Doc, My Knee Hurts

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Knee pain probably won’t kill you, but it will go a long way toward lowering your quality of life, especially if you are trying to maintain a fitness program. Of course we recommend diet and exercise as the best way to stay healthy and feel vibrant, but those same exercises that keep you fit if overzealously done can backfire. Because I’m a pain specialist, I deal with a lot of knee pain, and I seldom prescribe drugs for it.

The knee is one of the biggest joints in the body and the most commonly injured. Even adolescents have bad knees. In fact, there are more than 2.5 million sports related knee injuries annually.

People come to us all the time with knee pain, and they aren’t always old and arthritic; just as often they are tennis players, basketball players, and runners. If we were in the habit of prescribing pharmaceuticals for knee pain, we’d have many times the opioid epidemic we have now. But we don’t. We have better ways to treat it.

While the hip is a ball and socket joint, the knee is a hinge joint, which means it doesn’t really have the same range of motion as the hip. It connects the thigh bone, the fibula, and the kneecap. It has a big job to do, and we make it bear almost all of our weight while subjecting it to episodes of high impact and unaccustomed motion.

When a patient comes to us with knee pain, the first thing we recommend isn’t old-fashioned cortisone shots, either. It is physical therapy, and a particular set of exercises designed to strengthen the area that supports and helps the knee. Physical therapy works with meniscal tears, interarticular degeneration or ACL strains.

We offer a novel form of neurofeedback called ARP wave as part of our physical therapy. Whereas most therapies treat where the pain ends, ARP therapy treats where it comes from in the brain and nervous system. The ARP wave device causes muscles that usually contract about twice a second to contract up to 500 times per second, which forces your nervous system to respond to each contraction, training your brain to correct movement patterns and muscle integration much faster than you could do with just exercise reps. It’s like doing tens of thousands of squats.

Through this kind of rapid reinforcement we re-train muscles to absorb the shock that’s now being felt in the knee. While this doesn’t work for all knee pain, for athletes it is usually incredibly effective.

 If ARP doesn’t work, the next step is to give intra-articular steroid injections, and if they work we  urge resuming physical activity as long as it is tolerable. However, if steroids don’t work, the next step would be viscosupplementation or gel injections to lubricate the knee and decrease the amount of friction on the knee during exercise. Orthovisc is one of the hyaluronic acid injections we use at the cllinic.

By now you’ve probably realized we have an entire regimen of treatments. And that’s because we are trying to get to the root of the problem, not just control the pain symptoms.

Next in the regimen, if you are still in pain, we have another new modality, the genicular nerve block, where we anesthetize the nerves with local anaesthetic injected with small needles. This is actually a diagnostic block to determine if the joint will respond well to an actual treatment procedure of blocking nerves that influence the knee.The genicular block works well for people with bad knee arthritis or those who have already had a knee replacement and don’t have many other options.

Our final option is PRP, platelet rich plasma, which we’ve talked about in other articles and on our website. Along with stem cell therapy and amniotic fluid injections, PRP is part of a new discipline called regenerative medicine. We save it for last because it is usually not covered by insurance.

The takeaway from all this is that if you go to a qualified pain management specialist you are not going to be prescribed a pill. You are going to be examined by a person whose interest is in finding the root of your problem and addressing the pain at is root rather than at its end-point.

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