Tag Archive for: prevent surgery

Is Your Knee Problem Really a Problem? How to tell.

Is Your Knee Problem Really a Problem? How to tell.

Knee pain is the second most common musculoskeletal complaint after back pain. Studies say that 1 in 4 adults now suffer from chronic knee pain, and the number of swollen and stiff knees has risen 65 percent in the past four decades. But just because you have knee pain – doesn’t mean you have a knee “problem”. Knee pain can be tricky to figure out – especially if it’s chronic. Over the course of my career, I’ve seen so many cases of chronic knee pain that weren’t getting resolved because the real problem was coming from someone’s back or ankle. One of the most important factors in successfully resolving knee pain for good is correctly identifying its source.

So how do you know if your knee problem is really a knee problem?

First – pay attention to how and when your knee pain started. If you’ve had a fall or some kind of trauma directly to your knee, and you experience knee pain or swelling shortly after, odds are pretty good you have an isolated knee problem. People who perform regular, intense activities like soccer, hiking, skiing, football, and basketball are much more at risk for an isolated knee injury. Typically, you’ll know exactly when and how you hurt your knee. You may even recall a specific pop or strain of some kind.

Osteoarthritis (OA) of the knee is another example of a knee problem that could really be a knee problem. However, this one is tricky because if you’re over the age of 50, you most likely have OA in your knee, and it will show up on your X-ray whether you have knee pain or not. So what commonly happens is that if you’ve had knee pain for a while, and you get an X-ray that shows you have OA, the OA will get blamed for your knee pain. So yes – knee OA can be an isolated knee problem – but knee OA tends to be an over-diagnosed source of knee problems.

So what are the clues that tell you your knee problem might not be a knee problem?

One of the biggest clues that you’ve missed the correct source of your knee pain is that it doesn’t go away no matter what you’ve tried, or it keeps coming back.

This is the biggest complication I see with folks suffering from long-lasting knee pain.  They’ve iced it, taken pain medication, foam rolled, stretched, and strengthened – but their knee pain doesn’t get resolved.  And once your problem becomes chronic, knee doctors start to get involved.  This is great if you’ve actually got a knee problem. But if your knee pain is a symptom of something else, then you risk getting recommended unnecessary knee surgeries or procedures.

I spoke to a woman the other day who had surgery on her knee to clean out some cartilage and wear and tear from arthritis. It was supposed to be a “quick recovery” and take her pain away. Well, three months later, her knee is feeling worse than pre-surgery. And to fix the new pain she has, they tell her she will need even more procedures. Her initial problem wasn’t coming from knee OA – it was coming from something else. And now she’s going to have even more problems because she had surgery she never needed.

How does something like this happen?

The biggest reason is because of the over-reliance on imaging to form a diagnosis and treatment plan. If you’re over 50, and you get an X-ray or MRI taken of your knees, there is a 60-80% chance they’ll find arthritis or meniscus (cartilage) tears, 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 – and then blame your knee pain on it. But here’s the thing – and research backs this up – there is no way to tell for certain from a picture of your knee where the true cause of your pain is coming from. The only way to tell if what you see in the imaging is actually the cause of your pain is with proper movement testing. If you don’t do that, you risk getting an unnecessary procedure when the real problem might be coming from somewhere else.

In conclusion…

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 elsewhere – typically your back or your ankle.

Before you think about getting images of your knee, or undergoing some kind of surgery or procedure, you’ll want to make sure you get a thorough screen by a mechanical pain expert. Never rely on imaging to tell you the full story.

Remember that knee problems can be resolved 80% of the time without procedures or surgery. You just have to have some patience and make sure you’re working with someone who understands mechanical pain and the importance of looking at the whole body – beyond just where the pain is.

Are you looking for help with knee pain now?

Sign up for a discovery visit with one of my specialists to see if we would be a good fit to help you! CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. 

knee replacement surgery

Three Things to Consider before Knee Replacement Surgery

Total knee replacement (TKR) surgery has been around for decades, and generally speaking, results are very good. 90% of folks can expect up to a 20 year success rate. The most common reason for a knee replacement is to resolve advanced arthritis.

But what if advanced arthritis isn’t the true cause of your knee problem? Do you really need a knee replacement?

Only 15% of patients with evidence of knee osteoarthritis (OA) actually have symptoms. That means the other 85% don’t have any pain at all. These results are consistent for other joints as well. Signs of degenerating joints, bone spurs, and even meniscus tears all occur normally as you age. While some of the time these things can be the cause of your knee pain – more often than not it’s something else – or a combination of things – that are fully responsible for your joint pain or dysfunction. Evidence of knee OA shouldn’t be the only factor determining your decision of major knee surgery.

Here are three important things to consider before deciding if a total knee replacement is right for you:

 

1. How severe is your knee pain?

This is one of the most important factors to consider before undergoing major knee surgery. The X-ray might say you’ve got “bone on bone” arthritis and terrible OA – but if your knee pain is fairly tolerable – and you can still do most activities you love – why take the risk of major surgery when you could wait? Even though knee replacement surgeries are quite common and successful – there are still risks and complications.

The most common risk is infection. But you could also end up with blood clots, problems with anesthesia, or an ill-fitting prosthesis that doesn’t function right. Not only that, but people tend to underestimate the 6-12 month recovery that comes afterwards. If your knee pain is severe and intolerable, and you’ve already tried physical therapy, then you’re probably a good candidate for knee replacement, and the potential risks are likely worth the reward for you. But if your pain isn’t that bad yet, it might be a good idea to wait, and get a second opinion. There could be other reasons for your knee pain beyond arthritis. If those factors get addressed, you might find you don’t need surgery at all.

2.  Does your back hurt?

In a recent study by Rosedale, et. al (published in the Journal of Manual and Manipulative Therapy), it was found that over 40% of patients with isolated extremity pain, who did not believe their pain could be originating from their spine, responded to spinal intervention.  What does that mean in plain English? It means that you can have knee pain coming from your lower back and not even know it. Severe knee OA doesn’t come out of nowhere. It gradually progresses over time. But when you have knee pain that comes on for no reason, has good days and bad days, and especially if you have knee pain and back pain at the same time – you must get your spine evaluated before undergoing any type of intervention for your knee.

Luckily most surgeons consider knee replacement as a last resort. But if your spine is causing your knee pain and you miss it – you’ll end up down the path of failed knee treatment after failed knee treatment. Then suddenly it will seem as if you’re at your last resort, especially if you’re over 50 and have (normal) evidence of knee OA on your X-ray.  Always get your spine checked by a mechanical pain expert when your knee hurts. It will help you avoid years of mis-guided knee treatment, and could save you from an unnecessary knee replacement.

3. How stiff is your knee?

Typically, with severe or advanced OA of the knee, you’re going to have pretty restricted mobility. And any efforts to improve that mobility will be minimally effective and likely make your knee worse. But if your knee is not consistently stiff, only seems to get tight in certain situations, or perhaps it feels better after you stretch and mobilize it – you may want to think twice before getting it replaced. That’s because sometimes mobility restrictions in your knee can be caused by something other than arthritis – like a small tear in your tissue that gets “caught” in your joint. If you know how to move your knee joint in just the right way – you can actually remove this restriction. Not only will your knee move normally again, but your pain will go away too. This is really hard to figure out on your own. It even gets missed by a lot of medical professionals if they aren’t expertly trained in diagnosing mechanical pain. And it definitely doesn’t get picked up by an X-ray or MRI.

If your knee is not terribly stiff 100% of the time, and you’re tolerating most of your favorite activities – the best thing to do is get a second opinion from a trained mechanical pain expert. Because what you might be missing is highly specialized and specific mobility treatment for your knee. Once your knee mobility is fully and properly restored, you might find you no longer need a knee replacement, or at the very least can put it off another 10 years.

To be clear, I’m not saying you shouldn’t get a knee replacement.

I’m saying there’s a chance you don’t need one and it’s important to explore that. I’ve seen so many cases over the course of my career where people didn’t need a knee replacement – but got one because the X-ray or MRI “said so” – and then continued to suffer for years afterwards.

Are you looking for help with knee pain now?

Sign up for a discovery visit with one of my specialists to see if we would be a good fit to help you! CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group.