At some point we start to notice things are not quite as easy as they used to be. Reactions feel slower, standing on one foot feels like an acrobatic trick, and changing positions requires a moment to regain our orientation. There are multiple reasons for these changes, and we have the opportunity to get ahead of them right now! Our body’s balance is determined by three systems, the vestibular system, the visual system, and somatosensory system. Throughout our lives our body relies on different systems to create stability. Here’s why.

From infancy to approximately 3-6 years of age, we depend highly on vision, as this system develops and matures first.1 Our eyes have the goal of staying in line with the horizon, and if our vision doesn’t show us this, we know something is “not right” and our body will physically try to correct to reorient the image.

Children learn and gain stability and strength in their environment by exploring, sometimes falling, and making mistakes. What may seem clumsy in young age between the ages of 4 and 7 is actually a developing proprioception system. 2 Proprioception is the feeling in your joints. They tell us if we are in alignment, if there is abnormal pressure, or if we are in need of stepping to regain our balance. By 7 years old this proprioceptive system is most dominantly relied upon.2 However, at this young age, if we are to challenge ourselves with uneven surfaces or a narrow base of support, vision is again depended upon.

The last component of our balance system, the vestibular system, matures between the ages of 15 and 16.3,4 Our vestibular system is made up of a series of small bones and organs in our inner ear that tells via the movement of fluid in the inner ear where we are in space with relation to gravity. The vestibular system is very important, as when we experience a conflict in information (such as when your car is not moving, but the car next to you starts pulling forward or backwards), this is the system that corrects our experience and tells us what movement is truly happening.

As we age, neurons in our brains used to communicate information about our body’s special position lose dendrites (communicating branches), myelin sheaths (nerve coating that increases signal speed) degrade, cilia in the ear become damaged, and different pathologies including diabetes, neuropathies, unilateral vestibular hypo function, etc. can exponentially negatively impact all 3 systems.

The good news is, we are not helpless in this scenario! Numerous studieshave demonstrated the benefits of staying physically active as we age to improve our central nervous system (brain and nerves) as well as our muscle spindle function. In fact, a study by Duke- NUS Medical demonstrated that a tailored physical therapy routine for balance and gait challenges reduced patients’ risk of falls by 50%.6 What we can learn from this is that YOU have control over your balance and safety, and physical therapy has been scientifically proven to help you achieve reduced fall risk and improved mobility.

If you are concerned about your balance, Rye Physical Therapy is here to help. Call for an evaluation. We can get you scheduled ASAP!

1. REFERENCES
2. 1 Lear S. Pediatric Balance Assessment. BA Audiology.org. https://www.baaudiology.org/files/2114/5796/1722/1430_Samantha_Lear.pdf. Accessed January 4, 2020.

2 Sá CDSCde, Boffino CC, Ramos RT, Tanaka C. Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study. Brazilian journal of physical therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816079/. Published 2018. Accessed February 10, 2020.

3 Cherng RJ, Chen JJ, Su FC. Vestibular System in Performance of Standing Balance of Children and Young Adults under Altered Sensory Conditions – R. J. Cherng, J.J. Chen, F. C. Su, 2001. SAGE Journals. https://journals.sagepub.com/doi/10.2466/pms.2001.92.3c.1167. Accessed February 10, 2020

4 Ralli G. Maturation and evolution of the vestibular system. GiovanniRalli. https://giovanniralli.it/allegati/108/aging .compressed.pdf.

5 Ribeiro F, Oliveira J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. European Review of Aging and Physical Activity. 2007;4(2):71-76. doi:10.1007/s11556-007-0026-x.

6 Keeping the Elderly Safe. Science Daily. March 2017. https://www.sciencedaily.com/releases/2017/03/170316093025.htm.

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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.

Labral 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 treatments 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 treatments (soft tissue mobilization, mobilizations/manipulations, dry needling, etc) that may provide relief and speed up your recovery! Call Rye 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.

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by Jessica Leberman, DPT – Hampton NH Clinic

• Young athletes may have had an increase in complaints of knee pain this past winter after playing on harder indoor courts. Adolescent athletes are among those most frequently plagued by knee injuries. Knee pain and clicking not precipitated by a traumatic injury is a common complaint heard from young athletes. One of the most common diagnoses for adolescents with knee pain is Patellofemoral Pain Syndrome (PFPS)(1).
• 
  The knee joint is comprised of the articulation of 3 bones; the femur, the tibia and the patella (knee cap). The patella rests in a groove commonly referred to as the “patellar groove”. As a person bends and straightens the knee the patella glides within the groove(1).

• What is Patellofemoral Pain Syndrome?

• PFPS is an umbrella term used to describe pain and/or clicking or crunching in and around the knee joint associated abnormal gliding of the patella in the patellar groove. Often the symptoms occur on the front side of the knee and underneath the patella.
• Common signs and symptoms of PFPS include;
  • pain with repetitive activities such as running, jumping, or squatting
  • pain with climbing/descending stairs
  • pain after sitting with your knees bent for a long period of time such as in school at a desk, at the movie theater or on an airplane
  • Popping or crackling sounds (known as crepitus) in your knee when bending the knee or squatting down(1)

What Causes Patellofemoral Pain Syndrome?

Common causes of PFPS include a change in activity level, a change in activity surface, or a change in footwear. Adolescents that participate in activities on more firm surfaces such as basketball, indoor track and dance are more prone to PFPS. PFPS can be due to abnormal alignment of the patella within the patellar groove, muscle imbalances, biomechanical abnormalities of the hip, knee and/or feet, and walking/running/jumping mechanical faults1. Genu valgum (knock knees) is a biomechanical abnormality commonly associated with PFPS. PFPS occurs more commonly in females (55%) than males (45%) as females are more prone to genu valgum(2).

How can Physical Therapy help?

A physical therapist will perform a full assessment to determine the underlying source of your pain and establish a comprehensive individualized plan based on your presentation. Your individualized plan can include any combination of the following;
• Taping treatments to address mal-tracking of the patella(3)
• Guided strengthening activities of the core, pelvic, hip, knee and ankle stabilizing muscles(4)
• Myofascial treatments such as stretching, Instrument Assisted Soft Tissue Mobilization and Dry Needling.(5)
• Assessment for orthotic prescription to address abnormal biomechanics of the feet. Those who over pronate (more commonly referred to as having flat feet) are more prone to PFPS and can benefit from arch support in shoes.(6)
• Assessment of your walking, running, and/or jumping mechanics and training to optimize mechanics and dynamic balance to decrease abnormal stresses through the knee joint.(4,6)

Although adolescent athletes are those that frequently experience PFPS people of any age and activity level can experience symptoms related to PFPS. If you start to notice knee pain or crepitus within your knee Rye Physical Therapy can help you. If you have any questions regarding this condition feel free to call or stop into one of our two locations in either Hampton or Seabrook to speak to one of our physical therapists.

References:
1. Patellofemoral Pain Syndrome-OrthoInfo–AAOS. https://orthoinfo.aaos.org/topic.cfm?topic=A00680
2. Glaviano NR Kew M Hart JM Saliba S. Demographic and epidemiological trends in patellofemoral pain. Int J Sports Phys Ther. 2015;10(3):281-290
3. Kurt EE, Büyükturan Ö, Erdem HR, Tuncay F, Sezgin H. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome. J Phys Ther Sci. 2016 Jul;28(7):2034-40
4. Chevidikunnan MF, Al Saif A, Gaowgzeh RA, Mamdouh KA. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome. J Phys Ther Sci. 2016 May;28(5):1518-23.
5. Telles G, Cristovão DR, Belache FA, Santos MR, Almeida RS, Nogueira LA. The effect of adding myofascial treatments to an exercise programme for patients with anterior knee pain. J Bodyw Mov Ther. 2016 Oct;20(4):844-850
6. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003 Nov;33(11):639-46.

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