Do You Have Noisy Joints?

hpt-snapping-jointsby Michael Lambert, DPT –  Hampton Clinic

Have you ever heard a pop or a crack in your knee when trying to get down on the floor? Or maybe you heard some noise in your elbow one morning when you picked up your coffee cup or even a little click in your shoulder when you reached over to your alarm clock? The sounds you are hearing are called “crepitus”.

What is crepitus?
Crepitus is the pop, crack, or click sound that you hear from your joints with movement. Crepitus is commonly caused by air making its way into soft tissues that surround your joints. When you move your joints and use the soft tissues, the air pockets can “pop” causing an audible sound (1). Crepitus can start following an injury such as fall, after an increase in activity level, or from repetitive use. These sounds can be considered normal, and if you do not have any pain they can be considered harmless!

Can crepitus be painful?
Crepitus can be painful in some instances. Below are a few common instances where crepitus can be painful.

popping-shoulder2Labral Involvement:
Both your hip and shoulder are considered ball-and-socket joints, and are structured to allow movement in multiple directions. The “socket” portion over these joints is lined with cartilage to deepen the socket and allow for more joint congruency. This cartilage is called your labrum. Dysfunction or damage to either labrum can cause painful crepitus that would feel “deep” in the joint (2).

Osteoarthritis:
According to the Arthritis Foundation, osteoarthritis is the most common chronic condition that affects the joints, and although osteoarthritis can occur at any age, it is more common in people over the age of 65. In healthy joints, the ends of each bone are covered with cartilage, which allows for smooth, pain-free movement. With osteoarthritis, the cartilage is broken down, which can cause painful, noisy movement.

Myth Buster! It was previously believed that purposely cracking the knuckles in your hands and fingers could lead to osteoarthritis. Recent research suggests that there is no relationship between regular knuckle cracking and osteoarthritis (4).

Patellofemoral Pain Syndrome (Also Known As “Runner’s Knee”):
As previously mentioned, sometimes air can make its way into the soft tissues around the kneecap (1). When this happens, when you bend your knee to sit down, squat to pick something up off the floor, or climb up some stairs, the air pockets can pop, causing an audible sound. If you have pain with these activities or pain with the popping sound, it may be caused by muscle imbalances or by tight or irritated structures around the knee.

What should I do if I have painful crepitus?
If you have painful crepitus, the first step is identifying the cause of the crepitus. You may have tight muscles that need to be stretched, weak muscles that need to be strengthened, or a neuromuscular system that needs to be revamped (balance training, specific muscle recruitment, etc.). Or maybe you just may learn new techniques for activities that cause pain, such as lifting something off of the floor.

What If I do not know where to start?
Come to physical therapy! New Hampshire is a direct access state. This means that many patients can come to physical therapy without a physician referral for problems related to the musculoskeletal system! If you have crepitus associated with pain or feel that you are limited with your everyday activities, let us help! We can help uncover the route of your crepitus, and establish a plan to get you feeling better! Along with education for the best stretches, strengthening, neuromuscular exercises, and activity modifications for you, we are skilled in multiple manual intervention techniques (soft tissue mobilization, mobilizations/manipulations, dry needling, etc) that may provide relief and speed up your recovery! Call Hampton Physical Therapy and schedule an assessment at either our Hampton or Seabrook location!

References

  1. Crepitus (Joint Popping).” Aurora Health Care, www.aurorahealthcare.org/services/orthopedics/conditions/crepitus. Accessed 12/02/2017.
  2. Labrum” MedicineNet.com, www.medicinenet.com/script/main/art.asp?articlekey=18656. Accessed 12/02/2017.
  3. Arthritis.” Aurora Health Care, www.aurorahealthcare.org/services/orthopedics/conditions/arthritis. Accessed 12/02/2017.
  4. Deweber, K., Olszewski, M., & Ortolano, R. (2011). Knuckle Cracking and Hand Osteoarthritis. The Journal of the American Board of Family Medicine, 24(2), 169-174. doi:10.3122/jabfm.2011.02.100156
  5. What is Arthritis?” Arthritis Foundation, www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php. Accessed 12/02/2017.

Shoulder Impingement: Defining and Treating

hurt-shoulder-HamptonPTBy Kristin Keafer DeRousse, PT, DPT – Hampton Physical Therapy, Hampton, NH clinic

What is Shoulder impingement?

Shoulder impingement syndrome is the most common musculoskeletal diagnosis related to shoulder injuries. There has been an ongoing debate on the etiology of impingement and rotator cuff tears, but it is likely to be multifactorial(4). Impingement indicates that there is a narrowed space underneath the acromion (see diagram 1). Structures that may be involved in this diagnosis include the rotator cuff tendons, bicep tendon, subacromial bursa, and the coracoacromial ligament. Sometimes bone spurs develop within this space and cause inflammation to these structures, however other times there may be evidence of degenerative “wear and tear” of the rotator cuff tendon that is causing the pain.

The shoulder is a multidirectional joint and therefore the assessment of the joint capsule, scapular movement patterns, and shoulder muscles should be performed to determine the extent to each individual injury. A clinical examination and movement-based assessment should be used to determine the reason for underlying pain and inflammation.

Signs and symptoms
If inflammation exists within the subacromial space, the mechanics of the shoulder brakes down causing pain and movement dysfunction. This will typically result in anterolateral arm pain. Common exacerbating movements include laying on the affected side, stretching and reaching for overhead objects. A painful arc will be present when raising the arm between 60 and 120 degrees.

Rotator cuff anatomy
More than likely you will have involvement of the rotator cuff tendons. There are 4 muscles part of the rotator cuff: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles are responsible for stabilizing and gliding the shoulder properly when you move and raise your arm away from your body. The most common rotator cuff muscle involved is the supraspinatus since it travels directly under the acromion. Pain, inflammation, and weakness at any of these muscles will decrease the ability to raise your arm overhead.

rotator-cuff---HPTTreatment
Research indicates that conservative treatment methods are the most effective if you do not have a full thickness tear of the rotator cuff. Physical therapy is a critical component to your recovery of shoulder impingement and rotator cuff tendon injuries.

shoulder-therapySupervised exercise that includes range of motion activities, stretching, and strengthening is imperative in the rehabilitation process (2). Research also indicates that manual therapy in addition to exercise is better than just exercise alone (1). This may include joint mobilization to address the joint capsule as well as soft tissue mobilization techniques to address pain and muscular dysfunction. There is also research to support the use of cervical and thoracic manipulation to reduce pain and improve range of motion through the shoulder(5). All of our therapists are well trained in these manual techniques.

Corticosteroids are also commonly used as an avenue for conservative treatment by physicians. However, research indicates that these patients require additional doctors visits and multiple steroid injections as compared to those patients who receive physical therapy alone (3). Many times patients that receive injections require physical therapy additionally anyways.

Surgical intervention is not recommended unless there is a large rotator cuff tear and is most always the last resort as a treatment option.

Recommendations
Physical therapy should be the initial step to treating shoulder impingement and rotator cuff pathology. This ultimately allows for reduced healthcare costs and provides a conservative effective avenue for returning patients to their daily activities without pain.

Direct access allows for many patients to come directly to physical therapy without a physician referral to evaluate and treat a musculoskeletal dysfunction. If you have a pain in your shoulder, please call Hampton Physical Therapy with clinics in both Hampton, NH and Seabrook, NH to schedule a comprehensive assessment!

References

1. Bang, MD, et al. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome. J Orthop Sports Phys Ther 2000;30:126–137.

2. Halk, MN, et al. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016 Sep;50(18):1124-34.

3. Rhon, DI, et al. One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome: A Pragmatic Randomized Trial. Ann Intern Med. 2014;161(3):161-169.

4. Singh, B, et al. Current Concepts in the Diagnosis and Treatment of Shoulder Impingement. Indian J Orthop. 2017 Sep-Oct; 51(5): 516–523.

5. Vinuesa-Montoya, S, et al. A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement. J Chiropr Med. 2017 Jun;16(2):85-93.

Have a Pain in Your Head?

Types of Headaches and How They Can Be Helped…

headache cure HPT

by Michael Brezak, PT, DPT – Hampton NH Clinic

We all live stressful lives. The hustle and bustle of day to day activities at times can leave us feeling a bit stretched too thin. Stress plays an important role in how we feel and interact with our friends, family, and colleagues. Leaving stress to become so ‘built up’ as it were can lead to further medical complications including headaches. It is estimated that about 80% of all individuals have experienced some form of a headache in one way or another(1). It is about understanding your symptoms to find the best treatment for your condition. This article will go over three different types of headaches (Tension, Migraine, and Cervicogenic) and then see how Hampton Physical Therapy can help.

Tension headaches are the most common and usually the type that affects the majority of the population on a day to day basis(1). It is that constant “pounding” sensation that one may experience along their temple or even in the back of the neck. This type of headache typically is the result of increased stress which can cause tightened muscles at the base of the neck. Largely these can be managed with over the counter medication, ice, and reducing stress levels all are effective management techniques to reducing your symptoms.

“Migraine headaches have controlled my life for years now. After trying just about every medicine available, I have found the best way to keep the migraines under control to be dry needling therapy. Kate and the team at Hampton Physical Therapy are great!” Ginny Carr

Next are migraine headaches which can often times be debilitating in terms of severity or longevity. Migraine headaches can be attributed to certain ‘triggers’ that develop over time, but largely their exact cause is unknown(2). The more common triggers include light sensitivity, noise levels, and even changes in the weather. These type of headaches are usually precipitated in the form of an ‘aura’ which foreshadowing of impending symptoms.
cervogenic headache
Lastly are cervicogenic headaches which can often times be confused with tension headaches are their presentation is similar. These types of headaches present with decreased range of motion in the neck and joint pain ranging from the shoulders to the base of the skull(3). One aspect of these type of headaches is even a joint dysfunction of the spinal column can be the underlying cause(4). An interesting specific feature of this type of headache is that they are usually one sided in origin(5). Meaning that its presentation is one where it feels as if it radiates from the base of the neck and wraps around in a crescent pattern towards the eye.

In the end, it truly depends on what type of headache you have and how to find the right treatment. A thorough evaluation by a primary physician or a physical therapist can be the first step in the right direction. Each therapist at Hampton Physical Therapy is trained in various techniques including the latest research based treatment of cervical manipulation (similar to chiropractors) and Trigger Point Dry Needling to reduce or eliminate headaches and related symptoms.