Meniscal Tears

meniscus

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Meniscus tear

meniscus tear

Meniscal tear is one of the most common knee injuries in athletes. This is caused after a contact injury or a traumatic twist. The meniscus is a wedge-shaped cartilage that provides a cushion in the medial and lateral portion of the knee joint and acts as a « shock absorber ». It’s located in the area of joints contact to prevent the bones rub between them because of the bodyweight. It’s hard and rubbery to help cushion the joints and keep the knees stable.

It’s important to also know that the meniscus helps to nourish the knee by facilitating the diffusion of joint fluid. With this injury, athletes can experience acute pain with a swelling and often a catching or locking sensation.

Diagnose

A meniscus injury can be diagnosed on the basis of the story that the patient provides and a physical examination of the knee.

An orthopedic surgeon my also use other techniques to further diagnose such as magnetic resonance imaging (MRI), which gives a 3-dimensional image of the inside of the knee joint. In some cases, a surgeon can perform an arthroscopic inspection of the articulation, this is a minimally invasive surgical procedure.

Treatment

knee brace

A small meniscus tear can be treated with rest, ice and anti-inflammatory medications. When a meniscus tear causes a significant loss of movement or catching, the appropriate treatment is often a surgical operation. Depending on the location and type of tear, the treatment may be a simple arthroscopy to remove the torn fragment. Depending on how quickly the inflammation disappears, athletes can return to a full activity after a week or months.

For athletes with a repairable tear, sutures are used to sew the meniscus. In this situation, the knee is braced for 6 weeks. These athletes take at least 3-6 months to back to their activities but maintain the full cushion in their knees.

Prevention

There is not really any way to prevent a meniscus tear apart from a conditioning program to try to prevent an acromioclavicular ligament (ACL) tear and knee instability.

Stats

Women have meniscus tears more often than men and at an earlier age. These tears are often associated with an acromioclavicular ligament injury (ACL)

There are some variables of meniscus tears can be repaired and despite repair, they aren’t always heal. But arthritis can be avoided in the majority of cases when repair is successful. One study shows that 60% of patients who undergo meniscectomy (partial elimination) had some degree of progressive arthritis.

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-Steph

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Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph

Knee Instability

knee anatomy

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

When the knee extended, external and internal lateral ligaments stretched and prevent rotation of the joint. Standing on one foot, knee wedged in extension, which means that there is no need for muscle action to stabilize the joint.

knee anatomy extension flexion

When the knee flexed, external and internal lateral ligaments relaxed. In this position, the joint only stabilized by the action of the muscles.

knee anatomy meniscus

In flexion-rotation of knee, meniscus moves forward on the side of rotation If the extension of the articulation which follow is poorly controlled, it may happen that meniscus doesn’t back in its place quickly enough. In this case, meniscus pinched between condyles and there may be a meniscal lesion. If during pinching, a small piece of meniscus has been cut, a surgical operation may be necessary to remove it.

knee anatomy meniscus ligament

During asymmetical exercise such as lunges (lunges and dumbbell lunges), it’s important to preserve the knee joint to control movement in speed and straightness to avoid any injuries.

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Spinal Disc Herniation

disc herniation

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

First we can say : « disc herniation » or « herniated disc » but I prefer use « disc herniation » in my article.

Disc herniation is a common pathology in bodybuilding. This often occurs because of poor back placement during exercises such as squat, deadlift and rows (barbell bent row, seated row, etc).

During the execution of theses exercises, the main defect observed is the rounding of the back or a flexion of the spine. Because of that discs are pinched forward and loosened backward.

disc herniation

If an intervertebral disc cracked or aged, the gelatinous fluid of the nucleus pulposus moves backwards and can compress the spinal cord or roots of the spinal nerves. The symptoms of a disc herniation depends on the nature of the lesion, the amount of nucleus displaced and the surface that nucleus compresses.

The disc may have a bump or even worse, the nucleus may explode through the surrounding annulus fibrosus. It’s also possible that the posterior ligament that joins the vertebrae to each other is broken. The compressions caused by the rupture of the annulus fibrosus are always painful and incapacitating.

In bodybuilding, disc herniation are mainly at the lumbar level. Often between the 3rd and 4th lumbar vertebrae or between the 4th and 5th lumbar vertebrae. The pain is dull and deep and sometimes with numbness and tingling. Often the pain is in the middle of the back or on one side. The pain extends onto the glutes, pelvis and pubis. Sometimes pain can be felt throughout the leg following the path of the sciatic nerve because the sciatic nerve is compressed at the root (hence the name of sciatic to define this type of pain).

disc herniation sciatic nerve

Usually disc herniation resolve spontaneously and the pain gradually disappears. But in some cases the bump on a vertebral disc doesn’t disappear and can continue to painfully pres on the nerves or it’s a loose piece of intervertebral cartilage that compresses the nervous elements.

In these 2 cases, the doctor will think of doing a surgical operation to remove the part that compresses the nerves.

To avoid having a disc herniation, it’s essential to do squat, deadlift, « good morning » and rows (rows, barbell bent row, seated row) with excellent positioning technique.

Attention

For all exercises done with very heavy weight, it’s necessary to perform a « blocking » :

  1. Take a deep breath and block the breathing to fill the lungs like a balloon. This stiffens the ribcage and prevents the top of the torso form tilting forward.

  2. Squeeze abs stiffens the belly, This increases the intra-abdominal pressure and prevents the torso from sagging forward.

  3. By slightly arching the lower back with lumbar squeeze, this allows to have the spine’s bottom in extension.

These 3 simultaneous actions is what we call « blocking ». This « blocking » has the function of avoiding the rounding or bending of the spine because with very heavy weights, it can create disc herniations .

Note

After a training session with very heavy weights, it’s advisable to do stretching for the spine. There is an excellent exercise to relax the back muscles and rebalance the pressure inside the intervertebral discs. Click here .

Bad position

disc herniation bad positon squat deadlift

For exercises such as deadlift or squat, it’s important not to round your back to avoid lower back injuries.

Disc herniation

disc herniation

Flexion of the spine with heavy weights can create disc herniations at the level of the lumbar vertebrae.

These disc herniations are common at squat and deadlift. This is caused by a bad back position during exercise. That’s why it’s important to work the technique for these exercises.

Disc herniation according to the age

disc herniation intervertebral

From the age of 30 years old, intervertebral discs degenerate and don’t worry, it’s normal, The annulus can crack and the nucleus pulposus dries progressively.

Vertebral discs of people over 30 years old are more rigid, less elastic and the mobility of the spine is more limited. But as the viscous gel of the nucleus pulposus deacreases due to drying, the risk of the vertebral discs moving and compressing the nerves diminished.

Vertebral discs of people under 30 years old are more flexible, more elastic and there is more mobility with the spine. There is a greater amount of viscous gel in the nucleus pulposus which increases the risk that vertebral discs will move and compress the nerves. Disc herniation is very common among young athletes.

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-Steph

Rupture Of The Pectoralis Major

rupture, tear, pectoralis, major, tendon

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Pectoralis major begins on the anterior surface of the thoracic cage and its insertion is to the anterior surface of the upper end of the humerus.

Pectoralis major is a muscle which has the function of bringing the arm forward in front of the rib cage which make it possible to make hugs.

Bench press can create small tears at the pectoralis major which can sometimes cause a partial rupturing of its tendon (around upper chest).

This partial rupture of the tendon occurs in powerful athletes who have gained an abnormally rapid strength, which didn’t allow time for tendons to strengthen. This injury can also happen to athletes who make a « dry » diet, so a low-calories diet to better make muscles more visible. These low-calories diets weaken joints, tendons and muscles.

The wound always arrives during a bench press and affects only the clavicular head of pectoralis major.

The rupture of the tendon can be so painful that the athlete may lose consciousness. Often a tumefaction with eccymosis apprears on the anterior surface of the arm and the retraction of the clavicular head create a hollow around the upper chest.

Diagnostic error

how much

A problem that very often happens with this wound is that doctors, after diagnostic, considers it to be gravity-free. This is an understandable mistake because during the diagnostic, the injured person can make all movements related to the pectoralis major’s motor function. It’s for this reason that doctors consider this wound as a simple muscle tear rather than a ruptured tendon or a severe muscle tear.

Indeed, many muscles compensate the functional loss of clavicular head of pectoralis major to continue to move the arm. I spit of the rupture of the clavicular head of pectoralis major, it’s possible to raise the arm forward by the sternal portion (middle chest) and abdominal portion (lower chest) of the pectoralis major which also compensates.

When there is rupture of the pectoralis major, it’s necessary to have it reinserted as quickly as possible on the humerus with a surgery operation.

If not done as quickly as possible, there is retraction and fibrous transformation of the muscle. In this case, surgery is no longer feasible.

It’s true that the injured person can still move his/her arm without the upper portion of the pectoralis major but the injured person can never regain its initial strength and will be seriously handicapped to continue to do heavy bench press.

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Bench Press And Elbow Pain

elbow pain

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Elbows pain arrives because of bench press. This pathology of wear is linked to excessive training of long sets.

At the end of the bench press movement, when you lock your arm to block the barbell, it causes rubbing and micro-trauma on your joints. And this can create inflammation.

Note : This pathology which caused only by bench press can, rarely, create intra-articular calcifications. In this case, surgical operation is often the only solution to recover the complete arm’s extension.

If you feel pain at elbows, it’s advisable to stop for several days the exercies of arms extension to avoid complications. When you restart your workout, do bench press without locking your arms at the end of the movement until the pain has completely disappeared.

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-Steph