"The benefits of knee repair procedures in older adults for painful arthritic knee or torn meniscus are short-lived and “inconsequential” compared with the potential harms. Older patients who have knee pain but do not have osteoarthritis - a chronic disease of the joint cartilage and bone - should not be recommended the procedure."  Sabriya Rice from Modern Healthcare

According to the CDC's National Center for Health Statistics, there are 719,000 total knee replacements done each year in the United States.  And this doesn't count the millions of arthroscopies (scopes) that doctors do.  In light of what science has revealed over the past decade, this is way too many surgically-repaired knees.  And here's the thing; the medical community knows this but still continues these surgeries unabated.  My goal is to help you halt --- or at least dramatically slow down --- your current knee problem before it gets to that point.  It's not like any of this is new information.

Back in September of 2008, the New England Journal of Medicine published twin studies showing the same thing ---- that there are way too many knee arthroscopies taking place here in the US.  The two categories that these unnecessary surgeries were taking place in?  OSTEOARTHRITIS (Degenerative Arthritis) and MENISCUS TEARS.  The most prestigious journal for orthopedic surgeons (Journal of Bone and Joint Surgery) followed this up in 2011 with Increase in Outpatient Knee Arthroscopy in the United States: A Comparison of National Surveys of Ambulatory Surgery....  This study showed that knee scopes in America were, "more than twofold higher than in England or Ontario, Canada, in 2006. Our study found that nearly half of the knee arthroscopic procedures were performed for meniscal tears."  And now this....

This month's issue of the British Medical Journal (Exercise Therapy Versus arthroscopic Partial Meniscectomy for Degenerative Meniscal Tear in Middle Aged Patients) agreed.   The authors started the ball rolling by saying that in the middle-aged population (average age, 49.5 --- exactly my age), "most meniscal tears are degenerative and might be regarded as the first sign of osteoarthritis".  What should this statement lead you to ask?  It should leave you wondering if it is possible to prevent --- or even reverse --- arthritis symptoms or meniscus tears.  We'll get there, but first I want to discuss a sentence found in this study.

The authors state that, "Considering the large amount of surgery performed worldwide, and the inconsequential short term additional pain relief seen from surgery in addition to exercise, randomised controlled trials are needed to explore the comparative treatment effect of partial meniscectomy alone with supervised exercise therapy alone."  Did you catch that?  The pain relief from knee surgery is "inconsequential".   They backed this statement up by citing a significant number of similar studies showing that arthroscopic surgery on knees for arthritis or meniscal tears does not work well --- a fact I have noted in my clinic for decades.  Here is what was done in this particular study.

"In the exercise group, 61% of participants completed the exercise therapy program (25 sessions on average) with satisfactory or excellent compliance.   19% in the exercise group crossed over to receive surgical treatment between three and 16 months. Of these, approximately half had completed at least 19 exercise sessions.   Owing to persistent knee pain and catching of the knee 3% in the meniscectomy group were reoperated on, and one participant who had crossed over underwent another operation six months after the primary operation."

The surgical group underwent PHYSICAL THERAPY but not a strengthening protocol per se.  Thus, when comparing groups of people who received knee scopes to those who underwent strengthening protocols only, we saw that, "No clinically relevant difference was found between the two groups at two years.  Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option."

But make no mistake about it, it wasn't all champagne and roses for either group of participants in this study --- surgical or strengthening alone.  Here's the proof that you are better off preventing  arthritis that trying to do something about it after the fact.

"From baseline to the two year follow-up, 23% of the participants in each group experienced pain, swelling, instability, stiffness, or decreased range of motion in the index knee that was serious enough to seek consultation. Similar symptoms in the opposite knee were experienced by 21% of participants in the exercise group and 14% in the meniscectomy group."

This is an important study because it shows yet again that exercise is virtually indistinguishable from arthrosocpy for the two most common knee problems.  Why is this such a big deal to grasp?  Firstly, because we know that the incidence of KNEE PROBLEMS is literally exploding here in America (HERE).  And secondly, STUDIES HAVE REVEALED that if you have your knee scoped (even if there is no surgery done), your chances of developing arthritis skyrocket after only one year.  Fortunately for most of you with knee problems / pain, there's a better solution.

Are you interested in getting your knee(s) better without dangerous or invasive procedures or products?  There are large numbers of practitioners of all sorts who are selling knee pain relief with huge up-front case fees.   Want to hear something really cool?  Most of you can do these protocols on your own.  The doubly cool thing is that it won't really cost you anything other than some time, energy, and effort.  Follow the blueprint found in THIS POST to see how most of you can solve your own knee pain.  Always remember; not making changes until they are forced to is the typical way that the practice of medicine works, and why the "BEST EVIDENCE" is either not followed or anything but.

"Recent Center for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of pain from the various causes......   For U.S. adults reporting pain, causes include knee pain (19.5%)"  From the American Academy of Pain Management's Facts and Figures on Pain.

A new study (Annual Incidence of Knee Symptoms and Four Knee Osteoarthritis Outcomes in the Johnston County Osteoarthritis Project) from the official journal of the American College of Rheumatology (Arthritis Care and Research) sheds some light on the explosive manner in which KNEE PAIN and arthritis are increasing in America. 

Johnston County, North Carolina, with a population of around 175,000 is not too far from the Raleigh / Durham / Chapel Hill metro area, and has been home to an ongoing study on Osteoarthritis (OA), otherwise known as DEGENERATIVE ARTHRITIS or DJD since 1991.  After specifically looking at arthritis of the knee, the authors concluded that, "The annual onset of knee symptoms and four OA outcomes in Johnston County was high, and may preview the future of knee OA in the US."   This itself begs the question of how many people are being diagnosed with new cases of knee pain / knee arthritis each year in Johnston County?  Try 5.6% of the population on for size (the CDC's website says it is 3.5%).

Of course the authors said that this, "underscores the urgency of clinical and public health collaborations that reduce risk factors for, and manage the impact of, these outcomes."  Other than being older (over 75) one of the top risk factors for knee pain was, as you might guess, OBESITY / OVERWEIGHT.  Is this a problem in North Carolina?  Here is what a collaboration between the government and private sector (Eat Smart, Move More NC) says.   "In North Carolina, two-thirds of all adults (65.7%) are overweight or obese, and North Carolina ranks 5th worst in the US for childhood obesity."  It's almost guaranteed that these figures are too low, as a brand new study (Prevalence of Overweight and Obesity in the United States, 2007-2012) published one week ago today in JAMA Internal Medicine, revealed how severely we have been underestimating / under-calculating America's weight problems.

It's interesting, but even though every article or study I see talks about the nature of our national poor health issues as related to our burgeoning waistlines --- calling for more money to be spent on education, physical activity, better diet, etc (see the first red sentence in the previous paragraph) ---- the problem continues to grow, with every study being worse than the study that came out before it.   Unfortunately, many doctors are taking advantage of this --- and not only with unnecessary surgeries (HERE or HERE).

Doctors of all kinds are advertising solutions for Chronic Knee Pain and Obesity, not to mention DEPRESSION, INFERTILITY, TYPE II DIABETES, NEUROPATHY, FIBROMYALGIA, and a myriad of others (just look at the ads in the newspapers of any large city).   Because most health problems and pain syndromes are based on INFLAMMATION, these health problems are not only related to each other, but have common origins.  HERE are some examples of solutions that you can have free of charge.   Although there are some knee-specific exercises and protocols you may need to do in order to solve your specific knee problem, following this program (with your doctor's permission) will help you with any number of health problems and pain syndromes you may be dealing with, and help get you off the DANGEROUS DRUGS you are continually advised to take.

As I continue our series on THE MOST COMMON PROBLEMS I SEE at Schierling Chiropractic, LLC, today we will tackle a very common problem --- something most frequently called "Patellofemoral Syndrome".

Depending on whose research you believe, the number one or number two reason that people visit "Sports Physicians" is Palellofemoral Syndrome (aka Patellar Tracking Syndrome, Chontromalacia Patella, and several others).  The quote at the top of the page was written over 15 years ago, and comes from a paper that is still widely considered to be the definitive word on the topic.  The pain itself is found most commonly in the front of the knee and is thought to arise from contact between the underside of the patella (knee-cap) and the thigh bone (femur).  It occurs most often in younger female athletes, although it is commonly found in runners of all ages (male as well), basketball players, as well as athletes from various other sports.

Although there are a wide array of treatment options for this problem, the "gold standard" involves various exercises to strengthen the quadriceps (front thigh muscles).  My goal today is to show you why this is not necessarily always the best or only option --- particularly if you are one of those who may have been told that a Lateral Release Surgery is your only option.

Let me first say that many of those I see diagnosed with Patellar Tracking Syndrome actually have some form of TENDINOSIS (it is important to understand the difference BETWEEN TENDINITIS AND TENDINOSIS).  This Tendinosis can occur in several different places (click on image at left) and my be a concurrent problem, or may mean the person was misdiagnosed.  Just understand that when we talk about Tendinosis of the knee, this can be in the form of Quadriceps Tendinosis or Patellar Tendon Tendinosis (HERE -- named according to the specific tendon it's found in).  Sometimes, this can be confused with OSGOOD SCHLATTER SYNDROME --- particularly in a child or youth who has not yet developed the large "Tibial Tubercle".

As you might imagine, most sources will tell you that Patellofemoral Syndrome is caused by weak quadriceps (front thigh muscles).  I am personally not convinced that this is always the case.  In fact, I would say that this assessment is often times blatantly incorrect. 

I see a lot of people with Patellar Tracking Syndrome and more often than not, find the opposite to be true (weak hamstrings being overpowered by the quads, which are --- or at least should be --- the strongest muscle group in the body).  This is particularly true in athletes.  In most athletes (particularly those who are well-trained or weight lifters) the quadriceps are significantly stronger than the hamstrings.  Not only that, but when people train their legs in the weight room, most of the common exercises for legs (squats, hack squats, presses on the leg sled, leg extensions) mostly or entirely work the quadriceps.  In fact, other than maybe doing some hamstrings curls, I find that many athletes are doing very little for their hamstrings. 

Below is a video of Jennifer that was shot three days ago.  Although I had treated Jennifer for Patellofemoral Syndrome over a decade ago, it only took one treatment to solve a (severe) knee problem that she had dealt with for five years.  I do not actually remember doing this treatment, but when I recently suggested that she might have Fasical Adhesions in her neck, she reminded me of the Fascial Adhesions that she had in her knee.  I told her that I would be doing an article on that particular problem on Monday, so she agreed to do a video for us (thanks Jennifer!).

Besides the quadriceps strengthening exercises, one of the most common methods of treating people with with Patellar Tracking Syndrome involves the use of NSAIDS.  As you might guess, I am not a big fan.  And as for CORTICOSTEROID INJECTIONS; because the cartilage surface of the underside of the knee may already be 'soft' (Chondromalacia Patella), the last conceivable thing you would ever want to put into the knee is something that is likely to make it softer or degenerative, which is exactly what Corticosteroids do.

Symptoms of Patellofemoral Syndrome include pain in and around the knee.  This is because, according to a 2009 article by Tom Plamodon, "The cause of pain and dysfunction often results from abnormal forces (e.g. increased pull of the lateral quadricep retinaculum with acute or chronic lateral PF subluxation / dislocation)".  In light of the fact that this is the medical community's current thought process on this matter, this is an important statement to understand.  And in order to grasp it, you'll first have to understand what a RETINACULUM is.  A Retinaculum (often referred to as an APNONEUROSIS) is simply a very wide, flattened or thin, fascia-like tendon.  Listen to Wikipedia's definition of a common treatment for Patellar Tracking Syndrome; the Lateral Release.

I want you to look at the picture to the right (the muscle in red is the vastus medialis) and think about something for a moment.  If, as Dr. Plamodon above says, the lateral quadricep retinaculum has an "increased pull", we need to ask ourselves why.  Although we are almost always told that this is due to a weakness in the vastus medialis (the muscle on the inside front of the lower thigh opposite the vastus lateralis), I find that this is often not the case --- or at least it does not tell the entire story.  Instead, the problem is that there is very often ADHESED FASCIA (retinaculum) in and around the area of the vastus lateralis.  This area of adhesion can encompass the lower ITB as well.  What causes this?  Although I am not certain, I would speculate that it has to do with the fact that FASCIA can be broken down and scarred by either chronic repetition (i.e. running) or traumatic injuries --- both being exceedingly common in athletes.

Although strengthening of the quadriceps usually solves this particular pain, it can actually worsen the imbalance between the quadriceps and the hamstrings.  It was not that long ago that I read an article talking about the incredible increase in the numbers of cases of non-contact knee ruptures seen in today's athletes --- particularly female athletes.  The authors touted the fact that the number one cause of non-tramatic ACL ruptures in the female population, the quads were overpowering the hamstrings. 

For more information about PATELLO-FEMORAL SYNDROME and how to avoid a "Lateral Release" surgery, just take a few minutes to click and read the link.  You may want to look at our COLD LASER PAGE as well.