Knee Pain
Overview
Chronic knee pain is a major cause of lifestyle limitations and disabilities in adults that account for a significant number of doctor visits per year. Knee pain is reported in over half of adults over the age of 50. It is a strong predictor of future disability, and early treatment is likely to have a major influence on healthy aging. It has increased over time, and it has doubled in prevalence in the past 50 years, despite advances in patient care.
Luckily, in the majority of cases, it is a treatable condition if approached from a researched, conservative approach. This article will cover what your pain is, what it isn’t, how you can stop chronic problems from occurring.
What It Is and How You Can Manage
Pain is a heightened degree of awareness to a harmed area. It is our body’s natural way of doing extra surveillance to reduce future injuries. It is important to understand that pain is the body’s mechanism to ask for a change, and it isn’t intended to be a lifelong occurrence. It is important to recognize where the pain is coming from, but it is more important to recognize why that area is is under extra stress.
Let’s review some key anatomical considerations of the knee.
Knees are simple hinge joints that transfer force from the foot to the hip. They’re supposed to flex and extend, and when they rotate or wobble, we start seeing problems. When this happens, force cannot reach the hip, and the ligaments in the knee take the force of each step. We need our knees to be stable enough to stay inside the proper functional plane of movement, with rotation occurring at the hip and ankle.
Typically, knee pain arises from the anatomical structure that is taking too much force from the ankle - commonly the medial meniscus. The ankle bends and affects the angle at which the knee bends. If the ankle loses mobility, then the knee joint becomes unstable, eating force that doesn’t properly reach the hip.
If a mechanical force caused the problem, then logic would have it that mechanical force can cause the solution. However, a doctor must examine why the tissue is being overloaded.
In July of 2017, the PNAS Research team performed an incredible research study to examine knee osteoarthritis. They dug up and examined cadavers from different generations. They found 176 bodies from 6000-300 B.C., 819 bodies form late 1900s, and 1,581 bodies from the 1800s (all bodies over 50). They had some groundbreaking findings.
Knee arthritis long existed at very low frequencies, but since the mid-20th century, it has doubled in prevalence, after accounting for the effects of age and BMI.
The authors conclude the increase is not genetic.
They conclude that knee pain is preventable.
The evidence shows that lack of physical exercise is correlated to thinner cartilage, weaker muscles, and low-grade inflammation. A sedentary lifestyle leads to ankle immobility and a lack of stability of the knee.
Key Tips to Improving Your Knee Pain
Get physically active. Avoid severe, drastic or sudden increases in your routine, but incorporate being more active through the day.
Warm up before taking on a fitness routine.
Stretch the hamstrings, calves, quadriceps, and tensor fasciae latae prior to working out.
Try not to run on hard surfaces, if possible.
Strengthen the quadriceps, especially the vastus medialis oblique (VMO).
Strengthen hip abductors and external rotators.
Introduce hills to gain more movement in the ankle.
Visit a chiropractor to ensure that your joints are in proper alignment so force can be distributed evenly. Request they screen for movement dysfunction.
Perform corrective exercises to fix improper muscle stability.
What It Is Not
It's important to note that degeneration and pain are not synonymous. Research has routinely shown that asymptomatic people can show large amounts of degeneration. A prior diagnosis of degenerative joint disease does not mean a patient is subject to a lifetime of pain.
The 2019 British Journal of Sports Medicine released a monster study where they examined nearly 5,400 MRIs of knees with people who had absolutely no pain. They concluded:
Management of arthritis-related features without trauma should center on improving functional limitations. The care should NOT be driven by imaging findings.
The high rate of older adults with arthritis without pain explains why arthroscopy is no more effective in reducing symptoms than sham surgeries.
Although the use of MRI has gone up 30% for knees in the past 20 years, it does NOT result in improved treatment decisions.
75% of individuals over the age of 70 without pain will have tears in their meniscus and degenerative knees.
Our discs slowly degenerate over time, and this can be a painless process. However, if abnormal forces wear our tissues down at an accelerated rate, the rapid breakdown of our discs induces inflammation, which can amplify a pain response.
A thorough chiropractor should look at degeneration for what it is. Our bodies degenerate and build bone spurs in an attempt to stabilize an area. More specifically, the joints that degenerate rapidly are the joints that move excessively in the wrong directions. Therefore, a chiropractor should examine WHY the body degenerates, not just accepting degeneration as the cause for their pain intrinsically. This is frequently missed by pain-based chiropractors and medical doctors alike. Using a hammer on screws is an ineffective treatment solution.
According to the 2017 edition of the Clinical Journal of Pain, the author reports
Although chronic knee pain in older adults is usually attributed to degenerative joint changes, functional impairments do not appear to be due to increased structural damage.
Zeroing in and focusing on just the overloaded tissue/pain generator has low evidence for long term solutions. Identifying degeneration (overloaded tissue) is not backed by evidence. By identifying pain as mechanical and finding dysfunctions that fuel the mechanical overload, both structural and functional, a chiropractor can best equip you with the care needed to not just live pain free, long term, but to get your life back, doing the things you love.
Remember that you were made to have life and have it more abundantly; You were made to thrive.
Sources
Culvenor AG, Øiestad BE, Hart HF, et al. “Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.” British Journal of Sports Medicine 2019;53:1268-1278.
Farrokhi, Shawn et al. “The Influence of Knee Pain Location on Symptoms, Functional Status, and Knee-related Quality of Life in Older Adults With Chronic Knee Pain: Data From the Osteoarthritis Initiative.” The Clinical journal of pain vol. 32,6 (2016): 463-70. doi:10.1097/AJP.0000000000000291
Wallace, Ian J., et al. “Knee Osteoarthritis Has Doubled in Prevalence since the Mid-20th Century.” PNAS, National Academy of Sciences, 29 Aug. 2017, www.pnas.org/content/114/35/9332.
