knee arthritis

Common Knee Osteoarthritis Symptom Treatment Fails Again

July 11, 2015 by James Bogash

Knee osteoarthritis symptoms. For some, it seems like the diagnosis is pretty much the same as saying that surgery is inevitable.

There are times when I think that more information is a bad thing. There have been countless times in my practice where someone gets hooked on imaging findings (whether they are MRI, CT scans or X-rays) and focuses on what damage is present rather then what is reality.

Whether it’s a shoulder, low back, neck or knee imaging study, there have been multiple studies pointing out two very important problems. First, there is very little correlation between imaging findings and symptoms. In other words, if someone has “stuff” wrong on a MRI, it does NOT mean this person is going to have pain. You cannot look at a MRI and state that this patient will or will not have pain.

This misconception then leads to the second problem. There is a large chunk of the surgical field that is devoted to doing procedures based on stuff we find on imaging. Got a disc bulge? Cut it out. Have knee osteoarthritis? Replace the knee. Torn rotator cuff? Surgical repair of the shoulder.

This particular study highlights just how wrong this approach is. In yet another study on the relationship between arthroscopic surgery of the knee for arthritis found on imaging and beneficial outcomes of the surgery, researchers looked at the results across 9 different medical trials. Specifically, these middle aged and older patients with knee pain and degenerative knee disease underwent knee arthroscopic surgery. Here’s what they found after an average of 2 years had passed after the surgeries:

There was a very small benefit to surgery in patients’ pain levels (basically, a benefit of 2.4 mm on a 0-100 mm scale).
There was no significant benefit on physical function.
Harms included symptomatic deep venous thrombosis, pulmonary embolism, infection, and death.

The bottom line is that, going in for surgery just to “clean out” the knee has virtually no benefit but a list of risks. This is a procedure that, frankly, should no longer be done except in rare cases (and I don’t know exactly what these cases might look like…).

So what can you do instead of surgery?

Move. Not exercising is one of the worst possible things you can do for knee arthritis. Hiking, swimming, weights, stationary bike, whole body vibration–there are lots of things you can do to strengthen your knees.
Find a chiropractic who can competently treat the soft tissues of the knees–look for those that do Graston, ART, NMR, fascial manipulation.
Consider a TENS unit to control the pain in the short run.
Consider a joint support formula with glucosamine in it.
Add vitamin D to your supplement list.
Get down to your ideal body weight.

By using these tools to help manage your knee osteoarthritis symptoms, you won’t ever need to worry about whether or not the risks of surgery outweigh the miniscule benefits.

Torn Cartiliage in Knee: This Option is Better Than Surgery

August 20, 2014 by James Bogash

torn cartilage in knee — Weight plays large role in knee pain

Everyone who has torn cartilage in the knee seems to think surgery is the only option. This couldn’t be further from the truth.

I had addressed this topic some time ago in a prior blog article that can be read by clicking here. And, just in case you’d really like a lot more to read on the issue, you can download my Knee Pain Answers eBook by clicking here.

What you’ll find in the eBook is lots of research debunking common beliefs about knee pain. Which is good, because these beliefs are held by most everyone. Twice today I had to have the “knee conversation” with patients. Patients who have knee pain should just stay away from X-rays and MRIs (unless there has been significant trauma) unless they are hell-bent on having surgery already. Otherwise, the information we get from imaging may be misleading.

Why? Because on a knee MRI, upwards of 88% of people over 50 have “findings” AND NO PAIN! Society is so damn stuck on the idea that, if we see something on an X-ray or MRI, it has to be the cause of the pain. This is so far from true.

I’m not saying that osteoarthritis does not cause knee pain. Rather, before you make a decision about whether your knee pain is strictly from arthritis you need to find a physician that really understands the soft tissues of the knee and how to treat them correctly. In addition, there’s another important thing you’re going to have to do.

If you’re overweight, you’re going to have to work on losing weight.

I know, I know. Losing weight is the GOAL, not the process, and too many physicians leave it at that. Like people who are overweight don’t know that weight loss will help the knees?? We make sure that, if you are truly motivated to lose weight, we can facilitate the process of weight loss, either through our in-office weight loss program (also available remotely for those who do not live near the office) or with changes to your current lifestyle that are contributing to being overweight.

This particular study just drives home just how important weight loss can be for the knees. Researchers followed 250 adults with no knee arthritis for 2 years. MRIs were done before and after to evaluate what effect weight loss or gain had on the height of the cartilage and overall pain in the knees. Here’s what they found:

18% of the group had medial meniscal tears.
In those with medial meniscal tears, for every 1% gain in weight, there was a 0.2% increased loss of cartilage volume and 11.6% increase in pain.
In those with no medial meniscal tear, weight changes had no effect.

The cartilage volume changes were not all that great, but the changes in pain levels with even a very small weight change was quite dramatic. This may have to do with the fact that, as you lose weight through healthy lifestyle changes, your body will be less inflamed. Less inflammation means less pain.

Overall, though, it is clear that weight plays a very large role in knee pain. If you are serious about avoiding ANY type of knee surgery (and you should be…) than getting closer to an ideal body weight is high on the list of things you need to do.

Thinking About Injections for Knee Pain? Read This First

September 9, 2013 by James Bogash

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.

Using a Vibration Exercise Machine for Knee Rehab Exercises

October 24, 2012 by James Bogash

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:

Inflammation was lower in the vibration group (as measured by sTNFR1 and sTNFR2)
Self-reported pain was lower in the whole body vibration group
There was an increase in balance in the vibration group
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 Cartilage Damage? Alternatives to Knee Replacement

September 8, 2012 by James Bogash

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.

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.
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.
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.
The use of any type of anti-inflammatory may likely keep you from getting the best improvement possible because it blocks the healing process.
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?