Meet the Other Phone. Flexible and made to last.

Meet the Other Phone.
Flexible and made to last.

Buy now

Please or to access all these features

General health

Mumsnet doesn't verify the qualifications of users. If you have medical concerns, please consult a healthcare professional.

Any physio's who could maybe answer this?

9 replies

tunaday · 16/04/2012 18:33

anyone know if it is possible for a physio to actually tear cartilage by kneading/pressing/massaging knee very hard? My friend went to physio with a back problem. 14 months ago he had an op to repair some cartilage in his knee but has not had any knee problems since then. The physio said the knee was 'bent' and might be contributing to the back problem tho and proceeding to 'break down scar tissue' using such force that my friend came out with a bright red and swollen area behind the knee and saying it felt weird. This was in January and he know has the same pain he had before having knee surgery. Another physio says he thinks the meniscus is torn but doesn't seem to think a physio could cause it. It just seems too much of a coincidence to go to a physio with a back problem and no knee symptoms whatsoever and come out of a session with a sore knee?! Any thoughts as to whether a physio could have done this would be appreciated.

OP posts:
OutragedAtThePriceOfFreddos · 16/04/2012 21:42

I would have thought a physio could tear the cartilage in a knee, but they would have to do something drastic that would have been felt very painfully at the time. But my knowledge of the inner workings of the knee is pretty basic.

Sorry, not much help.

tunaday · 17/04/2012 10:04

Thanks OATPOF. My friend said as soon as he came out the surgery that something felt 'wrong' and the back of his knee was really red and swollen and v painful. The physio was a big strong guy and to quote friend was 'brutal' and went in like 'a bull in a china shop'. Didn't use any oil or anything. He's now waiting to see the guy who did his surgery 14 months ago to see if he can work out what's happened and what to do about it.

OP posts:
WhereYouLeftIt · 18/04/2012 01:47

Disclaimer : I am not a physio, just familiar with the anatomy involved.

The cartilage of the knee joint covers the articular surfaces of the bones (the ends that 'touch' another bone when the joint between them moves) to make them slide over each other smoothly - it really isn't accessible through the surface of the skin, no matter how strongly the physio manipulated the surface, it's just too deep inside the joint. The meniscus (the fibrous cushion on the top of the tibia) is sometimes referred to as cartilage, but even that is pretty inaccessible from the surface; only some of the edge of the meniscus could be reached, with ligaments etc. covering other parts of it.

If the physio was trying to break up scar tissue, it wasn't the cartilage he was working on (cartilage doesn't scar) but the muscles and/or tendons crossing the knee joint. Scar tissue is broadly made up of collagen, which is stretchy, but not as stretchy as the muscle/tendon fibres it replaced. The collagen fibres also tend to settle higgledy-piggledy when the scar is formed, in contrast to the muscle/tendon fibres which all lie aligned with each other - this contributes to the lack of stretchyness of scar tissue, as some of it's stretch is in the wrong direction IYSWIM. So scar tissue in a muscle/tendon means that it can't move as freely or as far as it could have were there no scar tissue there, and that affects the joint that the muscle crosses (all muscles cross a joint - the purpose of every muscle is to move the joint it crosses). If the physio was working at the back of the knee, it was probably the hamstrings he was working with. They all attach at different places, so pull in different directions. If one of them was scarred, there could be uneven forces pulling on the knee, pulling the bones out of their proper alignment to each other - maybe what the physio meant when he said the knee was bent. Or if several were scarred, the knee might be difficult to fully straighten as all the scarred hamstrings would be a bit tight. Either way, walking on a bent knee would affect the hip, throwing it out of its natural alignment; the spine would then compensate in the other direction to carry the head and shoulders horizontally, and in this way a knee issue would result in a back problem.

It sounds to me as if the physio was using a technique called 'transverse frictions', where the fingertips are pressed deeply into the flesh and moved side-to-side rapidly across the muscle/tendon perpendicular to the muscle/tendon fibres (imagine the fibres as lots of guitar strings being strummed). No oil is used in this technique as the physio doesn't want to slide over the surface but to friction it, dragging the surface (and anything attached to that surface) with his fingertips. This will irritate/inflame the underlying muscle/tendon because the frictions break some of the fibres, particularly the more inflexible fibres (the ones with the scar tissue attached). As it heals, if the muscle is stretched properly during the healing process, the new collagen can be encouraged to align alongside the muscle fibres and the muscle regains its stretchyness; so the joint moves properly again. The redness and swelling are part of normal healing.

Your friend had an operation to repair cartilage in his knee, which means it was considerably damaged. The body self-repairs cartilage, but it can't make it as-new, it's always a patch job. Once the damage has started the body can generally keep on top of the constant patching, often for decades, but eventually the body ages and repairs more slowly; it's not patching the cartilage fast enough and the damage increases to the point where the cartilage is worn through to the bone and pain can be felt (cartilage has no nerve supply, so feels no pain - the underlying bone does have a nerve supply). Common repairs include microfracture to stimulate the body to speed up repair, or shaving off damaged loose cartilage (and meniscus) to get a smooth surface that will move freely again. Again, the cartilage does not end up as-new. So if the body still can't self-repair fast enough, the damage can extend again until pain is felt again. If the knee is out of alignment through scar tissue, this could increase the contact between the tibia and the thigh bone, making new damage more likely. Cartilage repair is rarely a permanent fix to a knee problem (although it can last for many years), so recurrence of your friend's pain is not unusual.

I would be broadly disinclined to blame the physio for causing new knee pain; I would think it more likely that the damaged cartilage has got back to the level of damage where pain is felt, and possibly the degeneration may have been caused by this 'bent' knee joint. Post-op your friend should have been advised to exercise, including stretching. Do you know if they followed the advice given?

tunaday · 18/04/2012 18:52

Thanks so much for all the info Whereyouleftit. Really really helpful.

OP posts:
mybabyweightiseightyearsold · 20/04/2012 09:55

Wow, whereyouleftit.

I am a physio. That was a really clear and concise explanation. In fact, way better than mine was going to be!

Want to come and do my sickness cover?
x

gingeroots · 20/04/2012 10:49

fantastic explanation ,will reread when I have more time .

could most of what said be applied to shoulder joint as well ?

and if the osteopath I'm seeing is breaking up the scar tissue etc with transverse frictions ,are the exercscises really imp. to get it to heal in correct way ?
sorry if talking rubbish posting in haste as on way out.

WhereYouLeftIt · 20/04/2012 20:54

mybabyweightiseightyearsold, I'd have loved to have qualified, but there just weren't enough hours in the day for me to keep on top of the study at university Sad. But I did work as a TI for a bit, leading the classes for pre-op knee replacement patients, so I really should know this stuff!

gingeroots, this applies to pretty much every joint in the body (excepting cranial joints etc. - joints that most people don't regard as joints). And yes, the exercises are really important.

To expand my previous explanation - the body repairs damage to muscles/tendons with collagen fibres (think of them as long pieces of elastic) which land on the damaged area, and affix themselves on either side of the damage. They then contract, drawing the edges of the damage together, so that it can stop the bleeding/close the wound IYSWIM. That's all the body is interested in, not having a wound/not bleeding to death. When the damage is internal, the same rules apply, it's just trying to do a patch-up job ASAP; how well that body part works/moves afterwards is neither here nor there. Now, if the joint is not moved when all this is happening (it takes weeks), the collagen is able to be laid down without interruption; and like I said it will all land randomly/higgledy-piggledy. So once attached, the fibres contract in all directions and the tissue it is attached to becomes puckered i.e. you get scar tissue which is tight and less mobile than the muscle/tendon used to be. BUT, if the joint is kept moving (through exercise or normal use), the collagen doesn't get it so easy. Any collagen that is overstretched by the movement tends to be less able to attach - the movement 'pings it off' before it can become properly attached. Only the collagen fibres which have, by chance, landed in an alignment that is not overstretched by joint movement, get to stay and permanently attach. This leaves the repaired muscle/tendon more mobile, with the collagen not interfering with movement, and not forming this puckered, stiff scar tissue.

So, if you don't move the joint whilst the collagen is being laid down (mostly in the first three weeks) then scar tissue will form and the joint will become stiff. If you do ensure it moves regularly, you minimise the scar tissue and the joint can recover its pre-injury level of mobility. As you are having scar tissue broken up right now, you don't want new scar tissue to form and put you back to square one, SO DO THE EXERCISES Grin!

mybabyweightiseightyearsold · 20/04/2012 23:45

Whereyouleftit - I'm sorry that you had to leave your course. You've obviously spent a lot of time studying, and actually paying attention.

I hope you found something fulfilling to do apart from rubbing folk to the point that it hurts!

Seriously, I'm hoping to go on holiday in August. Come and be my locum?
x

gingeroots · 21/04/2012 09:37

whereyouleftit - I feel a bit that I'm taking the p**s asking for free advice from someone with such skill and comitment whom life has thrown a curve ball and stopped them in their tracks - hope temporarily .

But ... in a frozen shoulder scenario ( which is what osetopath now reckons ,+ tendonitis ) tho mystery to me as to how it can be clear what it is ,does all the above apply ?
As I don't understand how my shoulder can be injured/bleeding ...can that just arise by itself ?
( I think my posture + tension has caused mine ,second one )

And I'm doing the exercises ,tho they hurt ,and have started Alexander technique ,which I think will help .

New posts on this thread. Refresh page
Swipe left for the next trending thread