Commentary by a toe doctor
YOSHIRO YUASA
Keiro Yuasa
Dr. Toe, Director of Toe Research Institute, President of Japanese Society of Functional Foot and Toe Therapy, and developer of Halmek shoes. Former director, vice president, and medical director of General Hospital. He specializes in exercise physiology and anatomy. He is also a foot and shoe specialist and a leading expert in postural occlusion therapy. He has cured various orthopedic diseases (over 70,000 people) with toe therapy alone.
Introduction.
Structural problems in the legs or bending or stretching the legs in unnatural directions during exercise can put strain on the posterior cruciate ligament and cause damage. o-legs (outer thigh) and x-legs (inner thigh) are more likely to put strain on the posterior cruciate ligament and thus increase the possibility of damage. Therefore, it is important to manage leg health and take appropriate exercise and preventive measures by wearing HIRONOBA EXERCISE and YOSHIRO SOCKS.
summary
The knee is formed by the following major structures The posterior cruciate ligament extends from the posterior part of the tibia to the anterior part of the femur (Beginning at the anterior portion of the lateral wall of the medial femoral condyle, extending posteriorly outward and stopping posteriorly at the intercondylar ridge of the tibia.(see Figure 1). Understanding the attachment area of the ligament from a biophysical perspective can help us understand what causes posterior cruciate ligament injuries. Surprisingly, many physicians and physical therapists are unaware of this. Also, since they only look at the area where the ligament is injured, they are unable to see problems other than sudden movements or external forces, which is another reason why many people repeatedly have recurring injuries.
1) Bones: The knee is composed of three bones: femur (thigh bone), tibia (tibia), and fibula (fibula). The femur connects to the tibia at the upper end and connects to the tibia and fibula at the lower end.
2) Ligaments: The knee is surrounded by tissue called ligaments. Ligaments stabilize and support the joint. The most important ligaments include,Anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL)There are
3) Cartilage: The knee joint contains smooth, elastic tissue called cartilage. Cartilage prevents friction between bones and allows smooth movement of the joint.
4) Sciatic muscle: Located behind the knee, the sciatic muscle provides joint stability and aids in knee extension.
This is the part that non-specialists don't need to know about. Roughly speaking.When the structures of the four ligaments work well together, the knee joint can function properly, support body weight, and perform movements such as walking and runningI think you should just think of it as "the best way to get a good idea of what to expect.
What is a posterior cruciate ligament injury?
Posterior cruciate ligament injury (PCL injury) is a partial or complete damage to the posterior cruciate ligament of the kneerefers to the posterior cruciate ligament (PCL). The posterior cruciate ligament (PCL) is one of the most important ligaments that maintain knee stability and can be damaged by sports or sudden movement injuries, etc. PCL injuries can cause knee instability, swelling, pain, and other symptoms that require proper treatment.
Posterior cruciate ligament injuries (PCL injuries) are often caused by sprains from sports or sudden movements, though,Some people are more prone to it than others. The difference is whether the knee joint is in the correct alignment or not.It is a very important part of the body. Therefore, we hope that you will read this article in order to prepare your body to be less prone to damage of the posterior cruciate ligament in sports and other activities.
It means that if the knee joint is misshapen, it is easy to damage the "posterior cruciate ligament".
symptoms
Symptoms of posterior cruciate ligament injury (PCL injury) include the following
1) Feeling of instability or wobbliness in the knee
2) Swelling and inflammation of the knee
3) Knee pain or tenderness
4) Feeling of heat against a swollen knee
5) Painful to the touch against the swollen knee
(6) Limited range of motion of the knee
(7) Restriction of movement due to swelling of the knee
(8) Sense of weight or discomfort in the knee
9) Hearing a clicking sound when bending the knee
10) Discomfort or discomfort felt when bending the knee
If you have any of these symptoms, it is important to get proper toe treatment as soon as possible. This condition is similar to osteoarthritis of the knee and lateral collateral ligament injuries, but the result is the same thing to do, so you don't have to worry about it as much. If you are a doctor, physical therapist, or other professional, you should know how to recognize them by test methods, since most pathologies can be known by palpation without MRI or CT.
It means that you will have pain in your knee, but it is not caused by your knee.
Causes and pathogenesis
Factors in the development of posterior cruciate ligament injuries (PCL injuries)
Common medical causes of posterior cruciate ligament injuries (PCL injuries) include the following
1) Sports activities: In athletic sports such as basketball, soccer, and football, as well as winter sports such as skiing and snowboarding, rapid movements, landings, and sudden changes in direction increase the risk of PCL injury.
2) Trauma: The PCL can be damaged by external impact or strain, such as car accidents, falls, or loading the knee joint at an abnormal angle.
3) Knee joint instability: Imbalances in knee joint structure and muscular strength increase the risk of overloading and damaging the PCL.
4) Previous Knee Injuries: Experiencing a previous knee injury increases the likelihood of recurrence or new injury.
5) Insufficient Muscle Strength: Lack of muscle strength to support the knee joint can easily strain the PCL.
6) Excessive Exercise: Excessive exercise or improper training can strain the knee and cause PCL injury.
Other than injuries caused by sudden external forces, factors 3) to 6) are the most common causes of occurrence. Even if the same exercise (e.g., sports) is performed,Some people are more prone to damage than others. It is important to consider what the differences are.
It means that if a person is prone to ligamentous injuries, he or she should be suspicious of the shape of the legs.
Mechanical Mechanisms of Posterior Cruciate Ligament Injury (PCL Injury) Development
Posterior cruciate ligament in correct posture
Basically, animals, including humans, have bodies that can handle any kind of movement. Therefore, it is more reasonable to assume that those who suffer from sports injuries and are unable to return to work are not "caused" by a lack of muscle strength or excessive exercise, but rather that their bodies are not built to be injury-resistant or to recover easily from injuries. Let's start by learning about the "basics" of the body, namely the neutral position.
The neutral position is the basic posture for maintaining correct posture. This posture is one in which each part of the body is kept in the correct position and weight is evenly distributed.A state in which the burden on the body (joints, muscles, and ligaments) is minimized and the function of the whole body's motor and circulatory functions can be easily performed smoothly and in good balance.The following is a list of the most important factors. There are many details, but here we will only look at the area from the pelvis down.
In the neutral position, there is no load (tension) on the posterior cruciate ligament because the alignment of the knee joint (correct position and angle of the knee) is straight. If the tension when standing straight is 0, then if the knee (femur and lower leg bone) is twisted in the opposite direction, the tension is about 3 (small).
The ligament tension is expressed here as 1-3 as small, 4-6 as medium, and 7-10 as large.
In other words, the closer the knee joint is to the neutral position, the less the posterior cruciate ligament is affected by sudden movements during sports or changes of direction.
It means that ligaments are flexible enough to withstand a certain amount of movement and impact.
Posterior cruciate ligament in O-legs
So what happens in the case of O-legs, in which the posterior cruciate ligament is overstretched as the knee twists outward in a significant way?
The tension at this time is about "medium". However, since the O-leg is combined with the "outer thigh," the tension in the posterior cruciate ligament becomes "small" when the lower leg is externally rotated. The reason for this change from medium to small is that external rotation of the lower leg brings the stop of the ligament closer to the starting point.
There is some tension generated compared to the neutral position leg, but not enough to cause damage to the posterior cruciate ligament. But what happens if a person with O-legs + outer thighs becomes inward-thigh (lower leg further externally rotated) for some reason (e.g., sports, change of direction)?
The tension in the posterior cruciate ligament is at its maximum "large," making it vulnerable to damage.
In a neutral position leg, the tension on the posterior cruciate ligament was "small" no matter how much the knee twisted in the opposite direction. However, in a person with an O leg and external hip, the tension becomes "large" as soon as the lower leg bone is internally rotated.
This means that people with O-legs are constantly placing a higher load on the posterior cruciate ligament due to rapid movements and landings in sports and sudden changes of direction in daily life, and by suddenly turning the area below the knee inward, the posterior cruciate ligament is vulnerable to injury or rupture.
The following links will help you understand the causes of O-legs and how to heal them.
This means that the body is prone to ligament damage at the point of O-legs.
What are the causes of O-legs that make posterior cruciate ligament injuries more likely to occur?
For example, let's say you have a dysfunctional little toe or hallux valgus. The little toe is basically "responsible for keeping the foot from falling outward.
If you have hallux valgus or small toe dysfunction (e.g., inability to par your little toe), your foot will fall outward when you walk (kick your foot out). When the foot falls outward, it is called "turning outward foot.
When the foot becomes outwardly rotated, the lower leg bone falls outward, resulting in a foot deformity called O-leg.
The normal function of the thumb and little toe allows a person to stand up straight and walk upright. In other words, walking with hallux valgus or small toe dysfunction is directly related to having O-feet.
Another deformity that causes the foot to fall outward is ectropion. This is when the heel bone tilts inward due to weakness of the sole muscles caused by a clawed or floating toe. When the heel tilts inward, the lower leg bone above the heel falls outward to maintain balance. This can lead to an O-leg deformity.
If you can't use your little finger, you have an O-leg. It is a ligament problem but that the little finger could be the cause.
Posterior cruciate ligament in X leg
What happens in the case of the X leg, where the posterior cruciate ligament is overstretched as the knee is twisted inward significantly? Since the origin of the posterior cruciate ligament is located on the outside of the femur, the tension is not as great as in the case of the O-leg.
The tension at this time is about "medium". However, since the X-leg is combined with the "inner thigh," the tension in the posterior cruciate ligament becomes "small" when the lower leg is internally rotated. The reason why the tension goes from medium to small is because the stop of the ligament is closer to the start of the ligament as the lower leg is internally rotated.
There is some tension generated compared to the neutral position leg, but not enough to cause damage to the posterior cruciate ligament. But what happens if a person with X-legs plus inner thighs turns to the outer thighs for some reason (sports, change of direction, etc.)?
The tension in the posterior cruciate ligament is at its maximum "large" and can cause damage.
In a neutral position leg, the tension on the posterior cruciate ligament was "small" no matter how much the knee twisted in the opposite direction. However, in a person with an X leg and inner thigh, the tension becomes "large" as soon as the lower leg bone is externally rotated.
This means that people with X-legs are constantly placing a higher load on the posterior cruciate ligament due to rapid movements and landings in sports and sudden changes of direction in daily life, making it more susceptible to damage or rupture.
Have you found that it is important to keep the X leg as close to the neutral position as possible to prevent posterior cruciate ligament injuries from occurring or recurring?
This means that the body is prone to ligament damage at the point of X-legs.
What are the causes of X-legs that make posterior cruciate ligament injuries more likely to occur?
For example, let's say you have a dysfunctional thumb or big toe. The thumb is basically "responsible for keeping the foot from falling inward.
When the big toe or thumb dysfunction (e.g., inability to par the thumb) is present, the foot falls inward when walking (kicking the foot out). When the foot falls inward, it is called "turning foot.
When the foot is turned outward, the lower leg bone falls inward, causing a foot deformity called X-leg.
The normal function of the thumb and little finger allows a person to stand up straight and walk upright. In other words, walking with hallux valgus or thumb dysfunction is directly related to having X-legs.
Another deformity that causes the foot to fall inward is called clubfoot. This is when the heel bone tilts outward due to weakness of the sole muscles caused by a clawed or floating toe. When the heel tilts outward, the lower leg bone above the heel falls inward to maintain balance. This can lead to X-leg deformity.
If you can't use your thumb, you have X-legs. It is a ligament problem but that the thumb could be the cause.
Inspection and Self-Check
If you suspect a posterior cruciate ligament injury, check for the following symptoms
1) Sudden swelling or internal bleeding of the knee
(2) Decreased knee stability or instability
3) Twisting the knee causes pain.
4) Restricted knee movement.
5) Knee pain or discomfort when walking or exercising.
(6) Prolonged swelling and pain in the knee
Posture Self-Check
First, take a picture from the pelvis down, even with your phone. Note that you should "keep both feet together" when taking the picture.
Draw a vertical line from the "center of the heel." Ideally, this line should pass through the "center of the knee". Most people would have gone through the inside or outside of the center of the knee.
People who have a left-right difference in the line that runs through both legs, as in the picture above, and the further the vertical line from the heel is away from the center of the knee, the more likely they are to develop posterior cruciate ligament injuries. Since "muscle strength" alone cannot compensate for this area, the reason many athletes retire without being able to return to work, no matter how hard they train, is because they do not look at their toes or think about knee alignment.
Self-check of knee inward/outward rotation
An easier way is to check it while lying down. First, lie down in a natural position. Most people will have their toes pointing either outward or inward, outward for those with O-legs and inward for those with X-legs. The "knee cushion" should be pointing straight up.
From there, point your toes straight up. If the knee cap moves inward or outward in a circular motion, the foot is deformed to the extent that the posterior cruciate ligament can be easily injured.
If you have O-legs, your "kneecap" should be facing inward. To make sure that the "kneecap" is facing straight ahead, open your legs slightly outward while keeping your heels together. If the angle of the spread leg exceeds 45°, the leg is deformed to the extent that the posterior cruciate ligament is easily injured.
If you have X-legs, your "kneecap" will be facing outward. In order to make the "kneecap" face straight ahead, open the heel outward slightly while keeping the toes together. If the angle of the spread leg exceeds 45°, the leg is deformed to the extent that the posterior cruciate ligament is easily injured.
Toe deformity self-check
Most people today have deformed toes due to the wrong choice of shoes and socks, and the way they wear them.and the foundation is crumbling. Please refer to the following website for details. I have seen many Olympic athletes, world track and field athletes, professional baseball players, professional soccer players, etc. The more severely deformed a person's toes are, the more likely they are to break down.
Toe deformity self-check sheet
For those with X-legs, a simple check sheet is also available to check for thumb deformity. Download it and check it by putting your own foot on it.
For those with O-feet, we also have a simple check sheet to check the deformity of the little toe. Please download it and check it by putting your own foot on it.
medical treatment
Treatment of posterior cruciate ligament injuries depends on the extent of the injury and symptoms, but the following methods are generally used. The following treatments (conservative therapy) may provide temporary symptomatic relief, but recurrence is common.
1) Conservative therapy: To reduce swelling and inflammation, it is important to maintain rest and cool the affected area with ice or compresses.
(2) Traction therapy: braces and fixtures are used to stabilize the knee to protect the ligaments.
3) Strength training: Strengthening the surrounding muscles can reduce the strain on the affected area and help rebuild the ligament.
(4) Restorative activity: Exercise and activity should be limited to protect the affected area to avoid overloading.
5) Physical therapy: a common treatment of injuries by specialists, used to strengthen and rebuild ligaments.
(6) Surgery: Severe posterior cruciate ligament injuries may require surgery. Surgery includes endoscopic surgery and open surgery.
In many cases, surgical therapy can be used to treat posterior cruciate ligament injuries with good results, but without recurrence.To cure the root cause, toe care should be used to improve O- and X-legs.It is important to avoid putting undue stress on the posterior cruciate ligament by not straining the inside of the knee with
Basically, ligaments cannot be strengthened. However, the previous explanations have shown thatIt is important to "not create tension in the ligaments."I hope you have found that this is the case. If you have not been able to feel the effects of anything you have done, please start to restore the function of your toes and bring your leg deformities back to a neutral position.
Surgery for a torn ligament is good, but you have to be able to use the toe afterwards or it will recur, he said.
Training methods to avoid posterior cruciate ligament injuries
Did you know that leg deformities can cause posterior cruciate ligament injuries? The posterior cruciate ligament is one of the key ligaments that maintains knee stability and can be damaged by sudden changes in direction or excessive stress. Deformities of the leg can cause damage to the posterior cruciate ligament when the ankle or knee is not in its normal position and excessive stress is placed on the joint. Therefore, toe training is the alignment of the foot and leg to minimize the load on the posterior cruciate ligament.
Hironoba Exercise, a toe stretch to improve O-legs and X-legs
Try doing this once a day for 5 minutes; if you do not see any change in your symptoms after trying it for a few days, we recommend increasing the frequency to 2-3 times a day. The goal is to be able to par your toes for 30 seconds. For those who have repeated relapses, it is recommended to do it for 30 minutes a day.
Corrective 5-finger socks for optimal support of O- and X-legs
We have produced functional 5-finger socks made of cotton and silk and tried them on many patients in clinical settings, but we were unable to solve the problem of feet slipping in shoes and socks. Therefore, we spent two years working with a textile company to perfect the ideal fiber, and the corrective five-toed socks "YOSHIRO SOCKS" were born. If you suffer from posterior cruciate ligament injuries, give them a try.
Pure cotton and silk materials are slippery
There is a silken finish (or mercerization process). Silkette treatment is a process that gives silk-like luster to yarns, and involves soaking yarns in a caustic soda (sodium hydroxide) solution and stretching them like hand-pulled udon noodles to straighten the cross section of the yarns. It is overwhelmingly used mainly for cotton and silk fibers (cotton).
The cross-section of the cotton is aligned, coloration is improved, and fluff is suppressed when processed, giving it a luxurious appearance. It is smooth and slippery to wear, but as the words "smooth" and "slippery" suggest, it is easy for the feet to slip inside shoes and socks. In other words, it is a material that can easily cause deformation of the toes.
Of course, there are cotton and silk materials that are not silken, so choosing such materials is also an important factor in preventing knee pain.
Five-toed socks allow toes to function.
Common socks are also called tube socks, and most people around the world have this type of socks. It is a shape that has been used for many years, but the tube type makes it difficult to use the toes properly. For this reason, socks with five separate toes are better, but there are many different types of this type.
The most important thing is to make sure it fits your own feet just right.The socks should be worn with a soft, comfortable, and comfortable footwear. If the fingertips or instep area is loose, even a good 5-finger sock will "slip". On the other hand, 5-finger socks that fit too tightly and feel oppressive are not recommended, as they can impede blood circulation. It is important to find 5-toed socks that feel "comfortable" when you try them on.
Also,Supporting the arch is important, but arch structure is a property that can lose its function if it is lifted too stronglySo, be sure to choose an arch that is also not too oppressive.
How to choose the right shoes
The most common cause of toe deformity is the choice of shoes and how they are worn.Most spine problems are caused by not using the toes properly. Few people think of the feet and the person because they are located so far away from each other. If you are suffering from a posterior cruciate ligament injury, please take this opportunity to review your feet.
Moderate walking reduces strain on the posterior cruciate ligament.
To make it more effective
By making small changes in daily life, such as toe stretching and wearing corrective five-toed socks (YOSHIRO SOCKS), you can maintain correct posture, improve posterior cruciate ligament injuries, and prevent recurrence. Correct posture is created by correct muscles.Correct muscles can only be built by walking with "toes spread and extended"!The following is a list of the most common problems with the
Walk with a small gait.
・Use your toes, such as going up hills and stairs.
. Avoid wearing footwear indoors.
Try to walk at least 6,000 steps a day.
Make sure the laces are tight.
...No ordered pillows or mats.
Choose the right shoes.
Use a shoehorn to put on your shoes.
Stretching the toes and walking with corrective five-toed socks (YOSHIRO SOCKS) helps to use the toes functionally.(1) Toe deformity improved → (3) Center of gravity improved → (4) O- and X-legs improved → (5) Leg length difference improved → (6) Posterior cruciate ligament toStress improvedThis is the flow of the project.
References
Functional Anatomy and Physical Therapy of Hallux Valgus. Yuasa, Keiro. Physical Therapy Vol.31 No.2 2014.2 P159-165
2. "Shift Your Toes and You'll Be Healthy" by Keiro Yuasa/author, PHP Kenkyujo, 2014.6
3. "Your back and hips will never get bent again in your life by grabbing your toes in just 5 minutes! Written by Keiro Yuasa, PHP Research Institute, 2021.6
4. Bedi A, Musahl V, Cowan JB. Management of Posterior Cruciate Ligament Injuries: An Evidence-Based Review. Journal of the American Academy of Orthopedic Surgery. 2016 May;24(5):277-89. Accessed 7/26/21.
5. itälä A, Lankinen P, Pajulo O. Kasvuikäisten takaristisidevammat. treatment of posterior cruciate ligament injury in skeletally immature patients. . duodecim. 2015;131(11):1085-9. finnish. accessed 7/26/21.
6. Schüttler KF, Ziring E, Ruchholtz S, Efe T. Verletzungen des hinteren Kreuzbands [Posterior cruciate ligament injuries]. Unfallchirurg. 2017 Jan;120(1):55-68. german. Accessed 7/26/21.
