Chiropractor Chandler AZ
Knee replacement, also known as total knee arthroplasty (TKA), is one of the most common surgical procedures, with estimates of over 650,000 each year. Although outcomes are generally good, all surgery carries certain risks and a prolonged recovery period. Many of the conditions that eventually lead to the need for TKA, including tendon, meniscus and ligament damage as well as osteoarthritis, can be managed effectively with non-invasive treatments. The key here is to seek help before the condition becomes severe. If you are experiencing pain that doesn’t subside with rest, your best move is to contact a healthcare specialist and explore your options.
Knee pain can be caused by a variety of tendon, ligament and meniscus injuries. Sometimes these are acute injuries from contact sports, but they can also develop as the result of poor biomechanics. The quadriceps muscles in the upper leg play a major role in the way that the patella (kneecap) tracks. The kneecap is supposed to track straight up and down the leg. So-called “tracking problems” can be caused by muscle imbalance between the lateral and medial quadriceps muscles, chronically tight IT bands, hamstring tightness and foot structure problems that result in overpronation (rolling too far inwards when you walk or run). Rear-foot eversion and internal tibial rotation can also contribute to the condition.
Women are more likely than men to develop patellofemoral pain syndrome because they have wider hips. This affects the angle from the hip to the knee, and can cause over-reliance on the lateral quadriceps muscles.
Soft tissues inside of the knee itself, including the ligaments and menisci, can tear due to an acute injury or develop small tears over time due to overuse or poor biomechanics. Although severe acute trauma often requires surgery, chronic injuries respond well to physical therapy and corrective exercise.
Results of a study in the New England Journal of Medicine (May, 2013) compared surgery to physical therapy for treatment of meniscal tears and osteoarthritis. The study included 351 patients 45 years of age and older whose meniscus damage and osteoarthritis had been confirmed with MRI or radiography. The first group received surgery and physical therapy, while the second group was treated with physical therapy alone.
According to the authors, “results of the analysis… of the six-month WOMAC physical function score likewise did not show a clinically important or statistically significant difference between groups… there were no significant differences in the magnitude of improvement in functional status and pain after six and 12 months between patients assigned to arthroscopic partial meniscectomy with post-operative physical therapy and patients assigned to a standardized physical therapy regimen.” (Katz et al., 2013).
Non-invasive treatments such as transcutaneous electrical nerve stimulation, class IV cold laser, extracorporeal shockwave therapy, Graston Technique, taping, stretching, balance and corrective exercise can effectively treat knee pain and in many cases, eliminate the need for surgery.
The European Society for Sports Traumatology, Knee Surgery, and Arthroscopy reported on the best practices for knee injuries and conservative treatment. They reported most patients present with a variety of symptoms and clinical findings. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. These patients usually have loss of muscle and reduced function of the vastus medialis, and an imbalance between the vastus medialis and lateralis (inside and outside of the quadriceps muscle).
This muscle imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease strain on the knee. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least three months before considering other treatment options.
The European Society for Sports Traumatology, Knee Surgery, and Arthroscopy says that many people with knee pain have multiple problems that are resulting in their knee pain. There is a process and progression for getting better, and you should follow it for at least three months before more aggressive treatments (including surgery)!
People do not notice how their foot, ankle, knee, and hip bend when they squat to pet the dog or tie their shoe. Or how their knee dips inward when they squat. When you pick a shoe up off the ground, do you hinge at the low back or drop your waist toward the ground?
You are losing function over time, leading to tissue damage.
Realistically, most people do not care about their body's function until it stops working or hurts. The average person does not work toward maintaining optimal function, they only want it to not hurt when they go through their day. Unfortunately, this can lead to slow changes over time that cause dysfunction in movement patterns and pain.
The symptoms of knee pain vary according to the cause. To learn more about the symptoms for osteoarthritic knee pain please refer to that special section. Following are symptoms of patellofemoral pain syndrome, meniscus and ligament injuries specific to the knee:
Both endurance athletes and those involved in team sports such as soccer, rugby and football can experience knee pain. So can racquet sports players and golfers, due to the twisting and side-to-side motions in both sports. The following risk factors increase the likelihood of knee pain:
As with any type of inflammation, ice is your friend. We like the big gel ice packs because they are easy to mold over the knee and can be reused. Ice several times per day. You cannot ice too much.
Your primary care physician may recommend over-the-counter anti-inflammatory medications such as Advil, Aleve, aspirin or Tylenol to reduce the pain and swelling.
There are a variety of over-the-counter braces that can provide extra support. One caveat is that these braces limit range of motion, which can in some cases lead to other injuries. Avoid high-impact activities such as running, basketball and jumping. If you strength train, make sure that you are doing so with proper form. It’s possible to develop knee pain from weight machines if used improperly.
If home-based treatments don’t work, a physical therapist can work with you to assess the cause of the pain and come up with a treatment plan. During the assessment, your physical therapist will look at your gait (walking and/or running), test for muscle strength in the quadriceps, look for tightness in the hamstrings, IT bands and hip flexor muscles, check for dorsiflexion of the foot (should be at least 20 degrees) as well as overpronation.
One of the most frequent causes of knee pain is weak adductor muscles and overactive abductors. In other words, muscles on the inside of the leg are weak, while those on the outside of the leg are tight and strong. Corrective exercises can eliminate these muscle imbalances. Tight hamstrings are often the result of weak gluteal muscles: the glutes aren’t doing their job, so the hamstrings take over. In this case, the fix is to strengthen the glutes.
Flexibility exercises to restore normal range of motion to the quadriceps, hamstrings, calf muscles and hip flexors are important to reduce the stress on the injured knee. A Prostretch makes it easier to improve dorsiflexion in the feet.
In many cases, scar tissue has built up in and around the knee due to microtears in tendons, ligaments and muscles. Initially, scar tissue is the body’s way of creating a “patch” to help stabilize the injured area until it heals. Unfortunately, it can also cause the healing process to stop, and prevent healthy tissue from replacing it. Graston Technique is a very successful treatment for breaking up scar tissue so that the injured area can heal properly.
Graston technique is one of the most effective treatments for improving knee pain from tendonitis and tendonosis. It can be used on the knee, upper and lower leg muscles and IT band. Graston technique utilizes stainless steel instruments specifically designed to break up scar tissue by sheer force. When the tool slides along the skin, it pulls one layer of tissue past the other. The scar tissue that has developed in and around the knee from micro-tearing is pulled apart, triggering the body’s healing mechanisms to come in and repair the fibers. Treatment from Graston Technique increases the speed of healing and reduces knee pain.
Fascial restrictions or scar tissue develop in muscles, ligaments, tendons, or fascia. Scar tissue forms when tissue does not heal correctly, or is under chronic, repetitive stress. Scar tissue is weaker than normal muscle and connective tissue, which in your knee becomes chronically tender to the touch, especially after you are more active.
Scar tissue is like the body's duct tape; it is meant as a short term patch to help support tissue. However, in some cases the scar tissue is not replaced with normal collagen fibers. Scar tissue is also referred to as fascial adhesions, as it causes restrictions between the body's fascia. Stiffness, loss of normal range of motion, and chronic pain develop from patches of fascial adhesions.
The next time a scar tissue patch undergoes stress and strain, it becomes aggravated and flares up. This process causes more scar tissue to be added to the outside of the patch and the process repeats itself over and over, leading to larger accumulation of scar tissue patches.
Adding Graston Technique to any treatment decreases overall treatment time, especially with chronic knee pain with arthritis. Graston Technique enhances treatment by:
Class IV cold laser or low level laser therapy is an excellent treatment modality for decreasing pain and inflammation. Specific wavelengths and frequencies shut off inflammatory cells that may prolong inflammation of the knee. Excessive inflammation slows down healing and makes the area tender to the touch. Different wavelengths and frequencies help to turn on the healing processes inside cells. Cold laser speeds up the delivery of adenosine triphosphate (ATP) to the cells. ATP is “fuel” for the body, created from the blood sugar your body makes from food. The repairing cells use this energy to lay down more fibers in a faster time frame. Laser is speeding up the healing process and at the same time decreasing inflammation.
Research has proven that exercises to strengthen the lower legs and hips, correct muscle imbalances and improve flexibility can effectively treat knee pain and eliminate the need for surgery due to osteoarthritis, patellar tracking problems, tendonitis, tendonosis, meniscus and ligament damage.
Correcting muscle imbalances: It is very important to correct muscle imbalances between the medial and lateral quadriceps, quadriceps and hamstrings, gluteal muscles and hip flexors. All can contribute to chronic knee pain. In addition, you will need to work on lateral hip stability through exercises that strengthen the gluteal muscles using resistance bands and body weight. Examples of such exercises include glute bridging, squats, lunges and leg lifts.
Balance and agility: Many individuals including athletes don’t realize how much poor balance and agility, especially in side-to-side and transverse (twisting) movements, is contributing to knee pain. Core exercises on the stability ball and BOSU as well as dynamic drills on the vibration board will improve functionality in the lower legs and hips, to protect the knees from chronic pain and damage. See our section on Knee Exercises for more information.
Acupuncture has been shown to be highly effective in treating symptoms of knee pain. This holistic treatment works in three primary ways:
A component of Traditional Chinese Medicine (TCM), acupuncture involves the insertion of thin needles through your skin at various points on your body. It is a technique for balancing the flow of energy ("Qi") that flows through pathways (meridians) in your body. By inserting needles into specific points, acupuncture practitioners believe your energy flow will re-balance.
If over-the-counter anti-inflammatory medications are ineffective, your primary care practitioner may suggest a corticosteroid injection in the knee to reduce pain and inflammation. The injection can improve range of motion, and help you to tackle physical therapy treatments more aggressively.
Plasma rich prolotherapy or PRP uses platelets from the patient’s own plasma to stimulate healing. The provider draws blood from the patient, separates the platelets using a centrifuge and injects the platelet rich plasma into the injured area. More on PRP for knee arthritis.
Extracorporeal shockwave therapy uses a percussive instrument to break up tightness and fascial adhesions in and around injuries. It is very effective at treating chronically tight IT bands, as well as tendons around the knee.
If you are experiencing knee pain, seek treatment early on before the condition becomes chronic and is more difficult to resolve. An experienced provider can prevent knee pain from becoming chronic, and developing severe damage that requires surgery. Call Alpha Chiropractic today to resolve your knee pain at (480) 812-1800.
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Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint and ligament injuries. The clinic provides treatment to endurance athletes and weekend warriors in addition to common headache, neck and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents of Ahwatukee, Sun Lakes, Phoenix, Tempe, Gilbert, Mesa and Chandler AZ.