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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: knee pain

Product Review – POWERPLAY

I am a big proponent of cryotherapy in my rehab whether dealing with acute or even more chronic inflammation. I routinely use cryotherapy with compression via Game Ready in the clinic for post-op knee surgeries, ankle sprains, rotator cuff pathology, Little League shoulder, labral repairs, etc. I was recently contacted and asked to review a cryotherapy solution on the market – Power Play.  Full disclaimer: I am not affiliated with POWERPLAY in any way nor was I paid to write this review.

My intent in writing this review is to share information about the product itself and its efficacy for use in the clinic as well as for the general public. Power Play shipped me the standard kit which includes a carrying case, the cold compression ankle and knee wrap as well as the pump and wall charger.   The entire package is easily portable for the ATC on the go, and works well in the clinic because it has three ports on the unit making multiple treatments for patients with various body parts a cinch.

Below is a picture of one of my patients recovering from ACL reconstruction using the knee wrap:

power-play-knee-wrap

The different body part sleeves include gel wraps that attach to the sleeves via velcro along with a stocking to protect the skin from the wrap.  POWERPLAY advises placing the wraps in the freezer or refrigerator prior to use.  I noticed that if you place them in the freezer and pull them out for immediate use they are stiff and do not conform as well as desired to the body.  As such, I would advise taking them out at least 10-15 minutes prior to use.

In terms of compression, the default setting on the display reading is 50 mmHg of compression.  You can increase compression in 5 mm increments up to 70 mmHg.  This is easily done with the touch of a single button.  The compressor runs for 20 minutes and then shuts off on its own, so if you desire lass than 20 minutes you would need to set a timer (not a big deal).

power-play-pump

POWERPLAY pump

Overall, the unit is convenient to take on the road and very easy to use.  The company states it will run the unit for 8-12 hours on one charge, and I find this to be accurate so far.  Patient feedback is that they like the wraps and the level of pressure, and they are comparing it to the traditional GameReady clinic cryotherapy I use with them on a routine basis.  The POWERPLAY unit is also definitely cold enough and comparable to all other forms of cryotherapy we have in the clinic.

I find the entire package is reasonably priced for the overall quality and portability of the product.  I think it would be a worthwhile investment for PT clinics, ATCs on the go and a client looking to have a high quality cryotherapy solution at home while recovering from an injury or surgical procedure.  I have long been a fan of cold and compression so I like this product, and I look forward to trying out their shoulder wraps next!  Click here to learn more about POWERPLAY.

So, a very common issue I see in runners is iliotibial band (ITB) syndrome.  In a nutshell, it involves excessive rubbing or friction of the ITB along the greater trochanter or lateral femoral epicondyle.  It is more common along the lower leg just above the knee and typically worsens with increasing mileage or stairs.

iliotibial-band-syndrome

The ITB is essential for stabilizing the knee during running.  Several factors may contribute to increased risk for this problem:

  • Muscle imbalances (weak gluteus medius and deep hip external rotators)
  • Uneven leg length
  • High and low arches
  • Increased pronation leading to excessive tibial rotation = friction of the band
  • Improper training progression
  • Faulty footwear
  • Poor running mechanics
  • Limited ankle mobility (specifically dorsiflexion)
  • Tightness in the tensor fascia latae (TFL) and glute max

Related information on this topic include a 2010 study published in JOSPT on competitive female runners with ITB syndrome:

Click here to see the abstract of the study

Click here to read an earlier blog post analysis of the above research article

Common signs and symptoms include stinging or nagging lateral knee pain that worsens with continued running.  Hills and stairs may further aggravate symptoms.  Some runners even note a “locking up” sensation that forces them to stop running altogether.  How do I treat this?


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Often, people assume hip and knee pain begin and end in those respective joints. While this can be the case, the truth is the ankle may also have a say in the matter. In my practice, I often see gait deviations, IT band issues, patellofemoral pain and many other issues related to ankle stiffness or soleus issues.

In assessing athletes, runners and weekend warriors, I often pick up asymmetries when measuring closed chain ankle dorsiflexion. I have even observed people who have active dorsiflexion within normal limits while seated on a treatment table, but once they become weight bearing things change. Even small differences can dramatically affect the body as the brain will find a way to get the motion it needs to squat, run, lunge, etc.

This often involves a compensatory pattern at the knee and/or hip joint. So, to that end, I recommend several strategies to improve mobility. I am currently doing a three part series on this for PFP magazine to provide some effective exercises to improve ankle and soleus mobility. Click here to read the latest column.

Below is a sample video of the wall touches I use to improve ankle motion after mobilizing the soft tissue.

Typically, I advocate doing 1-2 sets 10-15 repetitions.  Using the wall allows clients to have tactile feedback and a target to focus on.  This is a simple, yet effective way to gain motion in a loaded closed chain fashion as the hip, knee and ankle flex together in running, landing, squatting, lunging, etc.

If you are curious how I assess side-to-side differences, click here to read my initial column on assessment.  I hope these tools enhance your training and/or those you work with.

Unearthing the cause of anterior knee pain and ridding our patients and clients of it is one of the never ending searches for the “Holy Grail” we participate in throughout training and rehab circles.  I honestly believe we will never find one right answer or simple solution.  However, I do think we continue to gain a better understanding of just how linked and complex the body really is when it comes to the manifestation of knee pain and movement compensations.

We used to say rehab and train the knee if the knee hurts.  It was simply strengthen the VMO and stretch the hamstrings, calves and IT Band.  Slowly, we began looking to the hip as well as the foot and ankle as culprits in the onset of anterior knee pain.  The idea of the ankle and hip joint needing more mobility to give the knee its desired level of stability has risen up and seems to have good traction these days.

Likewise, therapists and trainers have known for some time that weak hip abductors play into increased femoral internal rotation and adduction thereby exposing the knee to harmful valgus loading. So, clam shells, band exercises and leg raises have been implemented to programs across the board.

theraband-single-leg-hip-rotation-finish

Single Leg Resisted Hip External Rotation

As a former athlete who has tried his hand at running over the past 5 years, I have increasingly studied, practiced and analyzed the use and importance of single leg training and its impact on my performance and injuries.  As I dive deeper into this paradigm, I continue to believe and see the benefits of this training methodology for all of my athletes (not just runners).

As a therapist and strength coach, it is my job to assess movement, define asymmetries and correct faulty neuromuscular movement patterns.  To that end, I have developed my own assessments, taken the FMS course, and increasingly observed single leg strength, mobility, stability and power in the clients I serve. Invariably, I always find imbalances – some small and some large ones.

What are some of the most common issues I see?


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It is common knowledge in the medical community that treating patellofemoral joint pain (PFJP) is one of the most frustrating and difficult tasks to complete as there appears to be no standard way to do so.  While clinicians strive to find the right recipe or protocol (I don’t believe there is just one by the way), researchers press on to find more clues.

A new article released in the April 2011 Journal of Orthopaedic & Sports Physical Therapy seeks to bring clarification to a particular exercise pattern commonly used in rehab circles.  The three exercises they looked at were:

  • Forward step-up
  • Lateral step-up
  • Forward step-down

In the study, the authors looked at 20 healthy subjects (ages 18-35 and 10 males/females) performing the separate tasks with motion analysis, EMG and a force plate.  The goal was to quantify patellofemoral joint reaction force (PFJRF) and patellofemoral joint stress (PFJS) during all three exercises with a step height that allowed a standard knee flexion angle of 45 degrees specific to each participant.

Key point:  Previous research has been done to indicate that in a closed chain setting, knee flexion beyond 60 degrees leads to increased patellofemoral joint compression and this may be contraindicated for those with PFJ pain or chondromalacia.  Also keep in mind that most people with PFJ complain of more pain descending stairs than ascending stairs.

patellofemoral-force

In the study, the participants performed 3 trials of 5 repetitions of each exercise at a cadence of 1/0/1 paced with a metronome.  The order of testing was randomized for each person.  The authors used a biomechanical model to quantify PFJRF and PFJS consisting of knee flexion angle, adjusted knee extensor moment, PFJ contact area, quadriceps effective lever arm, and the relationship b/w quadriceps force and PFJRF.

Now on to the results……


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