Sunday, January 30, 2011

Treating and Preventing Meniscus Injuries - Part 3

Meniscus Injury Prevention – ART and the Denver Broncos
The last Lower Extremity Active Release Techniques (ART) course that I helped teach was in Las Vegas. At this course I learned some rather remarkable facts about ART and the Denver Bronco’s football team. Over the last last three years - a remarkable thing has occurred. Ever since Dr. Leahy (developer of ART) has worked on them, the Denver Broncos have not required any meniscus surgery (that I know about). This is an astounding statistic as apparently, in previous years, it was common to have six or more meniscus surgeries per season within the team. (If anyone out there has more accurate statistics about this, please let me know!)
This is a remarkable reduction in overall injuries. This is especially important for professional teams where there is a direct correlation between the injury rates and their standings each season. The higher the injury rates, the more poorly the team will perform, due to key players being benched.
As I mentioned in the earlier segments of this blog, most meniscus injuries occur during contact activities, usually when the knee is bent, with the foot planted on the ground. These sport-related factors cannot be altered. However, you can deal with a functional factor - meniscus entrapment – long before the tear occurs. If these meniscus entrapments are released before the traumatic event occurs, then many menisci injuries could be avoided.
More technical details…read on!
In the last blog we talked about how Murray’s and Ege’s tests use flexion and extension with internal and external rotation to locate the location of the meniscus tear. During treatment, ART uses these same active motions in combination with joint palpation to determine and clear the site of the functional entrapment.
Research has shown that joint line palpation is 89% percent accurate for the diagnosis of a meniscus tear with an MRI (the gold standard) being 98% accurate. An 89% accuracy rate is nothing to balk at; especially when one considers how fast and inexpensive joint line palpation is when compared to the costs of an, MRI.
Biomechanically, we know that the meniscus of the knee follow the motions of the bones to which they are attached:
A functional meniscus entrapment occurs when any of these motions are restricted. This is easy for the ART practitioner to observe during examination since the patient will experience a sharp internal pain of the knee when executing specific motions. The patient may also notice a locking of the knee in certain positions. Patients that show these symptoms are extremely susceptible to a meniscus tear.
It’s about more than just the meniscus
Once the exact site of meniscus entrapment has been determined, it is important to consider that many other structures are also involved. Dr. Leahy has mentioned numerous times “that virtually every tissue the crosses the knee joint must be considered in a knee injury”. (Mike…please feel free to correct this quote!) In the last segment of this blog, I mentioned the popliteus and semimembranosis muscles and how they have direct connections to the meniscus. In addition to these, there are many other structures that also influence menisci function including: knee capsule, medial collateral ligament, and popliteal ligaments. Bottom line, to effectively treat or prevent a menisci injury, you must address each involved structure.
The actual procedures that the Active Release Techniques practitioner uses always varies depending upon the combination of involved structures. But in general terms, once the position of entrapment has been identified, the practitioner will put the knee into the position of entrapment then use physical pressure to release that entrapment.
Getting your meniscus treated
Fortunately, you don’t need Dr. Leahy on your team, or in your clinic, to achieve some of these same results. Practitioners certified in Lower Extremity Active Release Techniques are trained to use the same procedures that Dr. Leahy uses with the Denver Broncos. These practitioners can find the specific site of entrapment, and then use specific ART procedures to open the joint space between the femur and tibia to release the meniscal entrapment.
So if you are looking to prevent meniscal injuries, you need to find an ART practitioner who is trained in Lower Extremity protocols ( It is important to remember that not all Active Release Techniques practitioners are trained in the protocols and techniques for the Lower Extremity. Make sure that your ART practitioner is currently certified for this area. Of course, if you are ever in Calgary, you can see us at Kinetic Health and we will do our best to release any of your entrapments.
Bottom line, it is always much easier to prevent an injury than to treat one. Whether you are involved in running, triathlons, basketball, football, soccer, or any other sport that involves high velocity lateral motions, it is well worth having your knees checked for existing meniscus entrapment
One final note: The information that I presented here is quite remarkable. Unfortunately, there has been no definitive large-scale study conducted on this procedure. It is my hope that with these impressive results, new research will be conducted on a larger scale. Integrating these ART procedures into the general healthcare system could save the system a remarkable amount of money.
Treating Menisci Injuries – see the next installment of this blog for more information about how you can treat menisci injuries. For more information about other types of knee injuries, visit the following sites:
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1 comment:

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