Chiropractor Chandler AZ
Although there are numerous causes for knee pain, one of the most common is osteoarthritis. About a third of older adults suffer from osteoarthritis, also known as “wear and tear” arthritis because it is due to deterioration of the cartilage in the joint, as opposed to autoimmune disease that underlies rheumatoid arthritis. If you experience knee pain due to osteoarthritis, your symptoms probably get worse during the day and are relieved with rest. You may feel more knee stiffness first thing in the morning. Your knee may also feel as if it is going to give way, due to joint laxity. Although some individuals think that the only “fix” for knee arthritis is joint replacement, physical therapy can not only improve your functional abilities and decrease pain, but decrease the probability that you will require a knee replacement down the road. The earlier you recognize and seek treatment, the more effective these conservative measures will be.
Osteoarthritis is a common joint disorder consisting of cartilage loss, new bone formation and involvement of all joint tissues. X-rays will show a progression of cartilage thinning and joint space narrowing that eventually lead to bone spurs along the joint line. Although age is one of the primary risk factors for osteoarthritis, poor biomechanics is one of the major causes. For example, if your medial quadriceps muscles are weaker than the muscles on the lateral (outside) of the leg, loading forces on the joint will be unbalanced, which will eventually contribute to arthritic symptoms.
Inflammatory cytokines that can be elevated by other chronic conditions such as diabetes, obesity and hyperlipidemia can accumulate in the affected joint, increasing pain and swelling in the area. This is why it’s so important to maintain a healthy weight, balanced and nutritious diet and to stay active.
While you may think that physical activity will make your arthritis worse, just the opposite is true. A study published in the Annals of Internal Medicine compared outcomes between groups of patients receiving physical therapy and corrective exercise prescription for their arthritic knee pain and a control group treated only with ultrasound.
According to the authors, “patients with osteoarthritis of the knee who were treated with manual physical therapy and exercise experienced clinically and statistically significant improvements in self-perceptions of pain, stiffness and functional ability… The beneficial effects of treatment persisted at 4 weeks and 1 year after the conclusion of clinical treatment.” (Deyle et al., 2000).
Unlike rheumatoid arthritis in which patients tend to have flares and remission, osteoarthritis is a degenerative condition. In some ways, this makes osteoarthritis easier to treat because symptoms progress slowly and more consistently over time. Unlike RA, symptoms of osteoarthritis are not generally bilateral, so you are more likely to experience the discomfort in one knee. Prior injury history can contribute to osteoarthritis, and there is some evidence that it is a heritable condition.
Although over-the-counter anti-inflammatory medications can temporarily ease pain and swelling for osteoarthritis, you will see more substantial and longer lasting results by working with a physical therapist on range of motion and strengthening, accompanied by daily physical activity.
There are many causes for knee pain, including meniscus and ligament tears, tendon damage and hairline fractures of the patella. However if you are experiencing the following symptoms, chances are good that your knee pain is caused by osteoarthritis:
Although individuals can develop osteoarthritis at any age, the condition is most common in older adults, particularly women. Risk factors include:
Your primary care provider may suggest using over-the-counter medications such as Advil, Aleve, aspirin or Tylenol to reduce that pain and inflammation. Icing the area can also help with swelling. Staying active is very important. If weight bearing exercise such as walking on land is too painful, consider walking in the pool to reduce the impact of body weight. Other recommended forms of activity include Tai Chi and bicycling using a stationary bicycle. A recumbent stationary bicycle may be more comfortable than a conventional model because it requires less bending of the knees to pedal.
If following the above recommendations at home fails to address increasing symptoms of pain and discomfort, the next step is physiotherapy. The physical therapist will work with you to restore range of motion in the area using active and passive stretching techniques. He or she will also assess your walking gait, to see if muscle imbalances are contributing to the problem. Electrical stimulation and ultrasound can help to mitigate the pain and discomfort, so that you can be more aggressive in your rehab efforts.
Physical activity to lessen the severity of osteoarthritis symptoms include flexibility exercises, strength training and aerobic activity. Aerobic activity (described above) is best done outside of the clinic. Keep an activity diary. Aim for 30 minutes of moderate activity (preferably a brisk walk) five days per week. If 30 minutes of exercise at once is too much, consider breaking your activity up into smaller bouts of 5-10 minutes. Every little bit helps.
Stretching should include all of the muscles surrounding the knee, particularly the quadriceps and hamstring muscles of the upper legs and hip flexor muscles. You should also make sure that you have the ability to dorsiflex your feet at least 20 degrees (dorsiflexion refers to pointing your toes towards your knees). All of these areas can impact stress on the knees.
Make sure that you are using good, supportive footwear. A specialty running store is the best place to get fitted for walking shoes that give you the proper amount of cushioning and stability.
Because osteoarthritis affects the tendons, ligaments and muscles in and around the knee joint, scar tissue that builds up in these areas can increase pain and stiffness. A very successful treatment to break up scar tissue and improve mobility is the Graston Technique.
Graston technique can be used on the leg muscles, tendons and ligaments in and around the knee to improve mobility for patients with knee osteoarthritis. Graston technique uses stainless steel instruments designed to break up scar tissue by sheer force. When the tools slide along the skin they help pull one layer of tissue past the other. The scar tissue that has developed from micro-tears in the ligaments, tendons and muscles is pulled apart, triggering the body’s healing mechanisms to repair the fibers. Scar tissue in and around the knee area can build up after years of poor biomechanics related to osteoarthritis. Treatment with Graston technique increases mobility in the area and slows down disease progression. Read more knee pain and Graston Technique.
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 the inflammatory cells that accompany osteoarthritis. Excessive inflammation reduces range of motion and can make moving painful. Different laser wavelengths and frequencies help to turn on the healing processes inside cells. They speed up the delivery of adenosine triphosphate (ATP), which is ‘fuel’ for the body produced from the blood sugar your body creates from food. As a result, repairing cells can lay down healthy fibers faster, speeding up healing and repair processes.
Two types of exercise are important to restoring function in knee problems: those that work on balance and stability, and those that target lateral hip strength.
Balance and Stability: If you come to our clinic for treatment, one of the first things we will do is to assess your balance. As we age, we lose proprioceptors in our skin, making it more difficult to balance. If you wonder why you have a much harder time standing on one leg than your four-year old grandkid, that’s why. The good news is that with practice, you can improve your balance. Functional exercises that work on balance in tandem, semi-tandem and single-leg stance positions will help you to develop strength and confidence. We may also work with you on walking up and down stairs and sit-to-stand.
Lateral Hip Strength: We live in a sagittal world, meaning that our daily movement is primarily forwards and backwards. As a result, people tend to develop weakness in their gluteus medius and minimus muscles at the sides of the hips that contribute to lateral (side-to-side) stability. Exercises such as glute bridging, sitting on an exercise ball, door frame touches will help to make these muscles stronger.
For more information on exercises to restore balance, enhance stability and lateral hip strength, see our sections on Core exercises and Lower body exercises.
Your primary care provider may recommend a corticosteroid injection to decrease the pain and inflammation in your affected knee, if over-the-counter medications are ineffective. In some cases, a corticosteroid injection can produce enough pain relief to enable you to rehab more aggressively.
Extracorporeal shockwave therapy uses a percussive instrument to break up scar tissue and fascial adhesions. It can be very effective at improving mobility and reducing pain in and around the joint.
If conservative treatments fail, TKA (total knee arthroplasty) is a joint replacement surgery for individuals with severe degeneration due to osteoarthritis. Your primary care physician may refer you to an orthopedic surgeon to discuss this option.
Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint and ligament injuries. The clinic provides treatment for 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, Phoenix, Gilbert, Mesa and Chandler AZ.