It’s Lyme Time: Lyme Disease Can Present As A Swollen Knee
Abigail Smith and Elizabeth Matzkin, MD
As the summer season begins, so does tick season. Ticks are miniscule arachnids that are found in most areas of the US. These creatures drink the blood of mammals, including humans. A tick bite may seem insignificant and small, but infected ticks risk transmitting Lyme disease to your body. Lyme disease is the most common vector-borne illness in the US.
Symptoms of Lyme disease are different depending on how early the disease is identified. In stage I, patients may have headaches, fever, and a rash known as erythema migrans. Stage II includes pain in joints, migraines, Bell palsy (muscle weakness of the face), meningitis (inflammation of the brain and spinal cord membranes) and fatigue. Stage III happens when the tick bite is never identified, and the Lyme disease is left untreated.
Lyme disease can often present as a painless swollen joint, most commonly as a swollen knee. A swollen knee without any injury or traumatic event could be the first sign of Lyme disease and may warrant testing.
How To Identify A Tick Bite
- Usually on the lower extremities
- Tick attached to skin
- Red spot near bite
- Bulls eyes pattern around bite
- Red rash
This early found tick bite exhibits red spots, bulls eye pattern, and a red rash.
Lyme disease should be taken seriously considering that if left untreated it causes serious musculoskeletal damage. Dr. Elizabeth Matzkin states that “Lyme disease is a problem but can be corrected if caught and diagnosed in a timely fashion”. Lyme disease is a common but preventable disease with the right education and awareness.
Snowboard Mountain Prep: Injury Prevention
Catherine A. Logan, MD, MBA, MSPT
Orthopaedic Surgeon, Sports Medicine
Colorado Sports Medicine & Orthopaedics
Snowboarding has been one of the fastest growing and most popular sports of the winter season. The sport combines power, velocity, and technique, making it appealing for both recreational and competitive riders. Snowboarding injury patterns of vary based on skill level; while novice riders experience upper extremity injuries more frequently, elite riders experience a higher rate of lower extremity injury.
New riders more commonly sustain wrist sprains, fractures, lacerations, and contusions. Preventative measures, such as using wrist guards and a helmet, have proven to be effective. Additionally, upon falling, riders should try to hold their hands in a fist position to avoid a wrist fracture.
In more elite riders, the lower extremity, particularly the knee, is more at risk for injury. The anterior cruciate and medial collateral ligaments have a higher incidence of injury secondary to more experienced riders are landing from larger amplitude jumps, riding at increased speeds, and enduring higher impact forces.
Injuries may be multi-factorial and may be due to lack of physical fitness, inadequate skill, poor conditions, collisions or improper equipment. Below are some tips on how to optimize physical fitness to prevent the more common injuries.
The average rider should also implement multi-planar, full body movements into their conditioning regimen. Basic exercises, such as a squat, act as a foundation for later progressions including ball tosses and unstable surfaces, for example.
With regard to flexibility, riders should incorporate a regular sequence of yoga inspired movements and holds including hip openers, thoracic spine rotations, and shoulder mobility.
Bridge Progression (Repeat 3 sets of 10-15 repetitions)
- Basic bridge: begin lying supine with arms relaxed at the side with knees bent and feet planted hip width apart. Draw the belly button down toward the spine, tighten the abdominals, then lift the torso toward the sky. Maintain a straight line from the shoulders to the knees, hold 5 seconds, then lower to the starting position.
- Unstable bridge: place the feet on a foam pad or other unstable surface.
- Ball bridge: begin lying supine with arms relaxed at the side with knees straight and heels on a balance call. Draw the belly button down toward the spine, tighten the abdominals, then lift the torso toward the sky. Maintain a straight line from the shoulders to the ankles, hold 5 seconds, then lower to the starting position.
Squat Progression (Repeat 3 sets of 10-12 repetitions)
- Basic squat: begin with feet hip width apart and lower down until the knees are bent to 90 degrees while maintaining an upright torso. Add dumbbells as appropriate.
- Ball toss squat: add a weighted ball toss; return the toss as you rise out of the squat position and while you lower down (different forces will be experienced).
- Balance Board hold: begin with feet hip width apart and maintain a slight flex in the knees with an upright torso.
- Balance Board squat: add a squat while balancing on the board.
Lateral Squats Progression (Repeat 3 sets of 10-12 repetitions, alternate sides)
- Basic lateral squat: begin with feet hip width apart, step either leg out to the side with toes pointing forward, then lower down until the knees are bent to 90 degrees. Maintain an upright torso and add dumbbells as appropriate.
- Ankle resistance band lateral squat: place resistance band around the ankles and perform as above.
Plank Progression (Repeat 3 sets of 20 second holds or 10-12 repetitions)
- Basic plank: begin in the push-up position with shoulders relaxed and the scapula drawn back and down; hold for 20 seconds, rest and repeat.
- Plank on Balance Board: perform as above with the palms placed firmly under the shoulders on the Balance Board; hold for 20 seconds, rest and repeat.
- Push-up on Balance Board: lower the chest toward the board while maintain a straight torso; repeat for 1-12 repetitions, rest and repeat.
- Mountain climbers on Balance Board: maintain a straight line from the shoulders to the heels while alternating controlled knees toward the chest; repeat for 10-12 repetitions, rest and repeat.
*Balance Boards can be replaced by a BOSU or another similar tool.