Wednesday, January 28, 2015

Wisdom Wednesday: The Knee

In athletes, knee injuries are second in frequency only to ankle injuries. So most of us damage our knees during adolescence. Unfortunately, proper care and rehabilitation is not generally performed as we seem to heal pretty quickly and are soon running around again. Of course, this comes back to haunt us latter on in life.

Knee replacement surgery was the 14th most common inpatient procedure in 2009. More than 4.5 million Americans are currently living with at least one total knee replacement (TKR). Over 650,000 knee replacements occurred in 2010.

Osteoarthritis is to blame for 96% of TKR. The conventional understanding of osteoarthritis is that constant wear and tear of the joint from micro trauma, or serious trauma damages the bone and it slowly breaks down. More recently, a theory has evolved that proposes that the trauma actually damages the blood supply to the bone and that it is the loss of blood supply that creates the osteoarthritis. While this seems to be merely semantics, this new theory opens the door for nutritional therapies to prevent and restore damaged bones and joints.

Several studies have found that the less invasive arthroscopic knee surgery has no better outcome than sham surgery. The first study, published in 2002 involved 180 participants randomly assigned to either have the real operation or sham surgery. The sham surgery involved cutting the knee to “fake” the surgery so the patient was unaware that no real surgical procedure had been performed. This multi-center, double blind controlled trial showed arthroscopic surgery had no benefits over sham surgery. In 2008, a Canadian study showed physical therapy alone to be as effective as surgery for osteoarthritis of the knee. The latest study in 2013, found no additional benefit from arthroscopic surgery over physical therapy for meniscal tears.

Typically, the first sign of knee injury is pain on walking up or down stairs. This generally occurs years prior to knee pain with walking, standing and eventually even when sitting or lying down. Most people wait, hoping the pain will go away, and just avoid stairs as much as possible.

Physical examination of the knee is fairly straight forward. The practitioner stresses the joint during flexion and extension, testing the various ligaments of the knee. You can watch this every Sunday during football season when the orthopedic surgeon comes onto the field to check some player’s knee.

The next step is to palpate the meniscus on the inside and outside of the joint, looking for pain. Unfortunately, the most common meniscal tears are on the posteromedial aspect of the knee and don’t often elicit pain on palpation.

In QA (Quintessential Applications), we also challenge the coronary ligament looking for an injury reflex. If found, the reflex is reset, then the alignment is checked. The knee tends to misalign by rotating externally as that is the normal motion during flexion. However, it often fixates in that rotated position and must be manipulated to restore normal joint motion. This is a simple procedure that is very effective in resolving many knee issues, especially when performed in concert with rebooting the injury reflex.

Nutritional support can be glucosamine or chondrotin sulfate, and/or MSM to support connective tissue repair. If damage to the circulation to bone is indicated (often the case in chronic conditions) then grape seed extract can be very effective for restoring the joint.

Physical therapy typically involves strengthening the quadriceps (the group of four muscles in the front thigh) and stretching the hamstring (back of the thigh). This can be performed at a gym or even at home with simple ankle weights.

The Bottom Line:
Don’t ignore knee pain. Have it evaluated quickly by a practitioner that is well versed in manipulation and nutrition.

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