maintain foot mobility, good quadriceps and hamstring control, adequate ability to maintain centering of the trunk, maintaining good thoracic rotation and adequate centering of the head above the rest of the body. These processes would be part of a walking assessment and treatment.

Low back pain is a very common cause of pain. Our sedentary posture and lack of activity could trigger an ongoing issue with low back pain.

Our body in all its created beauty, is connected. It is interesting to note that in recent times, research and refined anatomy has proved that the fascia which covers and encapsulates the muscles and organs are interconnected together. They also found that when a muscle attached to the bone, there are indirect connections that attach it to the surrounding areas or joints.

With this in mind, dealing with low back pain would involve looking at the dysfunctions that could be immediately close to the low back; such as the thoracic spine, rib cage, scapular attachments and also lower into the hip or all the way to the end of the limbs. Taking a detailed history usually unravels a pattern of dysfunction. Also assessment of the surrounding joints help rule out stiffness or pain in them. Hence treatment also will involve dealing with these areas.

Low back pain is possibly the greatest musculoskeletal dysfunction ever recorded. In countries where workers compensation is present, it is a major cost for industries. In other cases, majority of the people generally use medications and put up with the symptoms.

Physiotherapy is one of the areas that engage in treatment of the condition. Tailor made exercises specific to the condition is generally the suggested norm in most countries. The treatment world over includes using mobilisations/manipulations, soft tissue techniques, electrotherapy and exercises. It must be surprising to know that exercises have the best possible consistent evidence for the effectiveness in treatment of low back pain. Manipulations/mobilisations and soft tissue techniques definitely have their place dealing with the proprioreceptive feedback system within joints, ligaments and muscles. So in my opinion a more holistic treatment would include a combination of manual techniques and exercises. I would like to concentrate on exercises in the current blog.

I propose a relatively underused way, using the concept of axes of movements. Every joint has 3 axes of movements. The body almost never uses anatomical planes of movement but uses different angles at the proximal (Joint closer to the trunk) and distal joints (joint furthest from the body).

You may now ask, what all this means……How, this is relevant to my back pain….

Dealing with the available combination of movements in 3 plains would do the trick. It is hard to explain it on paper and i hope you would drop in to my subsequent blogs and drop in to my clinic for more information.

For example when we move our arm forwards it is the saggital plane, sideways would be the coronal and rotating our shoulder to do a hand behind back or the starting position of putting on your seat belt. These are some movements of the shoulder. Combining this with different leg positions/back positions would train the shoulder to move in varied environments.

To sum up this blog, the suggestion is move your back in all 3 planes to move well and retrain your back to move well in all 3 directions.

Frozen shoulder is the condition where there is pain and restriction of shoulder movement. The cause is unexplained. It is usually predominant in females, middle age and diabetics.

It goes through stages but the time periods associated with each stage is not set in concrete. The stages are: painful stage, frozen stage (movement stiffness) and thawing stage where there is a return of movement.

Physiotherapy could help in each of these stages, however it does not get rid of a true frozen shoulder. Hence 10 steps to get rid of frozen shoulder would be a myth!

Pain relief with gentle mobilization, soft tissue techniques and electrotherapy can have some symptomatic relief. The frozen stage is hard to deal with in terms of liberty of the shoulder movement. The best effect will be in the thawing stage where there is already a reversal of stiffness and pain. Joint mobilization, muscle releases and home exercising are useful in this stage.

Shoulder pain and restriction as a result of cervical (neck), thoracic (upper back) and lumbar spine restrictions are not frozen shoulder. These have good results and have quicker resolutions. Differential diagnosis is therefore very important in the treatment of frozen shoulder.

Sitting is the posture adopted by most working people. It is wise to have an understanding of what we all do so often for so long!

Sitting is meant to be loading the sit bones (ischium of the pelvis) but most often it is the sacrum and sometimes even the spine that we rest on. The spine is loaded during sitting. Recently some evidence suggested that some slouching is not bad for the body.

I beg to differ on this. The crucial thing to note is that breaks in between is the best way to avoid straining low back and pelvic area structures. Changing position often is the other strategy to help avoid over loading of a specific area.

The pelvis has a sit bone which is located along the center of the buttock. Sitting right, in my opinion loads up this area and that involves maintaining a neutral lumbar lodosis (lumbar curve). However there is a possibility of over extending at the lower thoracic or lumbar areas. That would counter all the benefits of good sitting. Therefore my advice is to visit a local physiotherapist to identify a neutral lumbar spine with adequate loading of the sit bone and also using a good chair.

I cant stress the fact that breaks every 40 minutes would be a better alternative than slouching at work!