Chiropractor Chandler AZ
If you have been considering undergoing knee replacement surgery for the degenerative effects of osteoarthritis, make sure that you have considered all non-invasive options first. Pain-reducing therapies such as cold laser, extracorporeal shockwave, transcutaneous electrical nerve stimulation and Graston Technique can reduce pain and swelling while improving function. While none of these treatments “fix” degenerative damage due to osteoarthritis, they can significantly improve your ability to perform activities of daily living as well as recreational sports such as golf and hiking.
Osteoarthritis or OA is “wear and tear” degeneration of the knee joint typically involves focal cartilage loss, joint space narrowing, new bone formation and involvement of all joint tissues. Unlike rheumatoid arthritis (RA) which is an autoimmune disease, OA progression is usually gradual, and most often in one knee. Symptoms include stiffness that lasts less than 30 minutes in the morning, pain that is often worse towards the end of the day, swelling, crepitus (crackling), and joint laxity. Diagnosis is typically made by imaging the area (X-rays). There may be some effusion in the area and deformation of the joint. If there is a lot of fluid in the area, your physician may aspirate the area to test the fluid for comorbid inflammatory disease. Red flags such as severe pain, redness and swelling that comes on rapidly may suggest sepsis, crystals or serious bone pathology and require prompt medical attention.
If you have developed pain in one knee and are experiencing a decline in function, the following symptoms point to a diagnosis of osteoarthritis:
Osteoarthritis is most prevalent in older adults, especially women. The following are considered risk factors for OA:
Although many individuals believe that pain is a signal to stop moving, this is not the case. While we don’t recommend high impact activities such as running and basketball for patients with osteoarthritis, it’s important to keep moving. Low or non-impact activities such as walking, swimming or bicycling are ideal. Any muscle weakness you develop as a result of inactivity will increase stress on the knee joint. Should you decide to undergo knee replacement surgery, strengthening the quadriceps muscles will be an important part of rehabilitation.
As with any type of inflammation, ice is your best friend. We like the large, reusable gel packs because they are easy to mold around the knee. Elevating the knee at night or when you are sitting will help to reduce the swelling, but you must elevate the knee above the heart. Your primary care provider may recommend an over-the-counter knee brace to provide extra support or compression stockings.
Over-the-counter anti-inflammatory medications such as Advil, Aleve, aspirin or Tylenol can help to relieve the pain due to inflammation. Use these in moderation; exceeding recommended dosages can cause side effects.
If home treatments fail to reduce pain and swelling, the active treatments mentioned at the beginning of this article can make a big difference. Although they must be administered by a healthcare provider, these non-invasive treatments have advantages over surgery of almost no down-time, and no rehabilitation. Even if you go into knee replacement surgery strong, you are bound to lose a significant amount of muscle strength due to the surgery itself and relative immobility in the weeks immediately following the procedure. In addition, knee replacement surgery affects the geometry of the knee joint, which can lead to pain and dysfunction in the opposite knee, hips, feet and ankles.
The European Society for Sports Traumatology, Knee Surgery, and Arthroscopy reported on the best practices for knee injuries and conservative treatment. They reported most patients present with a variety of symptoms and clinical findings. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. These patients usually have loss of muscle and reduced function of the vastus medialis, and an imbalance between the vastus medialis and lateralis (inside and outside of the quadriceps muscle).
This muscle imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease strain on the knee. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome.
A non-operative treatment of patients with anterior knee pain should be tried for at least three months before considering other treatment options.
The European Society for Sports Traumatology, Knee Surgery, and Arthroscopy says the many people with knee pain have multiple problems that are resulting in their knee pain. There is a process and progression for getting better, and you should follow it for at least three months before more aggressive treatments (including surgery)!
People do not notice how their foot, ankle, knee, and hip bend when they squat to pet the dog or tie their shoe. Or how their knee dips inward when they squat. When you pick a shoe up off the ground, do you hinge at the low back or drop your waist toward the ground?
You are losing function over time, leading to tissue damage.
Realistically, most people do not care about their body's function until it stops working or hurts. The average person does not work toward maintaining optimal function, they only want it to not hurt when they go through their day. Unfortunately, this can lead to slow changes over time that cause dysfunction in movement patterns and pain.
Non-invasive pain reducing procedures including transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave treatment, Class IV cold laser and Graston Technique should all be on your shortlist before scheduling knee replacement surgery.
Graston Technique is one of the most effective treatments for osteoarthritic knee pain because of its ability to target focal point damage within the joint and resolve it, vastly improving joint function while reducing pain. Graston technique can also be used on fascia and muscles such as the IT bands on the outsides of the legs and patellar tendons, both of which tend to become tight as they compensate for weakness in the knee joint. Graston Technique uses stainless steel instruments to break up the scar tissue by sheer force. When the tool slides along the skin it pulls one layer of tissue past the other. The scar tissue is pulled apart, triggering the body’s healing mechanisms to come in and repair the fibers. Graston technique improves range of motion while reducing pain and swelling from degenerative arthritis.
Class IV cold laser or low level laser therapy can significantly decrease pain and inflammation from osteoarthritis. Specific wavelengths and frequencies turn off inflammatory processes due to substances such as C-Reactive Protein (CRP) that build up in the damaged joint. Although swelling is part of the normal healing process for acute injuries (trauma), chronic swelling simply makes the pain and stiffness of the injured joint worse. Different waves and frequencies from the Class IV cold laser turn on repair and healing processes inside the cells. These wavelengths speed up the delivery of adenosine triphosphate (ATP) which is “fuel” for the body created from the blood sugar your body makes from food. This speeds up the repair processes inside of the cells to decrease pain and inflammation.
Although the above treatments reduce pain and inflammation in the knee joint, you must also strengthen muscles in the legs and hips in order to regain the most function. It is common for patients with osteoarthritis to have weakness in the quadriceps (upper leg muscles), or muscle imbalances in which the lateral quad muscles are overly tight and strong, while the medial muscles, particularly the vastus medialis obliques (VMOs) are weak or in some cases shut down completely.
Balance and Agility Exercises: Exercises to strengthen the lower legs may be done with inexpensive resistance bands, so you can continue therapy at home in between visits to your physical therapist. We also recommend balance exercises such as single leg and tandem stance, the clock, square dance, step-ups and step-downs that not only increase leg strength but reduce your fall risk. Since most of our daily movement is sagittal (forwards and backwards), many individuals have problems with side to side and twisting movements. Exercises that improve your ability to perform these movements will make you more mobile and injury resistant in sports such as golf and pickleball.
Lateral Hip Strength is important for reducing stress on the knees by making your walking gait more efficient. Exercises including glute bridging and core exercises on an exercise ball are non-weight bearing and non-impact, and can make a tremendous difference in strength throughout the hips and lower back.
For more information, see the section on Lower Body Exercises