Medical Musings, Health Hypotheses & Therapeutic Thoughts
Finally, we will consider some of the common causes of lateral knee pain. You may remember from the last blog that lateral means 'away from the mid-line of the body', so this is pain on the outside of the knee.
Many of the structures on the outside of the knee are similar to those on the inside, so they do not need much further consideration here (if you haven't yet, I strongly recommend that you read the first few posts about the knee, as they provide some much-needed background and context) These include:
Lateral meniscal injuries e.g. tears
In the last blog, we considered some common causes of pain in the front (anterior) and back (posterior) knee.
So, we have discussed how the poor 'design' of the knee joint means it is prone to various injuries and dysfunctions, but what does that mean in your everyday life?
Here we will consider the anatomy of the knee a bit further, and discuss some of the ways our knees can give us grief.
It is important to remember that, like most of the other joints in the body, the knee requires its neighbours to be doing a relatively good job in order to perform its own.
The human hand is such a sensitive and specialised structure; anatomically complex and strategically engineered by time and nature, having the ability to create such varied and precise movements.
Our hands contain so many weird and wonderfully specialised sensory cells that function to collect information via touch, position, pressure or temperature in relation to our current surroundings.
The information is continuously relayed to our brain where the appropriate networks of neurons pass precise instructions via the spinal cord, neural networks and down the nerves in our arms to the muscles responsible for generating the gestures we require.
This intricate sensory/motor control system is continuously checking itself and making small adjustments. We could be typing away in an attempt to conquer the monstrous, multi-headed hydra-like inexhaustible queue of office emails, operating an electric sander to remove tired paint in an effort to restore an antique to its former glory or just the general lifting and carrying as we go about our everyday activities.
With all these moving parts and capabilities made possible with our hands, we can create works of art and express ourselves. .
When we’re limber and feeling good, we barely notice how much we rely on and require that normal baseline level of ease.
However, when things don’t go as planned and if an injury occurs, whether caused by simple tasks or other health conditions, the loss of our normal function is very apparent.
One possible common condition responsible for hand pain is Carpal Tunnel Syndrome (CTS).
It affects 4-5% of the population (1) and can be quite disruptive, affecting a variety of people, from pregnant women, office workers and the elderly, to tradesman and others who work directly with their hands.
It seems to be caused by multiple factors, which could include (2);
Many of the structures that operate the hand are sandwiched together and must pass through a channel at the wrist (the carpal tunnel) bordered by sturdy carpal (or wrist) bones and ligaments, particularly the transverse carpal ligament as the ‘unyielding ceiling’.
Most of the space in this channel is occupied by rigid tendons that control finger movements, leaving only a small potential space for the squishy median nerve, which can be easily compressed here (1, 2).
Being the main sensory and motor supply for the palm of the hand, a squished median nerve can result in the frustrating and restrictive experience that Carpal Tunnel Syndrome is known for.
If you are experiencing signs and symptoms such as those described, the best course of action is to consult your GP or manual therapist as early as possible.
This could limit the impact on your everyday life activities and the need for any interventions in future.
If CTS is left to progress, a cortisone injection may be beneficial. It was reported that approximately 75% of patients experience improvement following this procedure (4, 5).
Failing that, a small surgical procedure can be recommended. It involves releasing the transverse carpal ligament (the mentioned ‘ceiling’ of the carpal tunnel), creating more space for the muscle tendons to glide together at the wrist, alleviating the direct pressure placed on the median nerve.
Luckily surgical intervention for CTS has a very high success rate, with over 90% of patients reporting alleviation of symptoms (6, 7, 8),
However, it is important to remember that as far as your body is concerned, there is no such thing as 'minor' surgery! Even in the best case scenario, the carpal tunnel now has (even more rigid and unyielding) scar tissue around it, which can cause other issues.
So the best thing to do is avoid any intrusive interventions.
And it’s entirely possible!
Along with osteopathic techniques for treatment, there are some simple and inexpensive things to try, some examples include (2, 3);
Developing an understanding of how and why this is happening; knowledge alone can alter the experience and help settle the worry.
Being informed is a powerful position to be in as you can select the best course of action and knowing what the possible benefits or disadvantages of the available options are.
CTS can be debilitating and impact negatively on your health and wellbeing and day-to-day activities. That’s why getting treated as soon as possible is so important.
By finding the right combination of strategies that are best for you, your osteopath can get you moving and back into your daily routines, whether it be gardening, writing, creating a masterpiece, or tackling a home renovation.
Not to mention going back into battle with inexhaustible email queues – the multi-headed hydras!
Some potential causes
Shoulder pain can be debilitating - you don't realise how much you use your arms until you can't any more!
What's more, shoulder pain can be due to any one of a number of structures within the shoulder itself (it's a complicated area!), or it can come from the neck, thorax (upper and mid-back), or ribs - commonly, several of these at once. It is also possible for various problems with the internal organs (or 'viscera') to refer pain to the shoulder, such as the heart, lungs, liver or gallbladder, or stomach (among others).
For this reason, your osteopath will ask you lots of questions that might not seem relevant to the pain you are feeling, but please bear with us - there is method in our madness! They will also perform a number of examinations and assessments of these different areas before coming up with a treatment plan.
This will often involve a stretching and strengthening regime for the affected areas. While this is important for many areas of the body, it can be even more crucial for shoulder issues. Not many people realise that your arm is only connected to the rest of the skeleton through your collarbone (or 'clavicle'). This is not a very strong bony connection, obviously, so the body relies on heaps of different muscles to help control and stabilise the area. Many of these are shared, and help with movement and control of the neck, or breathing, or the torso, or all of the above! If some of these are too tight, or too weak, this leads to problems. Elbow and wrist function is also very important - any issues in these areas will track 'further up the chain', so this will also need to be checked.
In the next few weeks, we will consider some of the more common reasons for shoulder pain, and suggest a few things you can do to help them.
Obviously, a blog post is no substitute for professional assessment and treatment of an area, so be careful when and if you follow any advice contained in one, and contact your health professional if you have any questions or concerns.