Tag Archives: ProOrtho

Knee Problems Associated with Snowshoeing

knee problems associated with snowshoeingEnjoying the beauty of the Pacific Northwest on snowshoes is a great way to see the “country” on a beautiful winter day. Snowshoeing was invented sometime between 6,000 – 8,000 years ago; a method of travel for prehistoric people in snow conditions. As you’re climbing a low hill, your moving foot catches the tail of your snowshoe that’s planted and down you go. You feel a tearing pain in your knee. Lying on the ground, you feel your knee swelling like a balloon, and then the agony really starts.

Knee injuries are not uncommon among those who snowshoe.

Falling to one side or sliding downhill while wearing snowshoes can lead to a knee injury because of the torsional forces applied to the joint. Trying to move backwards while wearing snowshoes isn’t really a good idea either; the tail can get caught in the snow and hopefully the only indignity you’ll suffer is landing on your butt. And stepping on the tail of the planted foot with the shoe on the moving foot can result in you landing with your face in the snow and your knee moving in ways that were not intended.

Knee injuries fall into three broad categories: sprains, strains and kneemeniscal tears. Sprains are injuries to ligaments (which attach bone to bone) while strains are injuries to tendons (which attach muscle to bone). You have two menisci in each knee.

The knee consists of four bones: the two lower leg bones (the tibia and the fibula) the upper leg bone (called the femur) and the kneecap (patella). The knee is stabilized by ligaments; the ligament on the inner side of the knee is called the medial collateral ligament (MCL) while the outer is called the lateral collateral ligament (LCL). These ligaments provide left and right stability. You also have two ligaments inside of your knee – the anterior and posterior cruciate ligaments, abbreviated ACL and PCL, which cross from front to rear in an x-fashion. These ligaments provide forward and backward stability.

To complicate things even more, the knee contains cartilage (the same stuff your ears are made of). There are two pieces of cartilage in each knee; each piece is called a meniscus. The cartilage provides a cushion that prevents the tibia from banging into the femur. There is also cartilage lining the back of the patella.

Mechanism of Injury

When one falls while snowshoeing, the knee undergoes a tremendous torsional (twisting) force because the body moves while the foot is planted in one spot. When this occurs, any or all of the following can occur:

  • Sprains, which are tears in ligaments are injuries graded from I to III

o   Grade I: A mild stretching of the ligament with overly stretch fibers

o   Grade II: A partial tear in a ligament

o   Grade III: A complete rupture of the ligament

  • Meniscal tears, which can range from mild to severe
  • Fractures

The first thing to do after a fall is to lie there for a minute and assess your situation. After making sure the rest of your joints are operating properly, focus on the injured knee. A Grade I ligament tear will be painful, but you shouldn’t have much swelling. A Grade II tear is going to result in some swelling and throbbing, while a Grade III tear is going to involve a significant amount of swelling and pain. Since you’ve got two knees, it’s a good idea to compare your injured knee with the uninjured knee. In general, if the two knees look the same and you can move the injured knee without too much pain, you may be able to stand and walk a short distance. As with any injury, it’s best if you flag someone down and have them report your injury to authorities who are trained to manage these types of injuries (another reason to always take a snowshoeing buddy with you).

If you’ve fractured a bone in your knee or leg, you’ll definitely know it; the pain and swelling will preclude walking. If you’ve sustained a fracture, you will need the assistance of trained medical personnel to stabilize your leg and evacuate you so you’ll get proper medical care.

A tear of a meniscus can range from being barely noticeable to incapacitating. If your knee doesn’t hurt too badly, but seems “locked” (meaning that you can’t bend it), you may have possibly torn a meniscus and a piece of it is stuck and is interfering with your knee movement.

Like a meniscal tear, damage to the ACL or PCL can range from minor to severe. If either the ACL or PCL is totally ruptured, you will probably need surgery to repair the damage.

Sometimes a fall can result in a dislocated patella. The patella is the anchoring point for your quadriceps, so if your patella doesn’t “track” or slide well in its grove, the mechanical stability of your whole leg can be compromised. Generally, physical therapy can resolve the problem of a patella that isn’t tracking correctly.

If you sustain a knee injury while snowshoeing, avoid walking if at all possible. If medical help isn’t going to be available, splint your knee with tree branches, rolled newspapers or whatever you’ve got. NEVER try to straighten an injured, bent knee because you can turn a minor problem into something catastrophic. Do not move your knee; if you have a torn meniscus or even a tiny chip fracture and you move your knee, it can create havoc with the inside mechanics of your knee.

How can one prevent knee injuries? The best thing you can do is strengthening your legs by using by exercise. This not only keeps the leg muscles strong and toned, but also keeps your ligaments supple which can minimize the chance of injury. Keep in mind that as you age, your ligaments become less limber, so exercise becomes even more important as you get older.

Keeping in shape, using the proper equipment and keeping common sense foremost can result in the minimization of injury and the maximization of some healthy fun.

Exercises to Strengthen Your Knee


1. High step-up: Place one foot on the floor and the other on a bench about 16” high. Lift yourself to full standing; then lower yourself to the floor. Repeat 15 times, and repeat with the other leg.

2. Lunges: Step out with one leg and bend the other to 900. Step out with the bent leg and bend the other. Walk 15 steps with each leg.

3. Spinal Twist: Place your feet in a comfortable stance. Hold your arms out parallel to the floor and swing one arm forward and the other to the rear. Hold for one minute and repeat with the other arm. Repeat three times.

4. Wall Sits: Place your back against the wall. Slide down until your knees are bent 900 and hold for one minute. Repeat five times.

If you are experiencing knee pain due to a sports injury, please call me at 425-823-400 or email me at ProOrthoAppointment@proliancesurgeons.com to schedule an appointment.


The Throwing Arm of a Baseball Pitcher – Understanding Shoulder Pain

Shoulder pain, particularly related to throwing sports such as baseball, involves the rotator cuff. You may have heard a variety of medical terms related to the shoulder, like rotator cuff tendinitis, rotator cuff tear, or impingement syndrome. But what does this mean  to a baseball athlete?

The first piece of good news is tha shoulder pain, like most other Pitcher at Mound, Throwing the Ballsports-related injuries, rarely requires surgery. Now that we are hopeful that surgery will not likely be required, what can we do to alleviate the shoulder pain and prevent it from coming back?

Before discussing treatments for shoulder pain, a basic understanding of the anatomy of the shoulder may be helpful. The shoulder is a complex joint. There are three bones and two joints that contribute to shoulder function– the humerus, clavicle, and scapula are the bones. The ball and socket joint of the shoulder is between the humerus and the scapula. The acromial clavicular joint between the scapula and clavicle moves with forward elevation of the arm and helps stabilize the shoulder on the chest wall. The shoulder is the most mobile joint in the body and because of this it is easily injured.

Causes of Rotator Cuff Injuries

The shoulder joint is often injured in the throwing sports, such as baseball, because it has a greater range of movement than any other joint in the body. Shoulder muscles and ligaments bare a tremendous amount of stress throughout the throwing motion.

When you raise your arm up above your head, as occurs during the cocking and acceleration phases of the pitching motion, the rotator cuff muscles can be pinched under the acromion, causing irritation and occasionally sharp pain felt on the front or top of the shoulder. This situation is referred to as “shoulder impingement’ or “impingement syndrome”.


 A good throwing technique requires the athlete to use his body weight and the large muscle groups of the legs, back and trunk to generate kinetic energy across the shoulder in the direction of the thrown object. After the ball is released, the retained energy in the throwing arm needs to be dissipated back to the large muscles which then absorb it. Stated more simply, after a ball is thrown, the arm must decelerate. The large muscles of the back and trunk, as well as the triceps and the rotator cuff all assist in deceleration of the arm. A tremendous amount of stress can be placed on the rotator cuff muscles as they assist in decelerating the arm after the ball is released. This is particularly true in pitchers who don’t follow through all the way. By not following through, deceleration must occur abruptly, increasing the amount of stress that is placed on the smaller and more easily injured rotator cuff muscles.


As stated above, when a pitcher has poor biomechanics, undue stress can be placed on the soft tissue structures of the shoulder. Different biomechanical flaws place stress on different structures. Volumes have been written on the subject. What is important to remember here is that pitchers with poor throwing biomechanics place undue stress on the smaller rotator cuff muscles, compared to the stronger muscles of the back and trunk.  Ensuring that an athlete learns proper throwing technique is a worthy investment in the health of their arm.


Overuse is the most common source of throwing related injuries. Most importantly, it is avoidable. Paying close attention to pitch counts and giving athletes ample rest is the best way to prevent overuse injuries. It is important that athletes are allowed to come out of a game at the first sign of shoulder discomfort or soreness, even if it is not convenient to the goal of winning the game that day.

Treatment and Prevention

Reduce Inflammation – Using the RICE method: 1) Rest; 2) Ice; 3) Compression; and 4) Elevation

Myofascial Release – When muscle tissue is injured, scar is formed. Scar formation (also called myofascial adhesion) is the body’s way of patching an injured area. The problem with scar is that it is tough and fibrous, whereas healthy muscle is supple and elastic, like a rubber band. Myofascial Release Technique is used to break up scar formation and restore the muscle’s elasticity, or rubberband-like characteristics. Once the rotator cuff muscles are painfree and myofascial adhesions are broken, therapeutic exercises are essential to a complete recovery. It should also be noted that myofascial release technique can increase throwing velocity by optimizing the elasticity of the throwing muscles.

Stretching and Strengthening Exercise – Stretching and strengthening of the rotator cuff is crucial to completing shoulder rehab and remaining pain free. A few simple rotator cuff exercises will strengthen the muscles, resulting in injury resistance and optimal performance. You’ll notice that college and major league pitchers perform rotator cuff exercises on a regular basis, even when they are not injured. This speaks volumes to the importance of a healthy rotator cuff in pitchers, as well as other athletes whose sport involves repetitive stress on the shoulder.

If you are shoulder pain due to a sports injury, please call me at 425-823-400 or email me at ProOrthoAppointment@proliancesurgeons.com to schedule an appointment.

Housemaid’s Knee (Prepatellar Bursitis) – Know the Signs and Symptoms

Housemaid’s knee is also known as prepatellar bursitis. It is caused by inflammation of the bursa (a small fluid-filled sac) in front of the kneecap. It more commonly occurs in people who spend long periods of time kneeling. Housemaid’s knee is more common in tradesmen who spend long periods of time kneeling -for example, carpet fitters, concrete finishers and roofers.

Any age group can be affected by housemaid’s knee. It is generally more common in males than in females. Housemaid’s knee in children is more likely to be caused by infection. Infection is also a common cause of housemaid’s knee in people whose immune systems are not working normally; people include those receiving steroid treatment or those on chemotherapy treatment for cancer.

What is bursitis?

Bursitis means inflammation within a bursa. A bursa is a small sac of fluid with a thin lining. There are a number of bursae in the body. Bursae are normally found around joints and in places where ligaments and tendons pass over bones. They can also be found in other places if there has been unusual pressure or friction placed on that area.

Generally, the function of a bursa is to help reduce friction and allow maximum range of motion around joints. When there is inflammation within a bursa (bursitis), the bursa swells due to an increase in the amount of fluid within the bursa sac.


What is housemaid’s knee?

There are four bursae located around the knee joint. They are all prone to inflammation, or bursitis. However, the prepatellar bursa (the bursa in between the skin and the kneecap) is most commonly affected. Its position is shown in the diagram. Housemaid’s knee is the name given to inflammation of the prepatellar bursa.

What causes housemaid’s knee?

There are a number of different things that can cause housemaid’s knee:

·      A sudden, one-off, injury to the knee – For example, a fall or direct blow on to the knee

·      Recurrent minor injury to the knee – This usually happens after spending long periods of time kneeling down, putting pressure on the kneecap (patella). Historically, this was typical of housemaids who spent long periods of time on their knees scrubbing floors; hence, the term housemaid’s knee.

·      Infection – The fluid in the prepatellar bursa sac can become infected and cause inflammation within a bursa (bursitis). This is particularly common in children with housemaid’s knee. This usually follows a cut, scratch or injury to the skin on the surface of the knee. This injury allows germs (bacteria) to spread infection into the bursa.

·      Another inflammatory disease – If you already have an inflammatory disease such as rheumatoid arthritis, you have an increased risk of developing a bursitis. Rheumatoid arthritis is a form of arthritis that causes inflammation, pain and swelling of joints.

·      Gout – If you have gout or pseudogout, you have an increased risk of developing a bursitis. Gout is caused by a build-up of uric acid crystals. Uric acid is a chemical in the blood that is usually harmless and passed out with the urine. In gout, it builds up and collects within a joint, causing pain, inflammation and joint swelling.


How is housemaid’s knee diagnosed?

Dr. Stickney is usually able to diagnose housemaid’s knee simply by examining your knee. He may ask you questions about your occupation or if you have had any recent knee injury and if you have any history of other joint problems.

If Dr. Stickney suspects that housemaid’s knee is caused by infection, he may suggest that they draw some fluid from the bursa. This is a straightforward procedure. The skin on the front of your knee is sterilized with some fluid and the procedure is carried out in a clean environment. A small needle is used to take a sample of the fluid from your prepatellar bursa, which is directly underneath the skin in front of your kneecap. This fluid is sent off to the laboratory to look for signs of infection. If infection is confirmed, the laboratory may be able to suggest which antibiotic medicines will treat it.

Treatment options for Housmaid’s Knee

Episodes’ of housemaid’s knee will settle with medical or supportive treatment unless infected, in which case, your Dr. Stickney may draw fluid, send for lab tests and prescribe some form of antibiotics. Drug or surgical treatment is determined in the treatment plan if the injury is recurring and/or infection is extreme.

If you are suffering from housemaid’s knee, call Dr. Stickney and schedule an appointment at 425-823-400 or email him at ProOrthoAppointment@proliancesurgeons.com.