LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Knee Pain

Using a Vibration Exercise Machine for Knee Rehab Exercises

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Knee pain sucks. Many think surgery is the only option, but soft tissue work and specific knee rehab exercises on a vibration exercise machine may save your knees.

I have written several posts recently regarding knee pain and knee arthritis. Most of these have addressed the research demonstrating that, just because you have arthritis, this may not be what is causing your pain. Our office targets the soft tissues surrounding the knees regardless of how much knee arthritis a patient may or may not have, and have seen many successes with this approach.

But what about exercises for knee pain?

The research is pretty solid on this one. Exercise is very important for knee pain, especially when arthritis is present. The stronger a knee is, the better it is going to feel. I experience this personally–in the summers, when we don’t go hiking here in AZ, my knee that I had a meniscectomy on in 1998 can give me some problems. However, in the winter during hiking season, my knee bothers me much less frequently.

Many knee pain sufferers get caught in a catch-22. Exercise can benefit the knee arthritis, but the knee is too painful to exercise. So they sit, with the knee slowly getting worse over time.

Luckily, there is a solution. Whole body vibration.

Our office has used a vibration exercise machine for about 7 years now and the results, when used appropriately, are quite dramatic. But, up until know, this response in our office has been largely anecdotal without much research to support its use.

But no longer.

This particular study looks at the use of a vibration exercise machine on inflammation and knee pain in a group of elderly patients with arthritis of the knee. The treatment group performed knee squat exercises on a vibration exercise platform 3 times per week for 3 months. The results showed that knee rehab exercises on a vibration platform were much more beneficial then the same exercises without vibration:

  1. Inflammation was lower in the vibration group (as measured by sTNFR1 and sTNFR2)
  2. Self-reported pain was lower in the whole body vibration group
  3. There was an increase in balance in the vibration group
  4. Speed and distance walked improved again in the vibration group

So, you went through a course of knee rehab exercises and maybe a cortisone injection or two but continue to need pain medications for your knee pain. Now you’re just waiting until you get the go-ahead for knee replacement surgery because you think you’ve done everything.

Now you know you have options.  Of course, this assumes you can find a chiropractic office that specializes in soft tissue treatments like Graston Technique AND has a whole body vibration unit. I just might know of one….

(As a side note, in a chiropractic office, Medicare will NOT pay for the use of a whole body vibration unit).

If you have used a whole body vibration exercise machine, what was your experience?

Knee Osteoarthritis Symptoms: MRI Images of Knee of Little Benefit

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Everyone wants an MRI. It’s cool to take a peek inside your body without the downsides of autopsy. But for knee osteoarthritis symptoms does an MRI help anything?

Regular readers of the Rantings know how I feel about ordering imaging before it’s necessary. It doesn’t matter what region of the body it’s in; sometimes TOO much information is not a good thing.

We have already seen studies suggesting that the rates of knee replacements are increasing, but there has been no change in the amount of knee osteoarthritis seen on imaging. What this strongly suggests is that knee osteoarthritis may not be the problem in a large chunk of the cases of knee pain.

For those providers that treat the soft tissues (and no–I’m not talking about exercises and electric stim here–these techniques do NOT treat the soft tissues), this comes as no surprise at all.

I firmly believe, based on the research and my own clinical experience, that most knee pain does not come from arthritis, but rather from pain being created in the soft tissues (muscles, ligaments, tendons, fascia) surrounding the knee joint as well as the imbalance and altered stress placed upon the joint by these damaged soft tissues.

This particular study adds weight to my thought process. Researchers looked at a group of patients who were older than 50 and had no signs of knee osteoarthritis on X-rays. They then examined this group using MRI images of knee and looked for findings that are consistent with osteoarthritis. These included:

  • osteophytes (also known as bone spurs)
  • cartilage damage
  • bone marrow lesions
  • subchondral cysts
  • meniscal lesions (usually described as a torn meniscus)
  • synovitis
  • attrition (a wearing down of the joint surface)
  • ligament lesions

What they were basically doing was looking at MRI as a tool to see how well findings on an MRI compared with what the patient was experiencing.  Here’s what they found:

  1. 89% of the group had at least one abnormality noted above (osteophytes were the most commonly found at 74%,  followed by cartilage damage in 69% and bone marrow lesions in 52%.
  2. As expected, the higher the age, the higher the prevalence of abnormalities.
  3. The likelihood of at least one type of abnormality was high in both painful (97%) and painless (88%) joints.

The last point being the most important. Basically, over the age of 50, a MRI becomes less and less important, and may actually lead the unsuspecting physician to recommend a more invasive procedure (injection or worse–knee replacement).

The bottom line is that just because you have something wrong on your MRI, particularly as you get older, does not really mean anything. If you have knee pain, my biased opinion would be to find a chiropractor that specializes in soft tissue treatment (Graston, Nimmo / Trigger point, NMR, Active Release, Fascial Manipulation, etc…) before you do anything else.

It is always worth trying this approach first. If it does not help, you can still opt for more invasive procedures. But the reverse doesn’t work so well…

If you had a knee replacement, was soft tissue treatment recommended to you before the surgery?

Knee Cartilage Damage? Alternatives to Knee Replacement

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The knees bear a tremendous amount of abuse in a lifetime, resulting in knee cartilage damage. Luckily, there are many viable alternatives to knee replacement.

Treatment in our office can be very, very effective at relieving knee pain. However, even we understand that there are limits to pain relief that can be obtained. While the numbers are low, we have had patients who did not respond proceed to knee or hip replacements.

Personally, I want to save everybody from surgery and keep them as functional as they want to be. In a perfect world this would be an obtainable goal.

Luckily, there are additional options that are available to arthritis sufferers that were not available even 10 years ago.

Before we get into those other options, we need to cover some important points first.

  1. Just because you have arthritis does NOT mean it is causing your pain. Countless times we have had patients with “arthritis pain” get total relief in just a few visits.  We did nothing to the arthritis, but the arthritis was not causing the pain.
  2. Treatment around the knee HAS to consist of solid soft tissue techniques such as Graston, fascial manipulation or ART. Anything less is not the best. That means that mobilization, manipulation, exercises, ultrasound, laser and interferential therapies are just likely not going to cut it.
  3. You HAVE to get off your butt and use the darn joint. It is abundantly clear that exercise and strengthening the knee joint will improve arthritis pain and function.
  4. The use of any type of anti-inflammatory may likely keep you from getting the best improvement possible because it blocks the healing process.
  5. Weight loss will always help. Drag out the old physics book and do some math on how much extra force the knee has to deal with at 10 extra pounds. Jack that number up to 50 and the forces start to have more zeros on the end. The weight’s go to go.

Ok…now that that’s out of the way we can address the findings of this particular article.

I remember the first time I had a discussion with a patient about injections of hyaluronic acid into the knee (Sandy–if you’re reading this I’m talking about you…). It was probably about 12-13 years ago, so this is not a new technology.

Basically, the procedure involves injecting hyaluronic acid, or some version of it, into the joint. Hyaluronic acid injections contain the building blocks of cartilage, so it makes at least some sense that this might be a good idea.

The results over the years seems to have been okay. Not stellar, but okay. With one exception (a patient who developed an infection in the joint after the injection–but this was a technique problem and not a problem with the treatment), I have not seen any downsides to this. Some seem to respond, some don’t.

In this particular study, researchers compared the effectiveness of two types of substance used in the injections. Hyalgan has been one of the main products available almost since the beginning and is considered a low molecular weight product. The results on pain reduction were compared to an intermediate weight product.

The pain reduction was better with the intermediate weight product. While the difference was not great, it was enough to suggest that this product was a better option for pain control and certainly adds to the total picture of what this type of approach can add to treatment of knee arthritis.

Have you tried these injections before? If so, how did they work for you?

GET RID OF OSTEOARTHRITIS WITH SOFT TISSUE APPROACHES – (12-03-07)

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Chondroitin for Osteoarthritis of the Knee or Hip

This review found minimal or no benefit to the use of chondroitin for arthritis of the knee. Before we jump to conclusions… How many people in these studies with knee/hip pain was actually coming from the joint itself? The answer, of course, is that we don’t know. Degenerative joint disease = pain in clinical studies but that just isn’t always true.

For a physician that addresses soft-tissue components of injuries, how often does a knee loaded with arthritis get complete relief with some solid soft tissue approaches? I can personally say that aggressive soft tissue techniques like Graston can sometimes bring complete relief for many OA sufferers. Did we fix the OA? Of course not–but in these cases the soft tissues were the primary pain generators. So we could assume that any type of joint support would not be effective in these cases.

So, in these studies, did they rule out non-joint related pain generators? More of a rhetorical question because of course they did not.

Read entire article here

RECIPE TO CREATE A DRUG USER

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The Federal Bureau of Narcotics was formed over 80 years ago in 1930.  In 1954, President Eisenhower formed a council to battle narcotics use here in the United States.  In 1971 President Nixon coined the term “war on drugs.”  This was further strengthened by President Reagan in 1982.  Overall, untold billions of federal dollars have been spent on this effort.  Man did we get it all wrong.

We were spending our money and efforts at illicit drug use, while slowly building a society that not only condoned prescription narcotic drug use, but PAID FOR IT!  Beginning at least in 2008, the number of deaths associated with prescription narcotic use exceeded those deaths caused by illicit drug use.

Codeine, OxyContin, Percocet, Vicodin, morphine,  Xanax and Valium (these 2 are benzodiazapines–but frequently abused), Valium, Tramadol, Tylenol 3.

It never ceases to amaze me how quickly prescriptions for narcotic pain relievers are given out.  In the ER it is almost a given.  High likelihood in urgent care.  Still far too common in a primary care settings.

And then there are the non-steroidal anti-inflammatory drugs (NSAIDs).  Why should we throw something as safe and harmless as NSAIDs in with the narcotic drugs?

I firmly believe that, as time progresses (decades, probably) we will begin to understand just how dangerous this class of drugs is.  Arthritis /  joint damage, heart attacks, strokes, impotence, GI bleeds, disruption of intestinal barriers, dementia…this list of known effects seems to lengthen every month.

The problem here is that of sheer scale of use. Between over the counter use and the 70 Million prescriptions per year, it is estimated that there are 30 BILLION doses used per year.  That’s with a “b.”  Even uncommon side effects become magnified by this volume of use.  Of course, bleeding ulcers, heart attacks and strokes are not uncommon, so the math just gets more complicated from there.

So what does all of this have to do with this particular article?  This article looked at analgesic use after low risk surgery (gall bladder, cataract, TURP for prostate enlargement and varicose vein stripping) and what happens after 7 days and one year.  The results were surprising:

  1. Opioids were newly prescribed to 7.1% within 7 days of being discharged from the hospital
  2. Opioids were prescribed to 7.7% at 1 year from surgery
  3. Instead of going down, the number of patients receiving a prescription for opioids at 1 year increased to 15.9%
  4. Overall, an opioid prescriptions within 7 days of surgery made it  44% more likely to be a long term user
  5.  NSAIDs were prescribed to 0.3% within 7 days of discharge
  6. NSAIDs prescriptions jumped to 7.8% at 1 year from surgery
  7. Those taking NSAIDs within 7 days of surgery were almost 400% more likely to become long-term NSAID users

Wow.  Talked about generating a society that is addicted to drugs.  And while this study looks at low risk surgery, how similar would the numbers be for neck pain?  Low back pain?  Knee pain or headache?  Makes me happy to be a chiropractor.

Again, I would ask…is the “War on Drugs” looking at the wrong side of the prescription pad?

PULLED A MUSCLE? WHY POPPING THAT ALEIVE IS A VERY BAD IDEA

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Obviously, this article is going to sound a little self serving since I am, after all, a chiropractor in Mesa with a vested interest in my patients not taking drugs of any kind unless absolutely necessary. My more inquisitive patients all seem to ask a similar question…if the body is so brilliantly designed, where do chronic musculoskeletal complaints come from?

Certainly there are injuries that are severe and result in tissue damage that is much greater in degree and have a high likelihood of producing chronic pain. Think skiing, skateboarding or snowboarding injury. High speed car crashes. Motorcycle accidents. Equestrian wipeouts. Surgery.

But what about the weekend warrior who pulls a hamstring? The 8 hour per day computer user? Or me, as a lifelong martial artist, who has had untold injuries over the decades to pretty much every potential area of my body? Why do these situations lead to chronic pain?

My personal thought (backed by lots of research and years of clinical practice) is that the development of chronicity has much to do with how we handle the immediate period after the injury or onset of symptoms. What do the vast majority of us do (which is, of course, the direction indicated by billions of dollars of advertising) in this immediate period? Rest the area and pop an over the counter pain medication or anti-inflammatory. This is arguably the worst possible combination possible.

Why?

First, let’s address the immobilization aspect. Literally within minutes of immobilization, the soft tissues surrounding the immobilized joint begin to break down. The longer that joint is kept from a full range of motion, the worse the tissue damage. Anyone who’s ever broken a bone and had it casted can attest to how much joint motion is lost once the cast comes off. Recovery time can be even longer than the immobilization time.

With tissue injury, ultimately, the size of the region affected is larger than the original injury size. Consider the swelling associated with an ankle sprain—the area of the ligament injury may actually be very small, but the entire ankle, foot and lower leg swells up to the size of a balloon and becomes discolored. Now the amount of injured tissue is much larger than the original injury and this tissue has to heal. But healing occurs in a haphazard fashion if the area is not used. I give the analogy of a leak in your bathroom faucet. You call in the plumber. He shows up with a crew that’s been drinking at the bar for half the day. They proceed to rip out half the bathroom to fix the leak and rebuild with a level of skill only a three-sheets-to-the-wind Irishman can achieve.

Our body is no different. As we heal after an injury, the new tissue, whether it is bone, muscle, ligaments, fascia or tendons, is laid down in a disorganized manner. Only as that region goes through movement do these healing tissues become stressed and become organized along the lines of force. Immobilization becomes the enemy of proper healing.

Next, let’s address the routine use of over the counter anti-inflammatories, or prescription, for that matter. All anti-inflammatory medications are, by their very nature, designed to interfere with the inflammatory process. Unfortunately, inflammation is the normal process of healing. Disrupt this and you disrupt the ability of our tissues to heal the way they were designed. Contrast this with the use of ice right after an injury. Ice works simply by reducing blood flow to the newly injured area, thus keeping the damage of the drunken plumbing crew from getting too out of hand. Arguably a good idea. But then blocking the crew from repairing the area in specific ways, like maybe taking all their crescent wrenches away from them, is going to result in improper repair.

Hopefully you can begin to understand why the combination of immobilization and anti-inflammatory medications immediately after an injury may be the first step in developing chronic pain. Repeat this cycle the next time you injure the area and the dysfunction begins to mount.

This particular study demonstrates just how bad the outcome can be when non-steroidal anti-inflammatories (NSAIDs) are used after a rotator cuff surgery tendon repair. Researchers looked at the tendon to bone healing that occurred in the presence of NSAIDs and found that every case was affected, from complete failure of healing to weakened tissue. No normal healing tissue was present when compared to the group in which no NSAIDs were used.

While this relates to surgical cases in animals, the same process is interfered with in every case of tissue injury that happens in our body when NSAIDs are used. While my opinion that you should run to your chiropractor at the first hint of any type of pain may sound self-serving, the reality is that you may be diverting the development of chronic pain.

DOES ARTHRITIS MEAN I HAVE TO HAVE PAIN FOREVER?

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DOES ARTHRITIS MEAN I HAVE TO HAVE PAIN FOREVER?  In our office, the answer is almost always a strong “NO,” but it is a perception that many patients have, possibly because their PCPs don’t have many answers.  Keep in mind that the joint is surrounded by the soft tissues (fascia, ligaments, tendons, muscles) and, in most cases, these tissues actually create much more pain than the joint does.  Address the problems in the tissues surrounding the joint and the pain can go away.

In this particular study, the authors looked at what patients did after being given a diagnosis of knee arthritis.  75% percent of them took matters into their own hands by increasing activity levels, 33% turned to acupuncture, orthotics, braces and 36% started supplements.  The results were very encouraging–after 6 months,  the majority of patients in the study had found some relief from this approach.  I know that in our office, we strongly urge patients to increase their activity levels with very good results.

Read entire article here.

CONSIDERING SURGERY FOR YOUR KNEE PAIN?

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Knee pain is something we see commonly in our office. Unfortunately, I think these are many more cases because patients have been told that their knee pain is arthritis and there is nothing that can be done. This could not be further from the truth.

From a treatment viewpoint, the knee is really not a complex joint. Basically it is referred to as a ginglymus (“hinge”) joint with a slight degree of rotation. There are ligaments, meniscus, muscles, the joint itself and….most importantly…the fascia!

While it is difficult to describe, I generally refer to the fascia as the sheath that our joints and muscles are encased in. It is far more complicated than that, but it seems to get the point across. Many patients come in concerned that they may have torn a ligament in their knee and may even have an MRI to back up the idea.  However, current theories are actually debunking the idea that ligaments truly exist.

Rather, they are thickenings of the fascia along areas of a joint that provide increased stability. We have called them ligaments and have seen them on cadavers because anatomists have dissected out what they were looking for. In other words, they were looking for a ligament so, as they dissected out a region they actually created the ligament from the fascia surrounding that area. So, this thickening of tissue exists, but it is actually the continuation of the fascia from the area above and below it.

So what does this mean?

It means that the fascia surrounding a joint may be the most critical tissue that needs to be addressed for joint pain. This can be addressed with fascial manipulation, Graston technique or Rolfing. Laser, chiropractic adjusting, ultrasound, strengthening exercises and any number of other techniques are not going to address the problems that occur in the fascia and may not be as effective for relieving knee pain.

The fascia is also a major source of pain in the knee. Because of this, patients develop knee pain, their primary care doctors orders X-rays (or worse-an MRI) done before any treatment, and they are told they have arthritis. They try some pain meds, maybe a short course of physical therapy, but don’t notice much of a difference. At this point they are resigned to wait until the pain gets debilitating enough for a knee replacement. Sounds like a great plan, huh?

It is common for this patient to come into my office, only to leave 2 or 3 visits later with much less pain in their knees. Did the arthritis suddenly get fixed?  Of course not. Rather, the pain was not coming from the joint itself, but rather from the fascia surrounding the knee.

So what does all of this have to do with this particular study?

Because of the marked increase in the number of knee replacements being done in the US, researchers look to confirm that this increase was due to the increased obesity and the increasing age of the population. This was not what they found.  Rather, knee pain increased independently of age and BMI.

Of extreme importance is what they did NOT find.

They did NOT find an increase in arthritis of the knee. So, our country is performing more and more knee replacements. This is not due to obesity (obesity did play a role, but it was a smaller one) or age. And there was not more arthritis found. So basically, we are replacing perfecting good knee joints because of problems likely due to fascia surrounding the joint that was never effectively treated.

The bottom line is that anyone with knee pain should first be evaluated by a chiropractor that specializes in the treatment of the soft tissues that surround a joint (in this case, the knee). If pain persists after several visits, then an evaluation by a surgeon may be warranted, but certainly not before.