LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Knee Pain

Thinking About Injections for Knee Pain? Read This First

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Knee osteoarthritis symptoms can be debilitating and wreak havoc on your quality of life, severely limiting what you love to do.  Injections are an option that many consider.

Usually, the first type of injection that comes to mind is a cortisone or steroid injection.  Hands down the worst idea you could come up with for any type of pain, even if it does seem to help for a day or week or even 6 months.  The long-term damage done by the cortisone to the soft tissues of the knee is tough to recover from.

The other type of injection that has become more popular over the past decade or so is hyaluronic acid injections in the knee.  In general, patients who have had this done seem to do well, or, if they did not see an improvement, there were no downsides (other than a single patient in our office whose knee went septic, but that was a procedural problem and not a problem with the injection itself).  I have covered the benefits of this type of therapy in a previous blog post that can be read by clicking here.

So what if something was even better and safer than these hyaluronic acid injection for knee osteoarthritis symptoms and didn’t need a physician to administer the therapy?

According to this particular study, a simple at-home device used for 20 minutes, 3 times per week for 4 weeks, resulted in greater improvements in pain at 6 weeks as well as at 3 months (as measured by the Visual Analogue Scale and the Lequesne index).

A Transcutaneous Electrical Nerve Stimulator (or TENS for short) is a simple device that uses a 9-volt battery to send a consistent pulse to an area in order to block pain from making it to the spinal cord and your brain.  You can read more about TENS units in a product review blog article by clicking here.

I do find it interesting that the use of a TENS unit had long-lasting effects because TENS units are generally considered to only manage pain and not affect healing or inflammation.  Maybe the study participants felt better in the short-term using the TENS unit and, as a result, became more active than the injection group.  Since exercise and activity are well-known to help with knee osteoarthritis symptoms, this may actually make sense.

Either way, it would make sense to ask your doctor to prescribe a TENS unit or look into getting one yourself.

 

18 US Women Per Day Die From Common Drug: 3 Scary Stats

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For those of you into math, that’s about 550 deaths per month, or more than a Boeing 747 could hold.  Imagine the heat on the FAA if one was dropping out of the sky monthly.  Would you fly?

For those of you following the Rantings, you can begin to guess that it is prescription opioids I’m talking about.  Not just OxyContin and morphine, but also Percocet and Vicodin.  They are handed out like candy in urgent care and the ER and concern has been raised to the equivalent of a Homeland Security threat level RED.  Earlier this year, the FDA reached out to providers asking them to increase their training in the prescribing of this dangerous class of drugs.

If the FDA has to politely ask providers to better understand the use of these drugs (this IS, after all, the regulatory agency tasked with protecting the public), one has to assume that the education required to prescribe these drugs may be lacking.

Scary.  And profoundly upsetting because I am, after all, a chiropractor.  I can’t count how many times over the years that a patient came in for a problem that was resolved in a visit or two, and yet had been given opioids after an urgent care or ER visit.  Completely avoidable had the patient been steered towards chiropractic treatment.  We remain a profession at the red-headed-stepchild level and yet hold the answers to many of the ills in medicine today.

With that intro, we need to move on to this particular article, which highlights just how dangerous this class of drugs has become.  Researchers looked at opioid deaths from 1999 to 2010 in women.  Here’s what they found:

  1. Nearly 48,000 women died of prescription painkiller overdoses  between 1999 and 2010.
  2. Deaths from prescription painkiller overdoses increased over 400%, compared to 265% in men.
  3. For every woman who dies of a prescription painkiller overdose, 30 go to the ER for misuse or abuse.

Despite these numbers, I still have patients coming into my office every week who have been given prescriptions for this class of drugs.  Much like the decades long delay that occurred to get pediatricians to stop giving antibiotics for ear infections, these statistics seem to be falling on deaf ears.

The next time a provider wants to given you a prescription of Percocet or Vicodin for some type of new-onset musculoskeletal disorder (neck pain, shoulder pain, low back pain…) but does NOT recommend seeing a chiropractor, maybe it’s time to find a new provider that keeps your best interests in mind.

 

Knee pain and osteoarthritis in older adults: a review – (01-15-01)

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Knee pain and osteoarthritis in older adults: a review

This article summarizes the high level of elderly persons afflicted with knee pain that affects their daily life. I will use this as an intro into the anecdotal success of chiropractic in many cases of knee pain. Because many cases of knee pain are actually not knee problems, but rather problems with the pedal foundation (feet) or hips, chiropractic can be very effective in relieving and preventing knee pain. There have been several patients who never would have developed knee pain if someone had noticed how flat-footed the patient was and recommended foot orthotics 10 years prior…

Ann Rheum Dis — Abstracts: Peat et al. 60 (2): 91

Read entire article here

Arthroscopic Sx for Knee OA No More Effective Than Sham Sx – (03-18-01)

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Arthroscopic Sx for Knee OA No More Effective Than Sham Sx

Think the surgeons are going to like this one? With more and more studies coming out on the effectiveness (or lack of) of surgery we are starting to see that one of the most important factors for surgery is only doing surgery on patients that meet strict criteria for that specific surgical procedure. The rates certain types of surgery in the US fare exceed that of other countries. This particular article actually did surprise me a little. The old “roto-rooter” for the knee may not be an effective approach. Of course, I am somewhat biased in this regard, and know that knee pain can respond very well and rapidly with chiropractic therapy…

(article) In a study of 180 patients with osteoarthritis of the knee, Houston surgeons found that those who received “sham” arthroscopic surgery reported as much pain relief and improved mobility as patients who actually underwent the procedure. In fact, the group that did not receive surgery reported better short-term functioning compared with the other patients, Dr. Bruce Moseley, Jr. reported here at the annual meeting of the American Academy of Orthopedic Surgeons. It has been unclear why arthroscopic surgery for knee osteoarthritis helps some people with the condition. Dr. Moseley and his colleagues at Baylor College of Medicine, in Houston, decided to test whether arthroscopic surgery might be associated with a placebo effect. After 2 weeks, patients assigned to sham surgery were doing better than the true surgery patients–probably, Dr. Moseley said, because they had been spared the trauma of surgery. After 2 years, the groups had made similar gains in walking and stair climbing, and their pain had eased to comparable degrees. Because all patients received pain-killing drugs and none underwent physical therapy after their actual or sham surgery, Moseley credited the placebo effect for helping the sham-surgery group. “I was surprised,” he said, noting that when colleagues first proposed the possibility to him, he discounted it. While this research is not the final word on arthroscopic surgery for knee arthritis, Dr. Moseley said it does suggest it may be time for surgeons to take a closer look at it. “We, as surgeons,” he said, “may need to put our time into finding better and more effective treatments.”

Limb-Length Discrepancy on Gait Economy in Older Adults – (07-09-01)

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Limb-Length Discrepancy on Gait Economy in Older Adults

It is interesting to see an article on leg length insufficiency relating to fatigue and oxygen consumption. Chiropractors have been checking for this for ever. This article relates to after effects of surgical joint replacement, but the concepts and end results can be the same. Sometimes something as simple as fitting a patient for orthotics can fix many problems…I’ve seen many patients with genu valgus (knock-kneed) and much knee pain and degeneration that would be in my office know if someone had fitted them for orthotics ten years ago.

JBJS — Abstracts: Gurney et al. 83 (6): 907

Read entire article here

Do You Need Surgery for a Torn Cartilage in Knee?

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Your MRI shows that you have a tear in the medial meniscus of your knee and you have resigned yourself to the fact that surgery is the only fix.

The belief has always been that the posterior horn (the back half) of the medial meniscus (the shock absorbing pad on the inside part of your knee) does not have a very good blood supply. For this reason, any tears that occur are not going to heal on their own. This means surgery is your only option.

I’ve never been one to believe in dogma.

From an anecdotal standpoint, I have had more than my share of patients with documented medial meniscus tears that do perfectly fine without surgery. I still remember one of my early ones. This particular patient was on track for surgery, but just did not have the time off of work needed for the surgery and recovery. So he waited. In the meantime, we treated his knee, thinking that anything we could do to restore balance to the knee prior to surgery would be a good thing. Turns out, he did really well and never had the surgery. Later, he even forgot which knee it was that used to bother him.

Over the years, I have seen patients with meniscal tears do very well. Typically, the patient that responds best is closer to an ideal weight and more active. Patients who don’t fit this mold don’t do as well and seem to be more likely to end up in surgery.

Of course, my personal experiences do have some backing in the medical literature. For example:

In case all this isn’t enough to sway your decision away from surgery, pay attention to this particular study.

In it, researchers looked at the outcome of patients with medial meniscus tears who had surgery and compared these outcomes to those who didn’t have surgery and instead did rehab for his or her torn cartilage. They were evaluated using the WOMAC scoring (0-100, with higher numbers equating to more severe symptoms). Here’s what they found:

  • At 6 months the surgical WOMAC score was 20.9 points.
  • At 6 months, the rehab group score was 18.5 (yes–better, if ony slightly).
  • At 6 months, 30% of those in the rehab group ended up having surgery.
  • On the flip side, 6% of the surgical group had not undergone surgery.
  • At 12 months the situation did not change from the 6 month scores.
  • Adverse events did not differ in the groups.

Overall, there was no difference in long term outcomes between the surgical and non-surgical groups. Although 30% of the non-surgical patients ended up with surgery, this seems to match up with what we see in our office–some patients (overweight, sedentary) just don’t seem to do as well.

Either way, it seems clear that, if you discover that you have a torn medial meniscus and you are told you have to have surgery, it’s a very good chance that this just is not true.

Effects of a ginger extract on knee pain in patients with osteoarthritis – (01-17-02)

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Effects of a ginger extract on knee pain in patients with osteoarthritis

Ginger is another of those natural compounds that has shown some pretty strong potential as an anti-inflammatory, particular in cases of osteoarthritis. Remember, also, that ginger has some very strong anti-emetic (anti-nausea) properties as well and can work well for morning sickness.

Entrez-PubMed

Read entire article here

Atorvastatin Side Effects–Add a New One to the List

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$20+ billion in sales for a measly 1% drop in heart attack risk would be great if money didn’t matter and the list of atorvastatin side effects wasn’t expanding.

Regular readers of the Rantings know that I see very little reason for the statin class of drugs to exist and remain stumped that atorvastatin was one of the first drugs to reach $10 billion in annual sales.

The concern with statins to lower cholesterol is that they really suck at protecting the heart and brain from heart attacks and strokes (about a 1% lower risk).  And I guess, if this didn’t cost tens of billions of dollars per year, it would be ok to use them if there was no downside.  Unfortunately, the list of problems associated with statins just continues to grow.  I have covered the very small benefit of using statins to lower cholesterol and the increasing list of side effects in previous blog articles that can be read by clicking here and clicking here.

If I were to speak candidly (and I usually do…) I believe that the reason that this class of drugs is so popular is that most physicians just don’t know any better.  They don’t understand the medical literature and they don’t know how to recommend the right lifestyle changes to patients to lower cholesterol naturally.

I’ve mentioned before how an unsuspecting physician can get duped by a drug representative into thinking that atorvastatin or any other statin is a good thing for his or her patient.  This can be done by playing with absolute risk and relative risk when the doctor does not relate to statistics.

The other way medical literature gets misunderstood is by the physician who basically “title read” the studies on just how effective the statins are or studies mentioning the side effects of atorvastatin.

This particular study is a perfect example.  Basically, mainstream medicine would like to consider statins as the wonderdrug of the 21st century.  They have been put on a pedestal.  So, if they can doctors can be tricked into thinking they are good for the heart, what about other conditions?

Think how much more money atorvastatin could make if it could protect against arthritis?  It would renew the patent and make literally tens upon tens of billions of dollars for Pfizer.  So they run medical studies to see what sticks.

Could statins help to lower the risk of knee osteoarthritis symptoms?  Turns out that the answer is no.  The conclusion to this study reads, “Statin use was not associated with improvements in knee pain, function or structural progression over the 4-year study period.”

So, the title reading physician skims over the conclusion and moves on.  What they may miss in the results section of the study is this little tidbit:

  • The only significant finding indicated that increased duration of statin use was associated with worsening in pain and function scores (as measured by the WOMAC questionnaire) over the study period (Tweet this).

SCREEEEEEEEEEEEEECH!!

The knee arthritis pain got worse?  In a study designed to see if statins would help?  And this little finding was glazed over and not included in the conclusion??

You would think that, if the results of a study found out the complete opposite of what you were hoping to find, this would be THE most important factor in the conclusion.  But alas, the game played with your health and your insurance dollar goes on.

Although this is a single study, do you think that this information on atorvastatin side effects should be shared with you if your doctor were to write you a prescription?