By Dr. Matt Fontaine.

The following are some topics that frequently come up in our clinic.

A quick note on over the phone consults or email inquiries

We live in a world controlled by technology and people want their information faster.  Email and social media play a big role in how we communicate and the technology can help us to work more efficiently.  That being said, when it comes to diagnosing a particular problem with your body’s engine or chassis, you need a mechanic to look under the hood.  This means you most likely cannot detect what the problem is just by feeling pain or listening to noises the body is making(cracking in the joints).  A physician must evaluate your condition to accurately assess the damage or mechanical problems.  Often times a quick and efficient way to get a consult is to email us a brief history of your problem, including pertinent past medical history and current complaints.  Once we receive that, our physicians can review it and have a better understanding of your problem when they contact you via phone to answer any specific questions.  It is important to note again, that ultimately we need to evaluate the condition to know for sure what the problems are and how best to go about managing your condition.

When will I be free to swim, bike, run without limitation?

Discuss mathematical equation  I= NF/AR

Injury(I) =  Number of repetitions(N) X Force of repetition(F)/ Amplitude(A) X Recovery time(R)

This means that all load into tissues is cumulative, meaning tissue damage occurs with repetitive movement.    Tissue load, over a certain threshold injury will occur.  Going a little bit beyond threshold results in minor microtrauma the body can repair.  Remember, the body repairs soft tissue with inelastic type III collagen and so some degree of adhesion will result.  If the mild overuse is followed by proper rest, RICE, foam roller and stretching may in fact release the newly laid scar tissue and restore normal gliding.

Beyond the threshold over and over and over may result in more serious injury, despite the lack of pain.

How to Stay in the Game

During treatment with athletes, one of the goals is to keep the athlete in the game if at all possible.  That may involve decreasing training volume to reduce the repetitive action below the threshold of further injury.  In acute or severe chronic cases, complete rest from the activity or sport for a period of time may be necessary for complete recovery.  After evaluation and initial first 2-4 treatments, the physician should be able to determine if the sport can be continued during treatment and rehabilitation. 

It is important to note that with training while recovering from injury, there is a fine line between the volume and intensity that can safely be handled by one’s body and still make progress in rehab and recovery.  Over that specific amount(training volume/intensity threshold) more injury can occur or at least create enough strain to prevent or slow recovery.  Everyone has different genetics and abilities that will make each individuals’ training volume/intensity threshold different from the next person.  It often requires trial and error to determine an athlete’s or individual’s particular threshold.  Once that is determined, he or she must keep training below that threshold during the rehab and recovery phase to allow the injury to recover.

What signs & symptoms should I  look for so I know the injury is coming back?

If the athlete can do his or her sport, like swim, bike, run etc. without pain during the activity or sport, that is a good sign the activity can be tolerated without very much if any further injury.  It is especially important to watch for pain and swelling the day or two after doing a run or lifting weights or playing a sport.  If the athlete has a lot of marked soreness and the injured area “feels raw and beat up” or has increased pain, this indicates the volume and or intensity of the sport or exercise was too much and overloaded the tissues creating further tissue damage.

During treatment and rehabilitation, it is imperative that we continue to monitor the athlete as they ramp up their activity for these signs of pain and swelling.  As long as we can avoid the pain and swelling with a certain level of activity, say for instance a runner who can tolerate a 5K run without pain, then we can progress them to increase their running volume each week.  Volume can be increased only as long as it is tolerated without pain and increased inflammation.  If we reach a point of too much activity and overload, we can deload by decreasing volume and or intensity of the activity or sport.

Pain: The Body’s Built In Fire Alarm.  Usually the alarm sounds way after tissue damage has occurred.

I have been playing tennis for over 30 years and I never had any pain or injury until now.  I don’t understand what happened.

Analogy:  If you punched the wall over and over for 20 hours, what would happen?  The first few punches may not hurt or cause injury.  But the trauma to the soft tissues and joints is cumulative, eventually enough wear and tear causes breakdown to the point of pain.  Likewise, if I drive my car over and over for years, I may not know there are problems lurking.  Eventually enough wear and tear occurs and warning signs emerge(noise, black smoke etc.)  For the body, it’s warning sign is pain, and although the presence of pain definitely indicates tissue damage, the absence of pain does not indicate the absence of injury, tissue damage or pathology.

I have pain all over my legs?  What is going on?  Why do I hurt all over?

Discuss the role of statins, muscle pain and CoQ10 depletion.

 For more on muscle cramping and nutrition

Muscle Cramps

Do I need ART or manipulation? 

Most  conditions involve injuries to soft tissues.  These soft tissues often have adhesions which can reduce range of motion, cause pain, muscle imbalance and faulty movement.  As such, we know the best treatment outcomes usually require a combination of soft tissue work, manipulation or manual therapy, and corrective exercise to rehabilitate the injured area and help prevent re-injury.

Is my condition something you typically treat and do you think you can help?

Our focus is physical sports medicine.  We treat a wide variety of muscle and joint pain syndromes.  We treat many conditions involving the extremities and spine, including complex spinal disorders.   For a list of commonly treated conditions, see our brochure on the homepage.

I have been diagnosed with arthritis, can you help me?

There are different types of arthritis and many benefit from conservative care.  For people with garden variety wear and tear degenerative arthritis, often one of the best treatments is exercise.  What we attempt to do is to diagnose faulty movement due to muscle imbalance and poor joint motion.  We correct these as best as possible to give you better range of motion and better movement so that you can better tolerate exercise and daily activity.  Motion is lotion for the joints.

It looks like you treat many athletes.  I am not an athlete.  Can you still help me?

True, many of our patients are athletes.  However, athletes and weekend warriors share a common bond, SOFT TISSUE INJURIES.  These soft tissue injuries can prevent normal movement and cause pain.  Many of the same injuries we see in athletes occur in non-athletes as well.  The difference is usually how the injury occurred, but once you have the injury, often times the treatment is the same. 

We focus intensely on functional rehab for all our patients, and athletes often receive special focused attention relative to their sport.  Regardless of your sport, functional rehab will be a part of your treatment and will help you to move better, stabilize your spine and posture, and leave you tolerating a higher level of activity.

My doctor ordered an MRI because he thinks I may have a tear.  What will that show?

All muscle injuries involving tendonitis type repetitive overuse injuries and acute trauma involve some degree of tearing.  Tears are graded I,II, III with grade I being a mild strain and grade III being a complete tear.  The severity of injury follows the continuum.  Grade I, and even some grade II injuries may not be readily visible on an MRI.  What typically does show up in these cases is effusion(swelling) which indicates injury and inflammation.  If the strain has occurred over and over again for a long time, which is the case with all cumulative repetitive overuse injuries, then the tendon will usually have some irregularity on the MRI.  That means that the signal intensity within the tendon on the MRI will be different from a normal healthy tendon.  This is evidence of chronic inflammation and degeneration within the tendon.  These injuries need ART to release the adhesions within the muscle and that are binding up layers of muscle and fascia.  Combined with foam roller, stretching and corrective exercise, these injuries can be resolved.

My joints make all kinds of noise when I move.  Is that normal?  Does that mean I have a tear or arthritis?

Your body is made up of moveable parts.  Bones are held together and the muscles move bones to create motion in the joints.  There is cartilage covering the ends of the bones at the joint, and some joints have fibrocartilage between the bones to aid in absorbing shock within the joint and aiding gliding of the bones(ie:  meniscal cartilage of the knee, spinal discs between vertebrae).  When mechanical parts move, they make noise.  Think of a machine with moving parts.  If the machine is well maintained, all its moving parts are well oiled and the mechanical motion occurs smoothly, then the machine usually runs quietly.  If however, there are parts not well oiled and that may have gunk built up on them, or  some parts are rusted(similar to arthritis), then there may be more noise with movement.  The body is no different, it’s moving parts make noise.  Typically the more well  oiled our body, the better muscle balance we have, the quieter and smoother our movements should be.  Even healthy joints can make noise if there is muscle imbalance within the system of muscles that coordinate motion at that joint.  Muscle imbalance can cause uneven pull or tension across a joint or across multiple joints, and that can lead to very noisy motion when those joints are moved.  This joint noise is called crepitus and it is very nonspecific.  Meaning, just because a joint is noisy, it doesn’t have to mean anything, good or bad.  Certainly we could expect arthritic joints to make more noise then a healthy joint, but the degree of noise does not correlate well with the degree of arthritic severity.  There are many joints that are very noisy and have very little arthritis, and there are joints that can be very arthritic and be very quiet.

Read the article on Common Mechanisms of Inflammation and Soft Tissue Healing