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FisioKiron Studio di Fisioterapia, Via Sant'Ermacora 2, Roiano, Trieste (2025)

05/01/2023

Dolore al ginocchio? Potrebbe essere causato dal disassamento della rotula...

🔊 KNEE PAIN? IT CAN BE PATELLA MALTRACKING

Patella maltracking is one of the main causes of knee problems, so it’s important to understand why it occurs. If you have general knee problems, this brief guide will help clarify exactly what patella maltracking is and how it might be responsible for your pain. We will explain what the patella is, why it tracks incorrectly and the problems this can cause, as well as briefly touch on what can be done to relieve pain.

What is the patella?
The patella is what most people know as the kneecap. It is the point highlighted green in the picture. The movements of areas of the whole body can have an impact on the way the patella tracks over the knee, so the movement of the kneecap can point to different problems. In the immediate area around the knee, we are most concerned with the impact of these quadricep muscles.

What is patella maltracking?
Patella maltracking is an imbalance problem. The muscles in the upper thigh, the vastus medialis (inside) and vastus lateralis (outside) pull on the patella tendon in different directions. If one side is tighter than the other, it will pull the patella out of balance. Demonstrated with this simple diagram, the patella should ideally run smoothly down the middle of the groove between the condyles (the two sides) of the femur, at the end of your thigh bone.

In most cases of patella maltracking, the lateral (outer) quad is overactive and stronger than the medial (inner) quad, which is weak and underused. In these cases, the patella gets pulled out of the groove, to the side, and rubs against the femur, and this is what causes the pain you feel.

When the outer quad is especially tight, it can even pull the patella out of the joint and cause a dislocation. To tackle patella maltracking, therefore, you have to address the tightening of the muscle and the strength imbalance.

What causes the muscle tightness?
There are a number of reasons that the patella movement can become imbalanced, but muscle tightness is caused by an imbalance in strength or through muscles being overworked or used incorrectly. The muscle tightness stemming from improper muscle use comes from an evolutionary survival mechanism. When the muscle is overworked, there is a risk that it will tear and be damaged. In order to prevent this, the body sends impulses for the muscle to contract and avoid overstraining. This contraction forms a permanent knot in the muscle, which shortens the muscle. The shortened muscles then pulls tighter on the joint, causing it to feel stiff. The stiff feeling makes you want to avoid using the joint.

The corrective measures made by your body are well-intentioned, as they may prevent you from performing seriously harmful actions, but these warning signs leave lasting stiffness in the body. The muscle knots causing this stiffness can be removed manually. If you remove the knot, the muscle can be restored to its full length, preventing tightness and alleviating the pain. You can do this, simply, by massaging the knot. This breaks it down, switching off the nervous impulse and releasing the waste products caught in the knot. It also restores blood-flow to the muscle.

16/11/2022

Sostegno muscolare e legamento in stazione eretta rilassata

🔈 LIGAMENTOUS AND MUSCULAR SUPPORT IN RELAXED STANDING POSTURE

The relaxed person leans on the Iliofemoral ligament ('Y' ligament of Bigelow'), the Anterior Longitudinal Ligament and the posterior knee ligaments.

The ankle cannot be 'locked', but when a person leans forward only a few degrees, the gastrocnemius must contract to support the entire body.

Relaxed erect posture is principally ligamentous, with only the gastrocnemius-soleus muscle group active.

An optimum posture is one in which the postural muscles are at their resting tone and no additional energy beyond this basal level needs to be expended for the person to remain upright.

Stand upright with your feet roughly shoulder width apart. Lift your right foot off the floor. Notice how you automatically shift your weight towards your left side in order to maintain your balance.

17/10/2022

La catena cinetica della gamba e le correlazioni nel dolore articolare

🔊 THE FOOT, KNEE AND HIP CONSTITUTE A KINETIC CHAIN

A study by researchers at Hospital for Special Surgery (HSS) and Harvard Medical School suggests new guidelines may be in order for evaluating and treating lower extremity pain. Investigators set out to determine if there was a relation between foot pain and lower extremity joint pain, and they found a significant association between foot pain and knee or hip pain.

The study shows that a physician evaluating a patient for foot pain should also ask about possible hip or knee pain, and vice versa, so we can address all of a patient's issues. In medicine, many times it comes down to 'what does your MRI look like or what does your x-ray look like?' But it's really important to conduct a thorough medical history and physical exam. A comprehensive orthopedic evaluation may prompt a broader treatment strategy and possibly a referral to another specialist.

Studying the interaction between the knee and the foot, or the hip and the foot is very important because it's a kinetic chain.

The kinetic chain, the notion that the body's joints and segments have an effect on one another during movement, can play a key role in pain. The foot is the first part of the body that makes contact with the ground. Its primary function is a shock absorber. If the shock-absorbing capability of the foot is somehow altered or minimized, it's going to affect other body parts.

The foot is also the foundation of the body. If the foundation is not sound, it could have a deleterious effect on the joints above the foot and ankle, namely the knee and the hip.

Researchers found that foot pain was associated with bilateral and same-side knee pain in men and women. For example, men with right foot pain compared to those with no foot pain were five to seven times more likely to have pain in their right knee or in both knees.

Foot pain was also associated with hip pain on the same side in men. In women, bilateral foot pain was associated with hip pain on both sides, on the same side or on the opposite side.

A theory that may explain study results looks at how an individual modifies his movements and postures when experiencing pain. This can result in malalignment and other problems, and the challenge for physicians is to develop a treatment plan to address all issues. The correlated and compensatory posture and movement theory may explain how multi-joint arthritis develops, as well as other abnormalities and associated pains that can result from overuse or trauma to one or more structures in the kinetic chain.

Source: Hospital for Special Surgery

28/09/2022

Interessante come fonte di dolore somatico...

ELEFANTI ROSA, SORCI VERDI, DISCHI VOLANTI E ... SENSIBILITA' AL GLUTINE NON CELIACA?
UNA STORIA VERA.
Giunge a prima visita una giovane donna.
Racconta come, da adolescente, per il fatto di avere problemi di digestione, era stata sottoposta a un day hospital.
Gli esami ematici mostravano UNA FORTE CARENZA DI FERRO (spacciata per anemia, anche se l'emoglobina era nella norma).
La causa sospetta?
Le dicevano che era legato al "ciclo abbondante"...
Come conseguenza della "sospetta diagnosi", da adolescente, è stata sottoposta a "trasfusioni" di ferro" (chiamiamole così...) fino ad avere uno shock (reazione allergica generalizzata).
Curiosamente, la quantità di ferro dosata nel sangue risultava "normale" da Natale a Santo Stefano, tornando a livelli bassissimi in breve tempo.
Venivano fatti esami di sangue per capire se era , ma gli anticorpi erano nella norma, la diagnosi veniva quindi esclusa.
E lei si teneva i suoi problemi, sia digestivi che ematici (il ferro sempre basso).
All'età di 8 anni, al figlio (che mostrava bassi livelli di ferro come la mamma) viene fatta diagnosi di celiachia, con livelli di anticorpi altissimi.
E viene messo a regime dietetico senza .
Giacchè anche la minima contaminazione faceva star male il ragazzino, anche i genitori iniziano a mangiare senza glutine.
E la giovane donna nota un miglioramento netto dei sintomi suoi digestivi.
E la pizza senza glutine non le da alcun fastidio.
E le sparisce quel fastidioso reflusso gastro-esofageo acido per cui per lungo tempo era stata posta in terapia (tu sai con cosa...)
Quando lo riferisce al medico, lui consiglia di reinserire il ("perchè se non lo mangi poi diventi celiaca", afferma) e le fa ripetere gli esami ematici dopo due mesi di reintroduzione.
Due mesi di reflusso gastroesofageo, difficoltà digestive, episodi di diarrea alternati ad episodi di stipsi.
Gli anticorpi per la celiachia vengono ripetuti.
Il risultato?
Sono negativi.
Al chè, il suo curante AFFERMA che non è celiaca e deve mangiare un pò di tutto (escludendo i fritti) perchè SENZA GLUTINE si vedono i sorci verdi, appaiono gli elefanti rosa e può capitare chissà quale altra malattia...
.
La signora - ovviamente ETICHETTATA come - si domanda: ma è l'ansia che mi fa percepire UN MIGLIORAMENTO DEI SINTOMI quando tolgo il glutine?
E' l'ANSIA che mi fa percepire un RITORNO AI SINTOMI quando reintroduco il glutine?
Io le rispondo: no, è l'ignoranza di una certa classe medica - nonchè la persistenza di certe "leggende metropolitane" - che si dimentica che esiste in letteratura la diagnosi di SENSIBILITA' AL GLUTINE NON CELIACA (Salerno!)
In un articolo ITALIANO del 2018, pubblicato sul GIORNALE MONDIALE DI GASTROENTEROLOGIA (Link1) è descritta così:

22/08/2022

Possibili cause di dolore al ginocchio

🔈 POSSIBLE CAUSES OF KNEE PAIN

04/08/2022

Esercizi per la borsite del ginocchio

🔈 KNEE BURSITIS EXERCISES

You can stretch your leg right away by doing the first 3 exercises. You may start doing the other exercises when your leg is less painful.

🔎 Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway. Stretch your uninjured leg straight out in front of you on the floor through the doorway. Raise your injured leg and rest it against the wall next to the door frame. Keep your leg as straight as possible. You should feel a stretch in the back of your thigh. Hold this position for 15 to 30 seconds. Repeat 3 times.

🔎 Standing calf stretch: Stand facing a wall with your hands on the wall at about eye level. Keep your injured leg back with your heel on the floor. Keep the other leg forward with the knee bent. Turn your back foot slightly inward (as if you were pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf. Hold the stretch for 15 to 30 seconds. Return to the starting position. Repeat 3 times. Do this exercise several times each day.

🔎 Quadriceps stretch: Stand at an arm's length away from the wall with your injured side farthest from the wall. Facing straight ahead, brace yourself by keeping one hand against the wall. With your other hand, grasp the ankle on your injured side and pull your heel toward your buttocks. Don't arch or twist your back. Keep your knees together. Hold this stretch for 15 to 30 seconds.

🔎 Hip adductor stretch: Lie on your back. Bend your knees and put your feet flat on the floor. Gently spread your knees apart, stretching the muscles on the inside of your thighs. Hold the stretch for 15 to 30 seconds. Repeat 3 times.

🔎 Quad sets: Sit on the floor with your injured leg straight and your other leg bent. Press the back of the knee of your injured leg against the floor by tightening the muscles on the top of your thigh. Hold this position 10 seconds. Relax. Do 2 sets of 15.

🔎 Heel slide: Sit on a firm surface with your legs straight in front of you. Slowly slide the heel of the foot on your injured side toward your buttock by pulling your knee toward your chest as you slide the heel. Return to the starting position. Do 2 sets of 15.

🔎 Straight leg raise: Lie on your back with your legs straight out in front of you. Bend the knee on your uninjured side and place the foot flat on the floor. Tighten the thigh muscle on your injured side and lift your leg about 8 inches off the floor. Keep your leg straight and your thigh muscle tight. Slowly lower your leg back down to the floor. Do 2 sets of 15.

29/07/2022

Anatomia del nervo sciatico

🔈 ANATOMY OF THE SCIATIC NERVE

Several important nerves arise from the sacral plexus and either supply the gluteal region (e.g., superior and inferior gluteal nerves) or pass through it to supply perineum and thigh (e.g., the pudental and sciatic nerves, respectively).

Sciatic Nerve is the largest nerve in the body and is the continuation of the main part of the sacral plexus. The branches converge at the inferior border of the piriformis to form the sciatic nerve, a thick, flattened band approximately 2cm wide. The sciatic nerve is the most lateral structure emerging through the greater sciatic foramen inferior to the piriformis.

Medial to the sciatic nerve are the inferior gluteal nerve and vessels, the internal pudendal vessels, and the pudendal nerve. The sciatic nerve runs inferolaterally under cover of the gluteus maximus, midwy between the greater trochanter and ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and adductor magnus muscles. The sciatic nerve is so large that it receives a named branch of the inferior gluteal artery, the artery to the sciatic nerve.

20/07/2022

Sindrome dello stretto toracico ed esercizi utili

🔈THORACIC OUTLET SYNDROME

Thoracic outlet syndrome is a disorder characterized by pain and paresthesias in a hand, the neck, a shoulder, or an arm.
Pathogenesis often involves compression of the lower trunk of the brachial plexus (and perhaps the subclavian vessels) as these structures traverse the thoracic outlet below the scalene muscles and over the 1st rib, before they enter the axilla.

Compression may be caused by:
• A cervical rib
• An abnormal 1st thoracic rib
• Abnormal insertion or position of the scalene muscles
• A malunited clavicle fracture
• Thoracic outlet syndromes are more common among women and usually develop between age 35 and 55.

Symptoms and Signs of TOS
Pain and paresthesias usually begin in the neck or shoulder and extend to the medial aspect of the arm and hand and sometimes to the adjacent anterior chest wall. Many patients have mild to moderate sensory impairment in the C8 to T1 distribution on the painful side; a few have prominent vascular-autonomic changes in the hand (e.g., cyanosis, swelling). In even fewer, the entire affected hand is weak.

Rare complications of thoracic outlet compression syndromes include Raynaud syndrome localized to the affected arm and distal gangrene.

Exercise:
• Pectoralis stretch: Stand in a doorway or corner with both arms on the wall slightly above your head. Slowly lean forward until you feel a stretch in the front of your shoulders. Hold 15 to 30 seconds. Repeat 3 times.

• Thoracic extension: While sitting in a chair, clasp both arms behind your head. Gently arch backward and look up toward the ceiling. Repeat 10 times. Do this several times per day.

• Arm slide on wall: Sit or stand with your back against a wall and your elbows and wrists against the wall. Slowly slide your arms upward as high as you can while keeping your elbows and wrists against the wall. Do 3 sets of 10.

• Rowing exercise: Tie a piece of elastic tubing around an immovable object and grasp the ends in each hand. Keep your forearms vertical and your elbows at shoulder level and bent to 90 degrees. Pull backward on the band and squeeze your shoulder blades together. Repeat 10 times. Do 3 sets.

19/07/2022

Tendinite del tibiale anteriore, che insieme allo Psoas é il muscolo che risente di più di un'idratatazione non adeguata...Sì, ma come bere 😊?!?

🔈 TIBIALIS ANTERIOR TENDONITIS - SYMPTOMS, CAUSES, TREATMENT OPTIONS

▶️ WHAT IS TIBIALIS ANTERIOR TENDONITIS?

The tibialis anterior is a muscle which lies at the front of the shin and attaches to several bones in the foot via the tibialis anterior tendon. The tibialis anterior is primarily responsible for moving the foot and ankle towards the head (dorsiflexion – figure 1), and, controlling the foot as it lowers to the ground during walking or running.

Whenever the tibialis anterior muscle contracts or is stretched, tension is placed through the tibialis anterior tendon. If this tension is excessive due to too much repetition or high force, damage to the tendon can occur. Tibialis anterior tendonitis is a condition whereby there is damage to the tibialis anterior tendon with subsequent inflammation and degeneration.

▶️ SIGNS AND SYMPTOMS OF TIBIALIS ANTERIOR TENDONITIS

Patients with tibialis anterior tendonitis usually experience pain at the front of the shin, ankle or foot during activities which place large amounts of stress on the tibialis anterior tendon (or after these activities with rest, especially upon waking in the morning). These activities may include walking or running excessively (especially up or down hills or on hard or uneven surfaces), kicking an object with toes pointed (e.g. a football), wearing excessively tight shoes or kneeling. The pain associated with this condition tends to be of gradual onset which progressively worsens over weeks or months with continuation of aggravating activities. Patients with this condition may also experience pain on firmly touching the tibialis anterior tendon.

▶️ CAUSES OF TIBIALIS ANTERIOR TENDONITIS

Tibialis anterior tendonitis typically occurs due to activities placing large amounts of stress through the tibialis anterior muscle. These activities may include fast walking or running (especially up or downhill or on hard or uneven surfaces) or sporting activity (such as running or kicking sports). Patients may also develop this condition following direct rubbing on the tibialis anterior tendon. This may occur due to excessive tightness of strapping or shoelaces over the tendon.

▶️ TREATMENT OPTIONS

Treatment for patients with tibialis anterior tendonitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Treatment may comprise:

- soft tissue massage
- electrotherapy (e.g. ultrasound)
- anti-inflammatory advice
- stretches
- joint mobilization
- dry needling
- ankle taping
- bracing
- the use of crutches
- ice or heat treatment
- exercises to improve strength, flexibility and balance
- education
- activity modification advice
- biomechanical correction
- footwear advice
- a gradual return to activity program

▶️ EXERCISES

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the advanced and self massage exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.

🔑 Foot and Ankle Up and Down

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 10 – 20 times provided there is no increase in symptoms.

🔑 Foot and Ankle In and Out

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 10 -20 times provided there is no increase in symptoms.

Reference: Physio Advisor

17/07/2022

I sei tipi di articolazioni sinoviali

🔈THE SIX TYPES OF SYNOVIAL JOINTS

Synovial joints are classified according to the shape of their articulating surfaces and/or the type of movement they permit.

1. Plane joints permit gliding or sliding movements in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement limited by their tight joint capsules. Plane joints are numerous and are nearly always small. An example is the acromioclavicular joint between the acromion of the scapula and the clavicle.

2. Hinge joints permit flexion and extension only, movements that occur in one plane (sagittal) around a single axis that runs transversely; thus, hinge joints are uniaxial joints. The joint capsule of these joints is thin and lax anteriorly and posteriorly where movement occurs; however, the bones are joined by strong, laterally placed collateral ligaments. The elbow joint is a hinge joint.

3. Saddle joints permit abduction and adduction as well as flexion and extension, movements occurring around two axes at right angles to each other; thus, saddle joints are biaxial joints that allow movement in two planes, sagittal and frontal. The performance of these movements in a circular sequence (circumduction) is also possible. The opposing articular surfaces are shaped like a saddle (i.e., they are reciprocally concave and convex). The carpometacarpal joint at the base of the 1st digit (thumb) is a saddle joint.
4. Condyloid joints permit flexion and extension as well as abduction and adduction; thus, condyloid joints are also biaxial. However, movement in one plane (sagittal) is usually greater (freer) than in the other. Circumduction, more restricted than that of saddle joints, is also possible. The metacarpophalangeal joints (knuckle joints) are condyloid joints.

5. Ball and socket joints allow movement in multiple axes and planes: flexion and extension, abduction and adduction, medial and lateral rotation, and circumduction; thus, ball and socket joints are multiaxial joints. In these highly mobile joints, the spheroidal surface of one bone moves within the socket of another. The hip joint is a ball and socket joint in which the spherical head of the femur rotates within the socket formed by the acetabulum of the hip bone.

6. Pivot joints permit rotation around a central axis; thus, they are uniaxial. In these joints, a rounded process of bone rotates within a sleeve or ring. The median atlanto-axial joint is a pivot joint in which the atlas (C1 vertebra) rotates around a finger-like process, the dens of the axis (C2 vertebra), during rotation of the head.

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