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.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.