Knee Pain Struggles?

Knee pain is a leading reason for visits to the orthopedic office annually. Read on to learn why knee pain is so prevalent and learn some of the best ways to beat it.

What Causes Knee Pain?

The knee is the largest joint in the body, and one of the weight bearing joints of the lower extremity. It is a hinge joint, meaning it only moves in one plane of motion: forward and back. The knee hinge is designed to flex and straighten with minimal motion in other directions, like rotation or side to side motion. 

Example of a Knee Hinge

There are many causes of knee pain and injury, and are specifically related to mechanical alterations to this hinge mechanism. The hinge mechanism is most commonly altered by repetitive motions over time or traumatic injuries. 

Repetitive Motions

Another term for repetitive motions is repetitive microtrauma. This denotes how relatively small the movement aberration may be, but that this is a cumulative process that happens over time. Examples of people with knee pain who fall into this category are those who are knock-kneed or pigeon-toed structurally. These types of knees put structural stress on the hinge joint, and can lead to overload of a portion of the joint that then leads to arthritis and pain. 

Image Credit: Tynor

Repetitive injuries can also come from dynamic motion, like the repetitive motion of a sport or ergonomics. If a runner has a distorted running form, for example, and doesn’t land on the knee joint evenly, eventually it can cause undue wear and tear on the joint and lead to pain. 

Traumatic Injuries

Another possibility for the cause of knee pain is in traumatic injuries. It is common that if an athlete plants their foot and changes direction, there can be a rotational shear force on the knee joint. After this type of movement, different types of injuries are possible, like:  a torn meniscus, sprained ligaments, or stress on the cartilage and joint leading to arthritis. Traumatic injuries to the knee often, like the repetitive stressors, can cause chronic issues and pain to the knee. 

The Two Best Ways to Beat Knee Pain

So, now the question is, if either of these types of knee stressors sound like they apply to you, there are two major ways we recommend addressing pain from repetitive stress on the knee joint or traumatic injury: 

  1. Regenerative Medicine 
  2. Corrective Exercises

Before we dive into what each of those options can do to benefit knee pain, it is important to discuss some updates on common orthopedic procedures for knee pain. Meniscal injuries are one of the leading causes of knee pain. For meniscal injuries causing pain, knee “cleanups”  with a scope or meniscectomies that trim the torn pieces of the meniscus have been a common orthopedic solution. However, some studies have evaluated the long-term effects of such procedures on the overall knee health. 

One study (1) evaluates the long-term effects of partial meniscectomies through a systematic review of five studies and found “radiographic signs of osteoarthritis are significant at 8 to 16 years’ follow-up after knee arthroscopic partial meniscectomy.” However, the systematic review findings also state, “but clinical symptoms of knee arthritis are not significant,” meaning there are significant radiographic findings showing increased osteoarthritis in the knee having undergone the meniscectomy but the patient does not complain of pain in that knee.

Another study (2) looked at a sample of 123 patients 21 years after a meniscectomy procedure. The radiographic results revealed that 71% showed at least mild arthritic changes to the joint, while 51% showed more advanced severe arthritic changes. The conclusion of this study states, “Surgical removal of a meniscus following knee injury represents a significant risk factor for radiographic tibiofemoral OA…after 21 years.”

Both of these studies reveal  the reality that we see often in clinical practice, there is a correlation between surgically tampering with the meniscus and arthritic changes over time. The good news is, there are more options than meniscectomies, scopes, or other knee surgeries in  the case of knee pain or injury, eg, Regenerative Medicine and or Corrective Exercise.

Using Regenerative Medicine to Beat Knee Pain

In an article by Jason Markle, DO (5), he summarized a review article that evaluated the efficacy of regenerative medicine, such as platelet rich plasma (PRP), bone marrow Concentrate (BMAC) and adipose tissue, on knee osteoarthritis. 

Nineteen of the studies reviewed met the criteria, and 15 of those studies showed statistically significant improvements in pain and/or function in the patients’ knees after a regenerative procedure. In fact, nearly every article reviewed showed positive gains in favor of the treatment. Additionally, all papers highlighted also found that there were little to no adverse events to regenerative procedures.

The Takeaway:  There is little to no down-side or risk of worsening the knee condition with regenerative procedures, and the current research body is growing in favor of demonstrating regenerative procedures have significant impact on improving pain and function. 

Using Corrective Exercise to Beat Knee Pain 

Corrective exercise is a fantastic adjunct to a regenerative procedure, or sometimes depending on your knee’s severity, our physicians will have you start with corrective exercise. As per the early discussion in this article, the knee is a simple hinge joint residing smack between the hip and the ankle. If there are aberrations to the kinetic chain, like a weak hip, or a tight ankle, or a collapsing arch, those factors can be contributing to the why of how your knee may have become painful over time. 

At Regenexx at New Regeneration Orthopedics, we have several practices we refer to that are out-of the box rehabilitation experts, like Back 2 Normal Physical Therapy, Love Health, and Peak Movement Physical Therapy, to name a few. Clinicians in these practices not only treat knee pain directly, but are able to assess the root cause of your pain. In sessions with these clinicians, you may undergo manual therapy to the affected areas and learn corrective exercises to treat the root cause of the issue, causing the knee to be compromised. 

Let’s say it is discovered that your lower leg is stiff and that your hip is weak, causing your knee to undergo repetitive stress. These are two exercises you may experience. However, remember these are just example exercises, and you should always consult your physician before beginning any new regimen. 

Toe, Plantar Fascia, and Calf Stretch

  • Stand in front of a wall.
  • Extend your toes against the wall and try to bring your knee towards the wall until you feel a gentle stretch under the foot.
  • Maintain the position for 30 seconds and relax for 30 seconds.
  • Repeat 5 times.

Hip Strengthening Boxes

  • Lie on your side and place the bottom leg at 90 degrees of hip and knee flexion.
  • Lift one leg and create boxes with the leg.
  • This movement can be performed in both directions, forward and backwards.
  • Repeat 10 boxes in each direction.
  • You should feel a muscle behind your hip bone working. 

The Takeaway: working on the why for your knee pain is just as important as addressing the knee pain directly. 

If this information resonates with you or someone you know, our physicians at Regenexx at New Regeneration Orthopedics are a great starting point to get a comprehensive evaluation, and an honest recommendation of what the best course of action for your knee pain would be.

References:

  1. https://www.sciencedirect.com/science/article/abs/pii/S0749806310008820
  2. https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131(199804)41:4%3C687::AID-ART16%3E3.0.CO;2-2
  3. https://www.quora.com/What-is-the-difference-between-a-hinge-joint-and-a-pivot-joint
  4. https://tynor.com.au/products/oa-neoprene-knee-support-right-varus-left-valgus?shpxid=887c971a-ae33-4ebd-93a8-da18e17ec387
  5. https://centenoschultz.com/treating-knee-arthritis-with-prp-and-stem-cells/
  6. Physiotec.ca
About The Author
James Leiber, DO

James Leiber, DO

James Leiber, DO, is founder and medical director of Regenexx® at New Regeneration Orthopedics.
James Leiber, DO

James Leiber, DO

James Leiber, DO, is founder and medical director of Regenexx® at New Regeneration Orthopedics.

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