knee pain source

When Knee Pain Doesn’t Go Away – Consider your lower back.

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One of the most important things to get right when it comes to successfully resolving knee pain is to correctly identify the knee pain source.

Is your knee pain actually due to a problem in your knee? Or is the root cause of your knee pain coming from somewhere else in your body?

Rosedale, et al published a study in 2020 that revealed 43% of all isolated extremity pain was coming from the spine. What that means is that you could have nagging knee pain, and no back pain at all, and your knee pain is the result of a lower back problem. I’m not going to get into the technicalities of how this happens. Generally speaking, it’s a mechanical problem in your lower back that causes irritation to nerves or structures that impact your knee – and only your knee.

But how do you know for sure?

One of the biggest clues you’ve missed the root source of your knee pain is that it doesn’t go away after trying everything that “should” help it. Perhaps you’ve tried ice, heat, pain medication, foam rolling, strengthening, and stretching. Even physical therapy – but no matter what – your knee pain just won’t go away. It might get better for a short period, but it always comes back. If the lower back is not considered at this point, then it’s typically when knee doctors get involved. This is great if you’ve actually got a knee problem.

Knee pain that doesn’t respond to conservative treatment should be looked at further. But if your knee pain is a symptom of a problem in your lower back, and it’s missed, you risk having an unnecessary knee procedure or surgery that will only cause you more problems later.

Here’s a quick story about someone this happened to…

I spoke to a client the other day – we’ll call him “David”. He had surgery on his knee to clean out some cartilage and wear and tear from arthritis. They recommended this surgery because he had “failed” regular physical therapy treatment. Nothing else seemed to be resolving his knee pain. It was supposed to be a “quick recovery” and take his pain away because they assumed all his problems were due to arthritis. Well, three months later, Davids knee felt (and functioned) worse than pre-surgery. Now he had back pain to go along with it. To fix the new pain he was having they were recommending even more knee surgery. And now they wanted to do an MRI of his back.

How does something like this happen?

The biggest culprit is over-reliance on imaging to form a diagnosis and treatment plan. Leading you to have the wrong idea of your knee pain source.

If you’re over 50, and you get an X-ray or MRI taken of your knees, there is a 60 to 80% chance they’ll find arthritis and/or meniscus (cartilage) tears. And this will be whether you have knee pain or not. That’s because these are normal changes that occur as you age.

So if you’ve got knee pain, and your doctor wants to do some imaging, there is a very good chance they’ll find one or more of these changes in your knee. They might just blame your knee pain on it without looking at anything else. That’s exactly what happened to David. They blamed knee arthritis for his knee problem when it was actually coming from his lower back.

How do I know?

Luckily for David, he refused the second knee surgery. He went to a mechanical pain expert for diagnosis and treatment, and in 2 months both his knee and back pain were gone.

Do you have knee pain that won’t resolve with typical knee pain treatment? You must consider that it could be coming from your lower back before you undergo any kind of surgery or procedure.

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your leg – there is a good chance your knee pain is a symptom of a mechanical problem in your lower back and you should get it looked at.

Knee Pain

Knee Pain? Top 3 Causes and What You Can Do.

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Knee pain impacts one-third of all Americans, and annoyingly interferes with activities of daily life. Such activities could be as simple as walking, squatting, going up and down stairs, and getting in and out of the car. This is in addition to the multitude of recreational activities knee pain can impact.

It’s the second most common complaint behind back pain when it comes to musculoskeletal problems. It’s one of the most common complaints I still hear about that started or worsened during the pandemic.

But what if there was a way to address some of the most common causes of knee pain on your own – without procedures or surgery?

Here are three of the most common causes of knee pain I see and what you can do to resolve it – naturally:

1. Patellofemoral Knee syndrome

Also known as “runner’s knee”, patellofemoral knee syndrome (PFS) is characterized by pain in the front of your knee. Usually this is just below or behind your knee cap. With PFS, the source of the pain typically comes from unwanted pressure around your knee cap. This will eventually results in inflammation and pain.

It’s very tempting to just get a cortisone shot or take pain pills to quickly reduce the inflammation and relieve your pain. But the problem with this approach is that you’re only putting a bandaid on symptoms. Inflammation is the result of an angry kneecap – not the cause. What you need to figure out is what is causing your knee cap to get angry in the first place.

Typically, PFS is the result of an imbalance somewhere in your body, typically from poor form and movement habits. Over time, this ultimately causes more pressure at your knee cap. If your hips, quads (front of the thigh), and hamstrings (back of the thigh) aren’t balanced and working together, for example, you could end up with problems with the way your knee cap tracks and functions. This will make your knee cap angry and inflamed over time.

When you figure out the true culprit behind the pressure and inflammation at your knee cap, you’ll not only be able to resolve and manage PFS naturally and for the long-term, but you can avoid temporary band-aid treatments.

2. Iliotibial band syndrome

The causes of iliotibial band syndrome are very similar to that of PFS. Except that your pain and symptoms will be experienced on the side of your knee instead of the front. Your iliotibial band (ITB) is a large band of tissue that runs along the side of your thigh to the bottom of your knee. Your ITB is formed from a muscle in your hip called the tensor fascia latae (TFL). When your TFL gets overworked, your ITB suffers. It will result in what often feels like stabbing pain at the side of your knee.

The most common treatment I see for this is foam rolling and massage. While these are great modalities to relieve your symptoms, they don’t address the root problem. You must figure out why your TFL is being stressed and overworked if you really want to get rid of your pain. Typically, it’s due to weak glute muscles, the deep ones designed to stabilize your pelvis. Your TFL is neighbor to your glutes. So when they decide to be lazy, your TFL loves to help out, and eventually overdoes it. When you can get these two groups of muscles working properly together, you’ll put an end to ITB syndrome.

3. Osteoarthritis

This is a very hot topic and everyone wants to know if they have it. (Spoiler alert – if you’re over the age of 50 – you already do.) Osteoarthritis happens naturally over time and is a normal part of aging. The problem with arthritis is that it only gets paid attention to when you’ve got pain. Then it gets blamed for all your problems. Arthritis certainly plays a role in your mobility and quality of movement. But it’s not the “death sentence” that many make it out to be. Many people find out they have osteoarthritis in their knees and think they have to just “live with it” or get a total knee replacement.

Remember, arthritis is normal and it happens to everyone as they age. What is not normal is for you to think you’re helpless or have to avoid your favorite activities because of it.

Arthritis occurs when the protective cartilage that cushions the ends of your bones wears down over time. There isn’t anything you can do to reverse this process. But, there is plenty you can do to minimize the symptoms you get because of this condition. It all comes down to balanced joints and movement. The more mobility you have, and the more stability you have around your knees, the less symptomatic your arthritis will be.

Some key areas to focus on when you’ve got arthritis in your knees is good core and hip strength. As well as good flexibility in your hips and ankles. If anything is off in these areas, your knees will want to compensate. This could result in compression at your knee joint and aggravation of your arthritic symptoms.

There is no need to rely on pain pills, or believe that procedures and surgery are your only options when it comes to knee pain.

As you can see, three of the most common causes of knee pain are due to – or influenced – by movement problems. Therefore, movement should be your go-to solution – not something you avoid.

If you’re having difficulty using movement as your solution and you want to contact a movement expert who understands mechanical knee pain and can diagnose the root cause of your knee problem – consider speaking to one of my specialists!

In your free Discovery Session we will ask you all about what’s been going on & see if we would be a good fit to help you. Book your free discovery session HERE.

tendinitis and tendinosis

Why Cortisone Shots Often Fail in the Knee

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When you’ve got nagging, persistent knee pain, it’s common for doctors to recommend a cortisone shot in the knee.

A cortisone shot in the knee, also known as corticosteroid injections, or “steroid shots”, works by reducing inflammation in your knee joint in an effort to alleviate pain. Sounds pretty straightforward, right?  Well… not so fast.

Assuming your knee pain is truly due to inflammation, then yes, a cortisone shot can be a successful treatment option. For example, it’s often used as a pain management strategy when you’re awaiting a major joint replacement surgery.

Advanced osteoarthritis is a common cause of knee inflammation.  The only real “cure” for this is joint replacement. Periodic cortisone shots may help give you the pain relief you need to pass the time until surgery. But this is a very specific and not common circumstance.

What we see more often than not is cortisone shots either working temporarily, or not working at all in your knee joint.

Patients are often told they need up to three cortisone shots to see results. There’s a problem with this approach. Every time you get a cortisone shot, you risk damaging the cartilage and tissue in your knee joint. This not only leads to irreversible joint damage, but more persistent pain in your joint that gets harder and harder to fix.

So when it comes to whether or not you should get a cortisone shot in your knee – you really want to make sure that the root source of your problem is inflammation.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the knee pain you are experiencing might be due to inflammation, the underlying cause leading to that inflammation could be something else entirely. Eight percent of the time the knee pain you’re experiencing is due to a mechanical or movement problem.

So while the symptoms you’re experiencing could be inflammatory in nature, the root cause of your issue is not. A cortisone shot is not going to help your knee in this case. Or worse, you’ll get temporary relief that fools you into thinking it worked. This only delays treatment that will give you the long-lasting relief you’re looking for.

So how do you know if you have a true inflammatory problem in your knee?

Let me explain.

Let’s say you have some arthritis and general wear and tear in your knee joint. You have good days and bad days. The pain comes and goes. Certain movements and exercises make your knee feel better while others seem to really aggravate it.

This is a pretty classic presentation of a mechanical knee problem. The mechanical issue (aka movement problem) in your knee can irritate certain structures within your knee joint (like a meniscus or ligament) and cause it to be inflamed.

If you go ahead and just inject cortisone into this knee, it might relieve the inflammation for a short time. It won’t help the underlying movement problem. It’s only a matter of time before the cortisone wears off and the structures in your knee feel irritated again. Not only have you masked the problem, but now you risk creating actual damage to those structures from the cortisone. Studies have shown that repeatedly injecting cortisone into your knee (or any joint) can advance the formation of osteoarthritis.

Another interesting statistic is that 41% of knee pain has been shown to be coming from your spine – even when there is no back pain present.

In this case, your knee could really hurt and appear to be inflamed. If a doctor can’t find any real explanation for this from an X-ray or an MRI (because the real problem is coming from your spine), he or she may assume it’s just inflammation from wear and tear and suggest a cortisone shot. This is not going to help your knee. Once again you risk causing real damage to an otherwise healthy knee joint.

These are just a few examples of where cortisone shots are unnecessary and can go wrong when incorrectly prescribed.

Have you recently had a cortisone shot in your knee and it didn’t work? It could  be that you never actually needed it. Or that the symptoms (inflammation) was being addressed instead of the underlying cause.

If you are considering a cortisone shot in your knee, it’s always a good idea to get a second opinion to make certain you really need it. A mechanical pain expert can tell you whether or not your knee pain is truly due to inflammation. If your knee pain is due to a movement problem (80% of time it is) then a proper movement prescription is your answer.

Are you local to Portsmouth, NH and looking for help with your knee pain NOW?

Consider speaking to one of my specialists.

Tell them about your knee pain and they’ll see if we would be a good fit to help you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

skiing

Four tips to Protect your Knees and Avoid Injury when Skiing

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Skiing can put a lot of stress on your knee joints and if you’re not careful – lead to pain and injury.

Your knee joint requires both mobility and stability to function well. It’s important for your knee joint to be mobile enough to allow for a full range of motion. But, it also needs to be stable enough to support your body weight and absorb the forces that come with everyday activities. When it comes to skiing, mobility is going to protect your knees when you fall, and stability is going to keep your knees feeling strong as you twist and turn down the slopes. Maintaining a balance between mobility and stability is crucial for knee joint health in general. It certainly is crucial when it comes to skiing.

Here are four tips to help protect your knees and avoid injury when skiing:

1. Warm up before hitting the slopes.

When you take the time to stretch and warm-up your muscles before skiing your knee is not only going to feel better, but be better equipped to handle the stress of the day. Warming up helps to increase blood flow to your muscles and improve your strength, endurance and agility on the slopes.

When warming up, choose exercises that take your knee, hips and ankles through full range of motion. Plus – if skiing is a day trip for you, you’ve likely just sat in the car for an hour or more. Prolonged sitting puts extra stress and compression on your knee joint, especially in the front of your knees. Warming up your knees can help relieve this added stress on your joints before you hit the slopes.

2. Strengthen your upper leg muscles and core

Having good strength of your upper legs and core can help improve both the stability and alignment of your knee joint – which is important during skiing.

Your knee joint is surrounded by a complex network of muscles, ligaments, and tendons. When the muscles around your knee joint are weak, imbalanced, or simply not functioning well – this will cause your knee to move in ways that add extra stress to your joint. Given the stress skiing already adds, you don’t want to make your knee work any harder.

Strengthening your core and upper leg muscles will improve the alignment of your knee during activity, reduce the risk of injury, and improve the overall function of your knee – which can only help you when skiing.

3. Keep your Knees Mobile

Full and free mobility of your knee joint is important. It helps maintain the health of your joint and surrounding tissues.

When your knee (or any) joint doesn’t move well, you will get added stress on your ligaments, cartilage, and tendons. Your knees need to bend all the way so you can squat and pick things up.  They need to straighten all the way to give you stability when needed. When either of these motions are lacking – your knee joint suffers.

When it comes to skiing, if your ligaments and surrounding tissues are already stressed due to lack of mobility in everyday movement – they will certainly not be happy when you add the stress of skiing. Having a good mobility routine for your knees as a preventative activity is important. It’s going to really pay off when you go to hit the slopes each ski season.

4. Talk to a mechanical pain expert

70% of all knee pain is going to be mechanical in nature. Everything I’ve already described above is going to help you deal with mechanical movement faults that might be happening in your knee joint. But occasionally, despite all your best efforts, you need help from someone who specializes in mechanical joint pain.

Mechanical joint pain responds very well to what we call “corrective movements”. When you know what specific movement your joint needs to feel better, it literally acts like a prescription medication. You can use that movement any time you want to help relieve knee pain on your own. This is particularly advantageous when you’ve gone a little overboard on the slopes. You can “fix” your knee and be ready for the next day.

If you’ve already tried many of the strategies I mentioned, and continue to have knee pain when you ski, it might be worth visiting a mechanical pain expert to help set you on a customized path to preventing knee pain and avoiding an injury that requires more invasive intervention down the line.

It’s more fun to focus on the ski day ahead than worry about whether or not your knee joints can handle it.

I hope these tips help you to not only enjoy what’s left of ski season – but help you have healthier knees in general to keep enjoying all of the activities you love.

Local to Portsmouth, NH and need help with your knee pain NOW?

CLICK HERE to request a Free Discovery Session with one of my Specialists. They’ll ask you all about what’s been going on – and figure out if we would be a good fit to help.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth. To get a FREE copy of her guide to knee pain – CLICK HERE