Entries by dmiddaugh

Upper Back Pain – Common Causes & Treatments


Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh physical therapist and I'm the owner of El Paso Manual Physical Therapy. We are talking today about upper back pain. Just to be specific about where the upper back is, because it can be confusing for some people. I'm going to include the mid back, and upper back as one, because a lot of these problems are in the thoracic spine, which is what we call it in the medical field. Basically, the parts of your spine where ribs are.

That's what I'm going to consider as upper back problem. But this goes all the way up to the base of the neck. It includes the backside of the shoulders as well. Now, some of the common diagnosis, we are going to go into that, and then we'll talk about the treatment options.

I'm just going to give you a little disclaimer right now, a lot of these problems that I'm going to go over, that affect the upper back, aren't always similar. In other words, there are very different body parts that are affected, which makes the treatments very different. We aren’t going to go into too many details on the treatments, just because there is a big giant variety, and it would take a whole episode for each one probably. But it's going to give you an overview of the different types of common causes of back pain, upper back pain and the treatments that are out there for that.

So, let's get into it.

By far, one of the most common problems in the upper back is rib problems. About the ribs, you have 12 pairs of ribs, and the first pair is way up top above your collarbones. I'll show you exactly where it's at. If you take your right hand. If you can't use your right use your left and put it on your neck on the side of your neck, like right into your ear, put your palm on there, and slide it down to where your neck moves into your shoulder. Right above your collarbone, but where your neck ends, and your shoulder starts. That's about the location of the first rib.

A lot of people don't realize that they are that high. And then they go all the way down to just right above your lower back. So, you got tons of ribs, you got 24 ribs, if you think about it. Ribs have the ability to shift, so they can shift up or down, forward or back. When they shift, they tend to get stuck. There are muscles that attach to ribs, and there are of course joints where they meet the spine in the back. Then they wrap around to the front and meet the front part of your sternum, they attach through a bunch of cartilage.

Not all the ribs attach to the front, the last two pairs that’s the 11th and 12th pairs don't actually attach, those are floating ribs. What well if you've got upper back pain, and typically it's off to the side, it's off to one side of the right or the left. Many times, it will radiate, it will shoot from the back off into the side of your body, under your arm might even be in the armpit area. Sometimes it will create some tenderness in the chest. That more often than not, is a real problem.

Depending on how it’s shifted, you have to get the right kind of help to make sure that you shift it back in the right direction. It's critical, because think about it, if your ribs shifted forward, and somebody's trying to put pressure on your back, it's going to further shift the rib forward, because you are pushing it from back to front, it's already shifted from back to front. So, you got to know which direction to go in, how it feels, it's a science definitely, it's its own specialty, in figuring out the position that rib is stuck.

The most common way that ribs get stuck is backwards, where they pop out backwards from the spine. Pushing it in is definitely a common treatment. I can tell you from experience, I've had that happen before. It's not a comfortable experience to have a rib shifted into position. It's one of the few things here in the office that I have to tell people that disclaimer ahead of time and say hey, this time it's going to hurt, but you are going to feel a ton better after it's done. Most techniques don't hurt to get them done on people. One of those, the most common problem that you can have in your upper back is a rib problem. A rib that's shifted or stuck.

You can also have cracked ribs, you can have broken ribs, and that's related to an accident usually, like if you were in a car accident or some severe fall, those are not that common. Here in our office, they can't happen obviously out in normal life. But if you've had a history of a cracked or broken rib, more often than not, after the rib is healed, you might have a shifted rib. That could be causing some back pain. If you have that history of that happening in the in the past.

If you are all the way healed, then you are going to be ready to do some sort of treatment that shoves it back into place. If you have an actively broken rib or it's cracked, you do not want somebody pushing on it right now because you can make it worse.

The next most common thing that happens in upper back pain is shoulder blade problems. The cool things about the shoulder blade is, they are floating bones, they float in a bunch of muscles on your rib cage. Of course, on the outside corner of your shoulder blade is the socket for the ball and socket joint of your shoulder joint. These bones are really cool. There are over 20 muscles that attach and control the shoulder blade. And because there are so many muscles, it's quite easy to develop a muscle imbalance that makes the shoulder blades not operate normally.

If that's there for a long time, it can tension certain muscles too much and create a back problem. Now here in the clinic, we call that scapular dyskinesia, that just means bad movement of the shoulder blade. There are a bunch of different ways that it presents. Sometimes it's related to posture problems. Sometimes it's related to strength. Sometimes it's related to the sleeping positions. Most of the time, it's a combination of all those things.

But shoulder blades can cause problems and it's never the bone. It's always the muscles that attach to the bone. Unless you have had trauma, like I said, with ribs is huge, because it is possible to have a cracked shoulder blade or a fractured shoulder blade, which of course is going to change the way the muscles operate. So, take that into consideration.

If you've been in an accident, you might have back problems, upper back problems related to an old fracture and your shoulder blade. But to fix that, there are tons of options. It just varies. There is usually some sort of exercise, some sort of hands on work needed, to free up the joints of the shoulder blade. It has three main areas where there is, I guess you can call it four joints, where the shoulder blade moves. It attaches to the collarbone, and the collarbone itself will move the ball and socket joint on the outside, and then there's what's called the scapula thoracic joint. It's not a real joint but if there is movement that occurs between the scapula, the shoulder blade and the rib cage, it slides on itself.

Then on the front side, there's a ligament that connects it to the rib cage as well. So the shoulder blade can cause lots of problems.

The other less commonly found, upper back problem that I find in people is nerve problems. If you think about it, our body is covered in nerves, you just don't see it and it's not commonly talked about. But for people that are dealing with having to work at a desk job, having to be in the same position for a long period of time, having to be sedentary because that's what their life requires them to do at this time. Their nerves can get very aggravated in the back.

The way this typically presents is a burning sensation that runs up and down the upper back, an achyness as well. It may get worse if you go pick up something heavy because attentions and nerves more if you look down, in fact, to try this out, you can check yourself if you have got an upper back nerve problem. If you look down and bring your chin to your chest, like try to push your chin against your chest as much as possible. If that begins to set off that bad, achy feeling, that's likely a nerve problem. It could be muscles as well.

There are different ways to differentiate it. But that's a beginning of a common test that we do here in the office to start to figure out if you have a nerve problem, there is more that we have to do for you, but half the time there's a nerve problem. When you look all the way down and you feel pain going down your mid back area that is almost always a real problem. There is muscle imbalances that are associated with that. We have to look at the neck, we have to look at the lower back as well, the shoulder blade positions.

There is a lot involved in fixing nerve problems in the upper back. This pain that radiates down, this burning sensation, this discomfort, it can also be present in the neck. We have to look at the neck joints and muscle imbalances up there as well.

The next two problems that I'm going to cover, that are commonly found in the upper back area are less common, but they do happen, and they are related to each other.

I'm going to talk about thoracic disc problems. In the medical field, they usually talk about cervical disc problems, which is neck problems. In your neck you can herniate those discs, you can bolt those, you can get degeneration in those. Then in the lower back, in the lumbar spine, there are lumbar discs as well that can get injured. But it's rarely ever discussed the discs that are in the thoracic spine, in the middle and upper back part. But you can get problems in those discs as well.

It's hard to detect them on an MRI or X-ray. It's more commonly found by hand, by an expert like myself, like somebody who's pretty good with hands on, feeling the body, feeling the joints, feeling the muscles around there. Once it's found, it's really easy to clear up actually, we have helped people with disc problems in the thoracic spine for years now, and it's actually quite straightforward to clear up. It almost always clears up. I've never seen somebody that was debilitating.

It didn't get better, but it can feel like, and the common words that people use is, it feels like somebody's putting an icepick right into the middle of their mid back, right in the center. And I have to ask, is it off to the right, or off to the left? And they always say Nope, it's right in the middle. Then once I do my testing, and for the discs in the middle back, I'll find the spot and I'll poke a little bit. They'll say, Yep, you found it. That's it. That's the spot that hurts. And I can tell that it's a disc problem based on how stable that section is.

Because whenever there is a disc injury, the vertebrae, the bones in that area aren't moving as good and they get loose. That's how I can feel all those little changes in the spine. Associated with this, with these disc injuries, is something called T4 syndrome. You can Google this it's a thing.

T4 syndrome is a loosening of a disc, they think it's at T45, but in my experience, I think it can be anywhere in the thoracic spine anywhere in the upper back and we are in the mid back. Because there are certain nerves that control a certain part of your nervous system, specifically the sympathetic nervous system, this is higher level stuff. You don't have to go look this up if it's confusing for you.

The sympathetic nervous system controls the fight or flight parts of the nervous system so it can regulate pain. There are all these details that we look at. But what you need to take away is that about t 45. That part of the sympathetic nervous system affects the arms. In people that have this T4 syndrome, they can sometimes get pain, numbness, tingling into their arm. And if it happens to be on the left side, and they also have a neck problem, a lot of times they think that they are having a heart attack, pain in the arm, pain in the neck on the left, especially a female because females tend to not live through heart attacks more so than men. It can freak them out.

We have had patients come in and say, I went to the hospital, I got my heart checked, I had all these checkups with a cardiologist, and they say, I'm fine. There's nothing wrong with my heart, thank God, but my arm still hurts, and I can't sleep at night and my back's killing me and my necks killing me. When we check them out, thankfully they've already cleared out all their heart stuff, so we don't have to send them to the doctor to do that. But then we find that loose disc in their spine and we diagnosed them with T4 syndrome. The good news like with other thoracic disc problems is that it heals just fine as long as you put in the right environment.

Since it is a disc, it can take up to a year to fully scar down and not cause problems constantly. But within the first few months, you can see a dramatic reduction in pain and be able to sleep comfortably, sit comfortably, move your arms and exercise as well.

Some people have trouble exercising because of this. For most people though, when they have been sitting for a while, is when they feel the most. They get that sensation that feels like an icepick into their back. This part of the back, just talking about treatment, because oftentimes, people go to a chiropractor and get their back popped, or they get their relatives to pop their back, they'll just do come up from behind and give them a bear hug and pop their back. That can be quite relieving for people that have stuck joints in their back and it will move some of the ribs that are stuck as well.

But in people that have a thoracic disc problem, you got to be very careful about doing any sort of those techniques. I wouldn't have your spouse do it or your relative do it. You got to make sure that it's done by a professional. I've had a few conversations with chiropractors here and there and I've never heard them know much about T4 syndrome whenever I bring it up. I can't say that I have a good sample of chiropractors that I've asked about it. But the ones that I have, just haven't talked too much about it. I don't think that they are aware of thoracic disc problems.

They have had the experience where clients come in and say, Well, I thought I needed to pop my back because I had that icepick sensation where it felt like stabbing. I went to the chiropractor and they couldn't pop it. They did their thing and it popped a little or didn't even pop at all, but actually left me feeling worse.

I think that that happens because they are overstretching an already loose thoracic disk and unknowingly, they may not know how to check for it and how to handle that kind of situation. They go through their techniques and it might be injury. If you think that you have a thoracic disc problem, if you think that you might have T4 syndrome, I just want to let you know to exercise caution with, letting anybody pop your back.

We do those kinds of techniques here in the office, we do thoracic manipulations. That's where we can create some pops in the back joints if needed. And we do it very judiciously, very carefully. And not everybody gets it, it depends on if you need it or not, and if you are comfortable with it, but for a T4 syndrome or thoracic dis syndrome, we are definitely staying away from those areas that are affected. Because we do not want to contribute to making that worse, we want to make it better.

But in order to make it better, we might need to work on some other spots nearby to make sure that that T4 area, or any of the areas that are affected are safe and getting better.

Now let's talk about some of the treatment options. We already went over thoracic manipulations and adjustments a bit. But let's discuss braces. I've seen some people get really, really into fixing their posture. And I think that's great. You should have improved posture. But some people go so far as to wearing braces that hold their shoulders back and make them sit up a little bit.

There are braces that you can find out there that are special for posture. I've even seen some clients that have a device that they can attach to themselves under their clothes, and it buzzes them a little bit, it vibrates. I haven't seen anybody have the one that shocks you, but there's one out there that actually can shock you a little bit. Where if you lean too far forward, and you start slouching, these devices let you notice it to back up and straighten up your posture.

That's definitely something that can help you out. Posture isn't always the solution, though. And some people overdo it with posture. There are actually cases where I have to tell people, you are sitting up too much, you are overdoing your posture and you actually need to slouch a bit because you are going to hurt your back, and that might be contributing to your upper back problem.

People will also go do certain exercises and stretches and there are so many muscles in the upper back and in the shoulders and neck, that it's hard to tell you exactly what exercises are best for you. The best advice I can give you is that if you are out there doing exercises for your upper back, and they are helping you great. Awesome! Sounds like it's probably going to be a good thing for you to keep going with that.

But if you are doing an exercise and it's making no difference, or it's making you worse, you definitely want to back off from those exercises so that you are not creating a bigger problem for yourself. That's going to take more time and effort and money to fix down the road.

Pain medications are often used, we I often hear people with upper back problems like to take over the counter pain medication. Stuff like Ibuprofen, Naproxen, Tylenol, those types of over the counter medications. Some people will go to the doctor and get prescription strength medications, they'll get steroids type of medications that are anti-inflammatory and pain relieving. They will get some muscle relaxers as well.

I have seen some people get injections into their spine for upper back problems and lower neck problems. Those tend to be pretty effective. But they just have short term benefits. It is still pain medication, but it's just injected into the painful area. It's not creating more joint motion or strengthening the muscles. It's not fixing your posture. There are other factors that need to be considered to make sure that this problem gets better for the long term.

Surgery is rarely done. I haven't really seen anybody get an upper back surgery. I can tell you I've never seen anybody get an upper back surgery. What I tend to see is, people getting shoulder surgeries because they start to have shoulder problems, if an upper back problem has been there long enough.

I've seen people getting neck surgeries for sure. They do neck fusions and discectomy and other things in the neck. That could be contributing from the neck problem as well. Now, something that I haven't mentioned yet that's important, I think, is something called a downward hump.

A downwards hump is the bump that people get on their upper back at the base of their neck. That bump is where the spine is bending forward. And it's stuck there because the joints are stuck, or it might be stuck because the person isn't strong enough to straighten up. But we often see that as a telltale sign that there's going to be some neck problems, there's going to be some upper back problems, and there's likely going to be some nerve and shoulder problems as well.

If you are listening to this podcast right now and you are thinking I might have some of these problems that he's been talking about, and I just put my hand on my neck and my lower neck, upper back and I feel that I've got a little bit of a bump going. Plus, my parents had that bump or one of my parents had the bump, I might be genetically predisposed.

I would urge you to work on fixing that bump as best as you can. Whether it takes some professional help, like you hire somebody like us at El Paso Manual Physical Therapy, or you go and do some stuff on your own. Any way you slice it, having that bump is not a good thing. It's going to set you up for all these problems that I talked about, shoulder blade problems, nerve problems, related problems, the first and second ribs are frequently affected with that bump. The discs above and below that bump can often get affected as well.

Even though the bump might not be painful, most of the time it is very tender, and painful. Plus, it's unsightly. I often see women that have it, they don't like to wear their hair up because the bump is exposed. They wear their hair down to hide it and they try to work on their posture but just can't quite seem to get it. There are many different reasons why the bump is there and there are many different ways to fix it, you have to find the best way to fix it.

But I would make it a pursuit to make that bump go away for your health. I'm sure you'll love the aesthetics benefit of it anyway, where the bump is no longer there. But have to fix it for your health.

If that bump has been there long enough, if you are older and you've had it for decades, what can happen is the joints in that area can become really stuck. We call it our thrust or fused and it won't get better. It won't really straighten out. And you see some people that are stuck in that position. They need a lot of pillows to get comfortable and their back. They are hunched over, and they have to look up at you and they get shorter.

There are all kinds of side effects to that. So, you don't want to live with that. You want to make sure you take care of it while you are younger. Here in the clinic, we check if there is any potential for the mobility to improve in those joints. We check the muscles that support the spine in that area. We look at the bones above and below there, to see if they effect in any way the muscles that run down from the back into the shoulders. And if we find that bump in somebody who's got a shoulder problem or another upper back problem, you bet we make a big deal out of it because they need to fix it.

For that bump I've never seen a surgery for it. I've seen people get it injected. I see people taking pain medications for it and people trying to work on their posture to get a better but sometimes there are specific treatments that need to happen.

Oftentimes here in the clinic, we help people fix problems like these upper back problems, the bump, the T4 syndrome, thoracic disc problems, nerve issues, problems with their shoulder blades and the rib issues. We help them address those problems without relying on pain medication, injections and surgeries. Usually an option for a lot of these things. We help them because there's no other option and they tend to get better where all these issues improve tremendously, as long as they are not too far gone.

People can generally get better sleep at night. Remove the unsightly bump, to get rid of the achyness and burning, they are having running down their back. That sharp, deep pain. They can come out with a disc issue or a shifted rib that just doesn't let you breathe right, and the pain radiates from the back to the front. That is very correctable.

I hope that this podcast was helpful in increasing your knowledge in upper back problems. I hope that you feel much better prepared in making a decision about how to treat your back problem. Know where to go, what to do, how to approach it, how to think about it even. Because some people may or may not be that bad, you may not need to do anything about it right now. But if it's been going on for a while, then you need to start thinking about how you are going to fix this for the long term.

If you are interested in hiring us to help you with this problem, it's really easy. The best place to start is calling us at 915-503-1314. And if you know of anybody else that probably needs to hear this podcast, please share it with them. Let them know about the tips that we have in here and to listen to it. Have the best day ever. Bye.

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Knee Arthritis – What Is It & What Can I Do About It


Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh, physical therapist and the owner of El Paso Manual Physical Therapy. Our topic today is going to be about knee arthritis. Specifically, we are going to figure out what it is, and what can be done about it.

These are questions we get in the clinic. The time people come in with x-rays, sometimes MRIs, and they have been told, by a doctor or they have read their own X-ray report, and they found out that it says, the dreaded words knee arthritis or osteoarthritis specifically.

But let's talk about what is knee arthritis.

We are going to answer these questions today. What is knee arthritis? How does knee arthritis happen? What types of treatment do people do for knee arthritis? And how much can I improve my knee arthritis? Is it possible to be normal? Let's get going with the first question.

What is arthritis?

Arthritis is actually, it's kind of a misnomer, there are different types of arthritis. The most common by far is osteoarthritis. We are going to assume that that is what we are talking about. I'm not a specialist in other types of arthritis, like rheumatoid arthritis, psoriatic arthritis and there are other types as well. Those are the types of arthritis that you want to see a rheumatologist for. You probably will need to get a different kind of treatment then what we can offer. It's definitely not mainstreams. It's its own specialty.

For the sake of knee arthritis in this podcast episode, we are talking about osteoarthritis. But I'm going to say arthritis a lot, just because I know that's what most people say. They say, “Oh, it's my knee arthritis”. Hardly anybody in the general public says osteoarthritis.

So, what is knee osteoarthritis? Knee arthritis is changes that happens on the surfaces of the joints within the knee. A lot of people don't know this, but your knee actually has three joints in one. It's the connection between the thigh bone, the femur, and the shin bone, the tibia. That's one, and then there is a connection between the kneecap, also known as a patella, and where it interfaces with the femur, the end of the thigh bone. So that's a patellofemoral joint.

Then you have an A joint, off to the side, that people don't typically think about as being part of the knee., but it is. It's called the tibial fibular joint. You have two bones in your lower leg, the tibia and fibula, and they connect in two spots to each other. Down at the ankle is one that makes up the ankle joint and then up at the knee. They connect as well.

In some people, that can be a little problematic, but that's a less seen injury, and for the sake of arthritis, we are going to focus on the kneecap and the femur, the thigh bone, and the tibia, and the femur as well.

Knee arthritis is when the surfaces of the kneecap, the backside of the kneecap, and the surfaces of the thigh bone on the end of the thigh bone, where it's at your knee, and then also on the top of the shin bone. When those surfaces begin to change over time, and when I say time, I'm talking about years, even decades, they change, and they decrease congruency. Meaning, how well they fit together. The surfaces are aligned with cartilage.

Cartilage is important because it's a really smooth tissue, and it eliminates friction. It reduces friction tremendously inside of a joint so that your bones can move on each other without popping, grinding or clicking.

If you have trouble with your cartilage, then it tends to lose its smoothness. It's hydration as well. We'll talk about that in a second, and how easy the joint moves and that's why you might get popping and cracking inside the knee joint. If you have arthritis type problems.

Arthritis is not a disease if you will, it's not like something that you catch like a cold, or an infection. I just want to clear that up, but some people might not know, and I want to just clear that up for them. It's something that happens over time. As we age, and as we use our bodies more. Now I said as we age, but I just want to make it clear that you can be older, you can be elderly, you can be into your 50s, 60s, 70s, 80s, and beyond, and still have fantastic knee health. Despite your x-rays showing that you have arthritis.

Let me say that again. You could have pretty bad looking arthritis on your X-ray. You can be older, and you can still feel great in your knees. I need to say that to you because many people don't associate those things. The proper way to think about arthritis, knee osteoarthritis, is it's a normal part of aging, just like we get gray hairs, and wrinkles on our skin, on the inside of our bodies, our cartilage changes over time in a way that isn't always the best.

The best example that I could give you, if you think about an old vehicle, maybe it's in great condition. For example, I have a neighbor, down the road from me, that collects 1957 Chevy's, I believe it's 57. I'm sure he correct me if you heard this, but he's got three of them, and he keeps them in great shape, but I'd be interested to see under that vehicle. If you poke your head under that car, you probably will see some spots of rust here and there, just because that's what happens to metal over time. Especially metal was used back in the day.

Now that rust is similar to arthritis happening in our body. It may not be detrimental to the function of the vehicle, those vehicles might still run just fine, if there are just spots of dust of rust here and there. It won't affect the structural integrity of the frame of the car, the struts, the shocks, the bolts, everything that builds the car. All the components of the car should operate just fine if you just have some rusty spots here and there.

But think about this, if that rust was so bad that it's starting to cause a hole in pieces of the metal. It's starting to bend because the structural integrity of the metal is being affected, because there is so much rust, then you have a serious problem. Then you may not want to drive around that car. You might be about getting it fixed somehow.

Same thing with arthritis. If the arthritis is so bad inside a knee joint, then it's going to start affecting the ability of that person to walk, to stand, to sleep, to do everyday activities. But if you get a little bit of arthritis on your X-ray, it may not actually be the source of your knee pain, it may just be that, going back to the car example, that you need new tires, or you need an oil change, or that something else needs to be fixed. It may not be the reason why your car is not working, right?

Going back to the knee, a little bit of arthritis may not be the reason why you are hurting, or why you are having any problem. It could be a bunch of other things. It's not a good idea to associate your age with arthritis, and with your ability to improve. I think that's really important for you, because let’s say you are in your 60s or 70s, or older, or even younger, and you have an X-ray and you found the dreaded words in the report knee arthritis or the doctor told you that you are developing knee arthritis. Another thing that people will say the doctors will say is that they have knee degeneration, or degenerative joint disease.

Diseases a misnomer, they actually talk in the medical field about getting rid of that term degenerative joint disease because it leads you to think that it's a disease, like something that you catch, or that there is a medicine for that cures it, and that's not the case. It's just, it's wear and tear, essentially on a knee joint. The cool thing about the body, though, that's different from a car, is that it can heal our bodies, or living tissues where obviously cars are not.

If you put the body in the right environment, if you give it exactly what it needs, it should heal. The predominant thinking in the medical field is, that once you have arthritis, that it only gets worse over time, and that it doesn't heal. If you have pain, especially knee pain from this arthritis, then you are only going to get worse. Some doctors will even go so far as to say that, you might need a knee replacement in five 5 or 10 years, or however many years, because that's what they typically see. They typically will see people that come in for knee problems, and physicians are doing their best, they are  helping them out with injections and medications, and might make recommendations for surgery. That's what they are trained in, and that's what they are specialists in. So, that's how they think to help you out.

Sometimes I even have clients that go to physical therapy, or get other sorts of treatment, and don't get better. I always question what was done? What do they do? Anybody that is therapists, the physician, the surgeon, was it the best thing for your situation? Did they check certain things in your knee that needs to be checked so that you can properly get better? There are all kinds of reasons why a knee can hurt, and arthritis is just one of them.

Let's talk about that, let's answer the question of how does knee arthritis happen? How does it progress? I mentioned the words wear and tear a second ago, and you hear that a lot in the medical field, especially patients that go visit their doctor and get an X-ray. The common way that doctors will explain what's going on in their knee is, they'll say you have wear and tear, and what that tends to mean is that there is cartilage that is thinner than it's supposed to be. So that's where it's worn down, and there might even be spots where there are tears in the cartilage.

Some doctors will mention the words “you have NO cartilage in your knee”. I want to clear that up, a mind picture that people get, whenever they hear these words, that they have no cartilage in my knee. They think that the entire surface of cartilage, on the back of the kneecap, or on the end of the thigh bone is completely gone. That's extreme. I can tell you right now, if you have been told that, that you if you are going to walk, your knee would be locked, you wouldn't be able to bend it, or straighten it out very much at all.

Maybe you do have some loss of motion and some locking here and there, but that could be for a slew of other reasons. Your knee would literally not move at all, it would be like trying to undo a very, very rusty bolt. Like it would be extremely stuck, and if you pry it loose, all this dust would fly out. You might even break the bolt where it's attached to and your knee would not function normally or anywhere near normal.

If you had complete loss of cartilage on any surface of your knee joint. What is more likely to be the case, if you have been told that you don't have cartilage is, that there is a spot on your kneecap, on the back of your kneecap, or on the end of your thigh bone, where the cartilage has worn down enough to go all the way through down to the bone.

Another phrase that doctors will typically use is, it's bone on bone. The knee joint is bone on bone, and they are not talking about the entire surface. We are talking about a single spot, usually in a severe case, where the knee joint is bone on bone, and once people get that, the picture in their mind is that there is no cartilage in there, there is no chance of it coming back. Then they start going down the thinking of I need a knee replacement.

In the root of the problem, what tends to make knee arthritis progress faster than it normally should, because you are going to get it as you age anyway, it may not be painful. But in people that are in their 30s 40s, or 50s, or some people in their 20s, as well, they have some severe knee pain. Usually, it's been going on for a while and you may have gotten x-rays and your cartilage is worn down, and maybe even have a spot that's bone on bone. What has been happening to you more likely than not, the most common thing that I see happen to these people is the mechanics in their joints. In other words, the way that the bones move on each other, has been off for a long time, and it's causing certain surfaces of the joint to rub on each other inappropriately.

It's causing extra friction, extra pressure in those areas where the cartilage is worn down or torn, or it's bone on bone. That's not the way that motion is supposed to happen in your knee. As a result, you have worn it down faster than it should. The good news about this is just like our skin and other tissues in our body. Cartilage can develop scar tissue, and scar tissue isn't a bad thing.

A lot of people get all worked up over having too much scar tissue and, and it being you know, you have to break up scar tissue I hear about that as well. But the reality is that scar tissue, when it's laid appropriately in a tissue, it's about 60 to 70, sometimes even 80 to 90% as strong as the original tissue. That's pretty darn good. In my opinion. That's way better than getting stem cells or PRP injections, where you are looking at possibly regenerating a small percentage of the tissue. I'd rather have scar tissue all day and fix your original root problems so that I'm not going to wear down my scar tissue as well.

How do you generate scar tissue though? Well, in the kneecap, it has to heal slowly over time. In the end of the thigh bone, cartilage just comes on very, very slowly, it heals at one of the slowest rates of all the other tissues in the body. In somebody who has bad mechanics, it has been going on for a long time. They wear down the cartilage.

What I often find if we are talking about the kneecap on the thigh bone, let's talk about the muscles for a second the thigh muscles on the front of your thigh. Those are called quadricep muscles, quads for short. People that have long standing knee arthritis and pain on the front of their knee or deep into the knee. They tend to have very over dominant quad muscles, very strong quad muscles.

I had a client not so long ago that we started seeing for a knee problem and she told me she's been exercising and fit for whole life and she's in her 50s. She is still pretty young to have knee arthritis problem. But she's gotten there because she's been so active, playing sports, going to the gym five days a week and getting on the treadmill running. She's convinced that she needs to stay active and healthy so that she can be healthy into older age, but she's worn through cartilage.

I asked her if she does squats in the gym and other leg exercises. I said when you go do your leg days at the gym, where do you tend to get most sore from, or where do you tend to feel the muscles work the hardest. She said hands down my quads. I have always worked on my quads. I've always been proud of having big quads, big thighs, strong, quad muscles. Then I asked the question, how about the hamstrings? How about the glutes, she said, rarely ever do they get sore, rarely ever do I work them out? I always get on this machine and do this exercise. I do the leg press. I do the squats. I do this. I do that.

I went through deep in detail through every exercise she would regularly do, and she confirmed that she always felt her quads work the most. When I told her what I discovered, I tested everything out in her in her legs to figure out what the root problem of the of the knee arthritis was. I told her you have got some of the most dominant quad muscles I've ever seen. And the evidence is there. From what you are telling me that you have worked out your quad muscles way too much and unknowingly have neglected other muscles that should be in balanced with the quad muscles.

When those quad muscles are as dominant as yours, what happens in the mechanics at the knee joints, those quad muscles all attach to the kneecap. Which causes them to shorten. The stronger the muscle is, the more it shortens just at rest. That's a known fact. So, it puts the kneecap against the end of the thigh bone the femur harder. Without even doing anything, the kneecap will be pressed up against the thigh bone. And that increases the pressures and it doesn't allow the cartilage to recover to rest and be able to regenerate itself and be healthy.

Then when she goes to exercise, when she's not doing any more, we've fixed a lot of things in her. But when she was going to go exercise, she was further strengthening her quads and in further increasing the forces in during the exercise itself. She was getting a lot of grinding, popping clicking in her kneecaps, which was just if you think of the cartilage surfaces, they are just being pressed against each other way too hard.

That's how arthritis happens over time. If you can imagine this woman exercising five days a week, doing things that involve her legs, pressing that cartilage up against itself, way harder than it should, and then doing that over the course of years, over the course of decades. She's in her 50s now, she said she's been active ever since she was in high school, playing high school sports and she never quit.

Occasionally, everybody goes through seasons of life where they might back off on exercise, they gets sick, the holidays come around. In her case, she has two or three kids. So things change in life, but she always came back to exercising. She was pretty consistent with feeding into this muscle imbalance and putting too much pressure on her knee cartilage. She developed knee arthritis.

But how do we undo this? Let's talk about the types of treatment that people do. First, I'm going to go into the types of treatment that are commonly done. What people tend to encounter first, whenever they visit somebody in the medical field. In our opinion, what I think we can do here in our office, I'll pass them a physical therapy to help people for the long term so that this is getting better for months and years, and possibly the rest of your life.

The first thing that people will do at home is use some sort of over the counter pain medication, Tylenol, ibuprofen, or they may rub what's called an analgesic lotion or gel. we are talking Bengay, Biofreeze, Tiger Balm, one of those types of lotions that take away pain.

Both of these things are temporary. They don't make your muscles stronger, they don't fix the way the joints moving, they don't fix the mechanics, which is a root problem for most arthritis problems. It can feel better, it can possibly help you sleep better at night. It may allow you to get through a few days of where you need to be on your feet a lot or use your leg a lot. And that's cool, but it's not a good long-term plan.

The next thing that people will do typically, they'll visit the doctor and the doctor, with best intention, will offer a prescription strength medication, they may offer an injection for the knee as well. Those two things, prescription strength medications and injections, can definitely help the pain but just like with the over the counter stuff, the things that people try at home, they do not help the pain for the long term. It's just short term. It just helps, instead of just a few hours or a day you might get relief for a few weeks, or maybe even a couple of months with another Injection. That might get you through a tough spot.

Other things people try at home, they get a knee brace. It's a hit and miss where some people swear by it, and say they feel better when they have a knee brace on, other people say they don't. The trouble with the braces is, there are no such thing as a comfortable knee brace. Everybody fights with them, they have to constantly shove them up. Everybody's legs are shaped differently, and no knee brace is truly one size fits all. They might say that on the knee brace, but everybody's just shaped differently, and they fit everybody differently.

The other thing with knee braces is, you ideally don't want to be in it forever. You need to have a plan to fix your knee problems, so you don't have to worry about being in a knee brace forever. You have to have some way to get out of the knee brace.

Other things people try at home is rest it. Which is great because your inflammation will go down. The trouble with that is, once you get back to being active or doing your normal routine, you are going to be grinding those knee joint surfaces again and aggravating the knee arthritis.

In extreme cases of knee arthritis, that joint just doesn't move as good. The joint doesn't bend as well and doesn't straighten as well. We see some elderly clients here in the office where we flat out tell them, you are not going to get much more motion than what you have already. I can work on you here. But maybe you'll get 50% better, maybe 70% better, is a good outcome. But if the knee arthritis is very advanced, then there is no guarantee that it's going to get completely better.

The only way to get beyond, the motion that they currently have, if they are limited, is to look at getting a knee replacement, but that's a whole other process, a whole other story. If you are very elderly, your health has to be taken in consideration as well as your ability to tolerate the recovery.

It's a massive surgery if you think about it, getting a knee replacement, they are literally chopping the end of your thigh off, your thigh bone, and the top of your shin bone, and replacing it, they are putting metal parts in there and other parts. They have to deal with your kneecap as well on the front end, and then they have to reattach everything. So you up and then you have to begin to learn how to use it, and walk on it. The cool thing about it is that surgery has been refined over time and if I had to get one at this point in time, I would be confident getting one.

I think the surgeons out there do a phenomenal job with it. But that's pretty last resort and ideally if you can save your knee from getting to that point, your own natural knee is the best thing you want. I know surgeons will tell you preserve your knee health, try to avoid getting a knee surgery of course but if you have to have it done. It's actually not a bad surgery to get. But ideally, let's avoid it.

Now let's talk about how much is possible to improve knee arthritis. Depending on the severity of it and how much it's limiting you. You may be able to get quite a bit of improvement. If you are thinking about your X ray that you got not too long ago, and they said it was, moderate or severe.

If you were to get an X-ray after doing some treatment, it may not change that much. I think the best scenario you are looking for as far as x-rays improving is that it stays the same, that doesn't get any worse. The changes that happen occur slowly over time. So you are not looking to have a clear X-ray.

What is way more likely to be the case, you feel better and that you can move better. We see that here in the clinic all the time. When I first meet a person here in the clinic, who's coming in to get help with any arthritis problem, after talking to them, figuring out their story, getting all the details that we need, checking them out by hand, feeling their knee joint, looking at muscles, all the stuff that we have to look at, I'll make my recommendation and I'll tell them, hey, realistically, we can get you 90% better, which should be enough to get you back to exercising, and doing certain things that don't aggravate it. You'll have to still baby it at times here and there. But that should be enough to allow you to enjoy your life just fine, and, be with your family, play with your grand kids, be active, be able to travel and be on your feet for a long time and you'll be fine.

In severe cases, then we are telling people, hey, we are looking at a 50% improvement. In those types of patients, usually their doctors have told them that they won't operate on them, that they are high risk. They can't have a knee replacement done. It's this or nothing, pretty much they don't want to be at home stuck taking pain medications all the time. So, they improved tremendously and get a lot of mobility back.

In those people, I'll tell them the realistic expectation of just improving about 50 to 70%. It just depends on how they present exactly. The more important thing for somebody who has severe, far gone arthritis, and they are not going to improve more than 70%. The more important thing for them is keeping their independence.

I had a client last year who was a pretty severe case. He could still walk, he could still drive, and he was in his 80's. He could still do a lot of things on his own. But his arthritis flared up tremendously over the holidays, and he just wasn't as active during the holidays. So that's why it got worse. He had lost his ability to walk on his own. He had to hold on to furniture, and people had to help him out. He was starting to use a walker, he had to use a bunch of different things to help him maintain his balance, because it was so painful for him to stand up and walk after treatment.

He couldn't straight out his knees all the way, he was lacking about 10 to 15 degrees in both knees. We got them maybe down to five degrees, six degrees, I forget the number exactly. But his knees, when straighten out all the way, they were pretty stiff at the end. I told him that's the expectation. We are not looking to have you strain out your knees all the way if you haven't been able to in years and years and years.

But he felt notably better his big concern was he could sleep better. He could stand for longer, he could tolerate getting himself in and out of cars without having so much help. He felt like he could take himself to the bathroom. That was a big deal for him. It's embarrassing to have your family help you out with the bathroom. He also could get himself dressed. That was another thing to get himself showered, he felt more confident being able to move around.

Being able to improve that small percentage, even if you are not looking at getting 100% better, because it's not realistic for you, it can mean the world of a difference, and keep you in a much happier place where you don't have to rely on family seeing you naked, or having to clean you up after using the bathroom. It's a big, emotional component that people can preserve when their knees are healthier.

If you are not in that type of severe situation with your knee arthritis, it's more mild, you can bend and straighten your knee all the way for the most part, maybe just hurts when you bend it all the way or straighten it all the way. You might have some grinding or clicking in there. There are a lot of mechanical improvements we can make. I can't tell you exactly what needs to be done for your knee right here. There are many factors to look at.

To exactly determine what exercises you need to do, what kinds of hands on work you need. It's it really is its own specialty. But we see people all the time, get back to exercising, get back to running, even impactful activities like running and jumping, they can do that. They have got to learn how to move better, and they have got to strengthen in certain areas. That takes some time and coaching, but it is definitely doable. You can definitely get back to being active again. Being able to kneel is a big problem for certain people, get down to the knee or even getting up and down from the floor. That's a big problem that people face too. They have many issues.

Some people that have had knee replacements already continue to have any trouble after the knee replacement, even they tend to not have as much pain because their knee is artificial. They don't have a normal tissue. But people with knee placements have typically not fixed all the underlying root problems that got them the Arthritis to lead to the knee replacement. They still have very overused quads and muscle imbalances and all kinds of issues that that never were fully addressed.

But at least you are feeling better because of the knee replacement. But because they have limitations and how they are able to bend their knee and use your knee, they have trouble kneeling, they have trouble getting up and down from the floor. And that can be improved a lot of these people, because the last thing you want is to lose your mobility as well as to not be able to be independent, not be able to drive, cook your own meals, do all the things that that you won't be able to do on your own at home.

I've had lengthy conversations with elderly clients that come in for knee problems, and they are pretty embarrassed to ask for help from their kids or other family members with doing some things. It's always tough but when you have to do that you need to because it's potentially dangerous if you don't get help. Of course, they think about where it's going to leave later down the line, am I going to put them nursing home? Am I going to have to have somebody move in with me when I've been by myself, or it's just been my spouse and I and I don't want them to have to hurt their back helping me all the time with putting on my socks and shoes, because I can't bend my knee all the way.

There are all kinds of problems that arise from not having healthy knees. If you are listening to this podcast, and you have knee arthritis, and it's not that bad, I strongly encourage you right now to take care of it before it gets too bad. Find out what treatment you need. I definitely recommend talking to somebody who's an expert in preventing surgery, injections and having to rely on pain medications. But take care of it. Don't let it get too far gone where you have to end up talking to somebody that tells you it's only going to get 70% or 80% better. Ideally you want it to be 99% better, even 100% of possible.

So guys, I hope that podcast explanation explains everything about knee arthritis. What it is and what can you do about it. I hope that we've set some expectations about it. Cleared up some myths about what knee arthritis looks like inside of a joint. And I hope that we can share with you all the information that you need to make the best decision about your knee problem.

Visit our website to find more resources on knee problems. We've got a tips guides that you can download for free. You can get them sent to your email right now if you go to www.epmanualphysicaltherapy.com and you'll see our tips guide there that you can download.

If you go to our blog, you'll find tons of helpful videos and blog information on what to do about any problem. If you think that you want to get in touch with us and get started with working on your knee problem with us, we'd love to help you out as well. You can call us at 915-503-1314 to find out more information. But if you are just at home, you just learning right now that’s totally cool. Absorb all the knowledge, do your research, talk to the right people, and make sure that you take care of any problem. Don't wait. Please don't let it get really bad. I hope you have a wonderful day.

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Knee Pain Treatment Options – An Exhaustive Talk


Hello El Paso! Welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh, physical therapist and I'm the owner over at El Paso Manual Physical Therapy. We are going to cover today knee pain, and all the treatment options. We are going to be pretty exhaustive about all the possible treatment options you could take, if you are dealing with a knee problem.

Now before we get into the meat of this episode and going over all the details about the treatment options, let's just talk about the big idea. You can pretty much divide all of these treatment options I'm going to go into, into a short-term treatment option, and a long-term treatment option. I tell you this because most people don't talk about this, if you are searching up knee pain treatment options on the internet, you are probably not going to find it labeled that way, you are not going to find, ice, for example, as a long-term treatment option, or a short-term treatment option.

If you think about it, and use common sense, you can pretty much figure out it's going to be a short-term treatment option. Just think about that as we are going through everything, and I'll drop little tidbits about whether it's short-term or long term. The reality is that a long-term treatment option typically involves the most effort on you part. If you are dealing with any problem right now, and you are looking at fixing it for the long term, just realize that there is no easy way around it, there is no shortcuts, you have to get stronger, you have to get to get to the root of the problem, you have to move better. You have to figure out how to take pressures off your knees, and how to put your knee in a situation where it heals the best.

Everything else is pretty much secondary to that. Depending on any sort of traumatic, massive injury, where you absolutely need some procedure done. If you haven't had that, if you just have knee pain that has developed over time, there wasn't really any big massive injury. Maybe you had an old injury in high school, or when you were younger, and it's just been following you as you have gone along and getting a little bit worse. That's typically how knee pain comes on. There is a way to get better naturally, without having to rely on surgeries, medications, and injections. But it's going to take some work on your part.

It's very doable here in the clinic, we help people directly with that treatment option, and we have people achieve long-term relief from the pain, and we have them avoid surgery, avoid injections, and stop relying on pain medications. That being said, think of everything as a short-term treatment option, or a long-term treatment option.

Let's start with the at home remedies that people will typically do. I'm just going to go down the list here. Some of them we will talk about, some of them I'll just mention.

Ice and heat are one of the most commonly used home remedies for knee pain. It is completely temporary. The ice is thought to numb the area, and take away the pain temporarily, while your body part that you are seeing is really cold, you kind of don't feel the pain. Heat is providing a similar feedback to the body. It's providing a different sensation so that you don't feel pain. Now really quick, just a side note about this, because it's going to follow the rest of the things that we are doing here, the home remedies that we are covering here.

There is a theory on pain that is called the ping gait theory. Now there are holes in it, but for the sake of simplicity, we are going to use that. The idea is that, if you can distract your brain from the pain that you are feeling, then you won't feel pain, and it's beneficial for you to move on in life at that moment. The classic example is, if you ever bump your shin real hard on something, that really hurts, and what you reflexively will do is rub your leg right where you got bumped on your leg. Rubbing your leg does not heal yourself. It just distracts your brain from feeling the pain that you have caused yourself from hitting your shin. But we do that reflexively. Think about it, you will grab it, you will rub it. Same thing with bumping your head. That's just what we do.

I think that ice and heat may be similar. I can't tell you for sure, I'm not an expert in researching that kind of stuff, I can just tell you from what I've read, and what I've seen with patients. But don't look to solve your knee pain problem with ice and heat, it's only going to give you some temporary relief, which is okay.

Because it helps you avoid the next thing, over the counter pain medication. Some people need to take pain medication for their knee problem. That's cool. If you can avoid it, it definitely can hurt your organs over the long term. The idea with over the counter pain medication is that you just take it for a short period of time anyway. If you are doing that, then you are okay, but if you are relying on pain medication to fall asleep every night, or to get through the day, because you are going to be on your feet a lot, then that is not a good situation.

Some over the counter pain medications that you typically see will be Tylenol, Advil, Aleve, etc. and these are all different types of medications, Acetaminophen is Tylenol, but naproxen and ibuprofen are all NSAIDs, something that you might find on the internet, non-steroidal anti-inflammatory drugs, and they work a little bit differently from paracetamol and Tylenol, that kind of thing. You have to be careful when using these over the counter pain medications. Make sure that you are not taking them for the long term.

Another type of medication that you can get over the counter, but you don't take by mouth is pain patches. Typically, these are using lidocaine. Now in some places, they not legal without a doctor's prescription. You have to have a doctor's prescription. You will have to figure out what's available to you in the drugstores. But I have seen people using lidocaine pain patches, they will put it on their knee, they use them for their back, as well as other parts of their body. That can temporarily take away the pain as well.

There are other lidocaine pain creams, that's what we'll talk about next is lotions or gels that you rub on your knee and can relieve pain temporarily. There is a bunch of brands asper cream is one, Bengay, IcyHot, BioFreez just to name a few. There are dozens others. Tiger Balm is another one that comes to mind. They all use different types of chemicals and products, and they all are a version of a medication that you are just rubbing in. Essentially, they do penetrate your skin and go into your bloodstream.

Although they tend to be safer than taking pain medication by mouth, you are still putting ingredients that are dangerous into your body, just through your skin, and I have heard of some extreme cases. Of course, you would have to use a heck of a lot of lotion of these pain lotions or people have died from using too much of certain pain lotions. I'm not sure which one but I'm sure that's very rare. You have to like dip your body in one of these lotions pretty much.

Some other home remedies that people will use are Epsom salt baths. They will draw a bath, fill their tub of warm water and you can get Epsom salts at pretty much any drugstore, grocery store, and you can dump that into the hot water and soak in it. Some people find some temporary relief from using that.

Another option is the trending essential oils.

There are a lot of people out there that are picking up essential oils. We actually use them here in the office occasionally, and mainly for defusing. We put them in the air for a room for therapy type stuff. We don't use it heavily every day, we have some clients that are a little sensitive to odors, I myself too, if somebody that wears too much perfume or cologne or something like that it's a little overwhelming sometimes. But there is some suspected benefit to certain essential oils. I can't tell you which ones exactly, you would need to talk to an essential oil expert. You would be rubbing it in onto your skin, kind of like you would these pain creams, and getting a pain relief benefit from it.

But it is temporary. To my understanding, it's not going to fix anything for the long term, but it might be safer than using pain medications.

Along the same line of essential oils. There are homeopathic alternatives.

We are talking stuff like CBD oil, which is a derivative of marijuana. It's the part of marijuana that's safe to use, as far as not making you high. It's the pain-relieving part and there is a growing market for that right now where more people are getting interested in it. It's kind of ambiguous as to whether it's legal or not, I'm sure you might know about all the controversy surrounding it or you might not, you just got to be careful with where you are using it, when you are using it, all that stuff.

I've had clients in the clinic that report they are using it and say that it makes them feel a little bit better. But again, it's just a temporary thing. It's not going to last and cure the problem. If you have knee arthritis, a torn meniscus, torn cartilage, or some chronic injury that's starting to hurt you, oils are probably not going to be the main factor in fixing this problem.

Other homeopathic alternatives are apple cider vinegar, Ginger turmeric.

There are a bunch of other herbs out there. I've heard of patients telling me all kinds of things that they've tried taking, and some report some benefit, some say that they hardly notice anything or nothing. I haven't had anybody flat out tell me that it made them worse though, so I can't speak to it hurting any problem. But you can try that out.

Along the same line I get asked all the time about supplements, supplements that you should be taking for knee joint health, and the two most common ones that have been around for a long time are glucosamine and chondroitin. You can find these in all kinds of forums, typically they are in pill form. You can go buy a bottle of glucosamine and chondroitin, usually combined into the same tablet at the at the store or at a drugstore.

There is a decent amount of research on it. What I've gathered from reading the research is that some people benefit from it. Some don't. I haven't seen that anybody gets hurt from it though. So, it's worth a shot. If that's something that you want to try out.

Going along the next step from supplement is diet.

Diet is something else that people often try at home. They will avoid inflammatory foods, and those tend to be foods that are high in sugars lactose, as well as which is found in milk. I've heard of that being a big one, and they will go more for anti-inflammatory foods. You are talking more plant type foods and weight management along with that, so making sure that your weight is in the proper range so that you are not putting too much forces to your knees.

That's a process as everybody is probably familiar with dieting that is. It's definitely possible to lose weight, and manage your weight, but I've had people too that are in great health, as far as their weight and they eat pretty healthy, from what they eat in their diet, and they still have problems. So there are other factors as well besides diet that can influence your knee. But it's definitely going to help you on other fronts. If you have some weight to lose, going on a diet is not at all a bad idea.

Next on the list, we have massage. Massaging.

Whether it's done by a professional or it's done by yourself or a family member or something like that. Massage on the thigh and hip muscles, or leg muscles can definitely relieve some knee pain. I've seen that happen. We actually do it here in the clinic, but it is short lived. There are other things that need to happen along with the massage. The way that the massage happens and where the massage is exactly as far as the techniques use, the forces use the muscles worked on. There is quite a bit of detail to it.

We have clients that try self-massage and get a pretty good effect from it. And then we have others that get frustrated because they feel like their knee gets worse doing it. So just watch out with using self-massage or getting a massage from a professional as well. If you go to a massage therapist, you just got to be careful about what their training is in, what their background is as far as, are they doing more spa type massage, like relaxation massages, which is cool, you might want that and that's fine.

But if you are going to one of those types of massage therapists, to get a knee treated, you got to think about that plan. You might want to see somebody who has some pretty good experience in doing massage on the problems.

The next thing on our list is stretches and exercises.

We get people in the clinic all the time that are showing us their stretches and exercises, that they have been trying on their own. They may have learned them from the internet, from YouTube or from Google. They may have gotten them from family or friends, or they may have been doing stretching exercises that they learned from a trainer, or from when they were doing sports in school. People pull out all kinds of things, and they get them from all sorts of places. And that's cool.

A lot of times it benefits them, and they feel better with their knee problems. Sometimes though, it does make it worse. You have to be careful with that. The body is complex, there are over 400 muscles in the body, and understanding how they all work together, and influence the joints and nerves and ligaments, cartilage, all the different body parts in there are complicated. If you have been trying stretches or exercises, and haven't really been getting much luck, then I strongly suggest you get some professional help on that. Because that can be harmful in the long term.

With stretches an exercise I have to tell you, we use some of those in the clinic here. There is a component of what we do, which is exercising. But it's in combination with a bunch of other things. It's really just one thing that makes somebody recover for the long-term from a knee problem. It's really about finding the right mix of treatment approaches for you.

Which means you got to try different things, you got to maybe get some expert help sometimes, to point you in the right direction. You have to figure out what works best for you. There isn't one thing, it's rare that one thing helps fix long-term knee problem.

Next on the list, we have sleeves, like knee sleeves.

These are the type of sleeves that you buy at athletic stores, or even Walmart. You slide it up on your leg, it gives you some compression, a variation of that would be braces. The difference for me between a sleeve and a brace is that, a sleeve you just slide on, and it's compressive on your knee. A brace you will slide on and then you usually have to strap around your leg to cinch it down. And many times, they have brackets built into the sides that stabilize your knee.

Some of these sleeves and braces are infused with certain materials like copper. You hear about the copper sleeves all the time. They are pretty heavily marketed, and some are not. There are other materials out there that are helpful for knee health. Magnets is another one that I've seen. All of these braces can provide some immediate relief in in certain knee problems. In fact, when I see clients with certain knee problems, I make a brace part of their treatment plan for a certain period of time, because especially if you have a ligament injury, we are talking like an ACL or an MCL, or some other related ligament injury, it almost always requires bracing for a period of time to let that ligament heal.

That's expert advice I'm giving patients after I've checked out the ligaments, and after I've watched other things about them and learned, in talking to them and have been able to determine that that's a component of what they need to get better for the long term.

If you are trying to get a brace or sleeve, make sure that you have some guidance on when to get off the brace or sleeve, because if you have it on too long, that could cause some problems. It's not a good idea to use a brace or sleeve for the long term, or indefinitely. You need to have an endpoint. You got to have a good reason to put it on, and a good reason to take it off. You might be trying it to see how it feels better. That's definitely a good reason. But you have to know when it's time to get out of the brace.

Related to braces are wraps, like your Ace wraps.

Those are those long strips of stretchy cloth that you can wrap around your knee. Those are typically used for a fresh injury like somebody that was playing sports and just hurt their knee. Or I've seen people use them at home as well, and those can be beneficial. They will use that in combination with putting on some sort of cream or homeopathic concoction, or using other stuff that I talked about earlier just to add some impression, and also get the other effect from the creams and medications and herbs they put on, and I think that's cool.

That's definitely a great way to avoid harmful medications that could damage your organs. Wraps can be beneficial for sure.

Straps is another one.

I used one of these when I was going through high school. There are different types of straps out there. One of the most common ones is called a jumper’s knee strap. It's literally a thin strap, maybe an inch and a half wide, that you wrap around your knee and the part that sits on the front of your knee. It usually has a little tube on it that puts pressure right under your kneecap. I actually remember using this in high school and it did feel better.

They use it for jumpers’ knee, something that happens. It's a pain that happens right below the kneecap to people that are involved in running sports and sports. It involves some jumping when using these nice straps, they slide on with Velcro, so they don't stay on the best, especially if you are really active. But they are just a temporary thing. They don't fix a long-term knee problem. It's not a good idea to wear that long-term along with the sleeves, the braces and wraps idea.

There has been an increase in people purchasing their own electrical stimulation units for home use.

Another name for these is TENS units. TENS stands for trans-cutaneous electrical nerve stimulation, and all it is, it’s a little machine that you put batteries in, it has wires that attach to these sticky pads that you put around the area that hurts. It usually has an on switch and a dial, where you dial up the intensity. There are other settings on there that give you little electrical signals that go through the pads and you can turn it up to where it makes your muscle contract. Usually, and in terms of frequency, of how often it turns off and on, you can vary with it. There are all kinds of little settings you can put on these machines.

The research around these machines are that they do help with pain, so they can actually take away pain. I think it's along that same line of hitting your shin, and if you rub it, you get distracted from the pain. I think it's a similar effect to get with this, because what the research also tells us is that the machine stops helping you after you take it off, obviously, right? So that just means that it's a short-term effect. The machine only really helps you when you have it on and it's sending little electrical signals to your body. But the pain usually comes back right after you take off the machine.

These are commonly found in Chiropractic and physical therapy offices, and I think they are cool, they use them, and they can provide you some relief for sure. In an office like that they might put a hot pack over the electrical stimulation pads and it typically feels really nice to do it for anywhere from 10 to 20 minutes. But you just always have to question how effective is this, in fixing my knee pain for the long-term?

Because if I have a knee problem right now, I sure as heck don't want to be dealing with it in six months or in 12 months, or even next month. I want it gone. I don't want just temporary relief, because everybody wants to get to the fun parts of life, right? You want to be able to go travel, do fun stuff with family, be with friends, exercise, be able to be active, feel comfortable doing whatever the heck you want. And this electrical stimulation machine is not going to get you there. It's just going to give you some temporary relief.

Up next on the list of things to try at home is shoes.

So many people will say: “Well, my knees have been hurting and these shoes are really old. I've had them for over a year and look at them.” They are all worn down. You can even see the treads on the bottom anymore, and I'm sure the sole of the shoe lost its cushion. You hear all kinds of things and yes, I agree that get keeping some adequate shoes on your feet, whenever you are active, some shoes that are adequately cushioned, adequately treaded because you need that grip.

Basically, you should have some good shoes on pretty much all the time. That is a good thing for you. But chances are that your knee problem is not just coming from the shoes, that's rarely ever the long-term fix. You might get some good relief. People that change their shoes out, find that it really helps out their knees.

They might be better for a while and it could last you 6 to 12 months, about the same time-frame that the shoes begin to wear out again, and they need new shoes. But I always have to look up the chain of joints and muscles, and see what's going on at the hip, and the knee muscles around the thigh and those things are not influenced directly from the shoes. Usually the foot position, and the foot muscles have to be addressed as well.

Along that same topic insoles in shoes or something else that people go to get.

I think those are great. They can make a huge difference in the position of your ankle and foot, supporting your arch, or supporting your heel, depending on what you need. But the confusing thing is to go shopping, especially if you are on your own and you are trying to pick up the right pair of shoes, or the right pair of insoles to slip into your shoes.

Another name for insoles is orthotics and some people will go to podiatrist to get orthotics, or there are certain stores out there that sell high-end insoles or orthotics. I think they are generally good. Occasionally the complete bad fit will make your foot hurt more, or your knee hurt more. So you just got to be careful. There is a bit of trial and error with that.

But keep in mind that if you are not very strong up top, if you are not moving very well, if you have other issues, shoes are only going to solve a small piece of the problem. But it's worth a shot to see how big of a problem it solves for you.

Now, the last few things we are going to go into here are definitely more extreme, but I have seen people do it. I won't put it past anybody here to try their own.

I have seen people using crutches for the long term, where they won't even put weight through their leg, they would rather be on crutches for months on end, years even because their knee hurts so much, and they are afraid to use her leg.

Crutches are okay in the short term, maybe a few weeks, maybe over a month at most, but there needs to come a time where you put pressure through your leg, and you need to start using your leg normally again so that your knee can act like a normal knee again. Long-term use of crutches is not a good idea. But if you just got hurt, and you need to get around, definitely crutches can be a good plan for the immediate future.

Canes and walkers are other variations of crutches essentially.

Now a cane a walker is definitely a more long-term device to use. You typically see older people using them, but I'm not opposed to making somebody who's younger, say a person in their 40s or 50s or even younger, using a cane, or a walker when it's appropriate. But generally, the idea with a cane or walker is like the crutches that you should be able to get out from using it.

Canes and walkers are helpful for people with balance problems, and if you have a knee injury, and you can't support yourself very well in your knee, whether it's arthritis, a ligament problem, a cartilage problem, or meniscal problem, it's likely going to affect your muscles over time, which will affect your balance over time. So, for some people, they will need to be using a cane or walker for a longer period of time, but it may not solve their knee pain problem.

It's important to still look at what needs to happen, exercise wise, movement wise, to fix a knee pain problem. And that's what's going to set this person up to get away from the cane and walker, and have the confidence to go out and walk into the public, unfamiliar areas, on gravel, on uneven ground, going up and down stairs, being able to go up and down the curb, or small steps in public, so that you can feel that you are not going to fall, or not further injure your knee.

The most extreme thing that I have ever seen, I'm in El Paso of course, which is in in the southwest of the United States, and we are in the desert so it's definitely warmer than many other places in the country. I have seen some people that have had long standing knee arthritis that lived up north, that moved down south where it's warm, because their knee feels better in a warmer weather versus colder weather. The people that I met that did this move to El Paso, say they love being in warmer weather anyways, so it wasn't like that was their only reason for moving.

I just thought it was interesting, and I'm sure it's crossed some people's minds out there. Maybe I should move to where it's warmer, so my knee won't hurt so much. Maybe I should move towards sunnier, and there is not so much rain and clouds so that my knees won’t hurt so much, or my back. I hear people talking about their back hurting with the weather as well.

So that is another thing that people will try at home and it may affect it. I honestly can't tell you how effective that is. The people that I've met that did that said that it helped, but they were still seeing me here in the office for knee pain with their knee problem. So I doubt that it's a cure for any problem. There are other things to look at.

All right, so great job and hanging with me. We are going to go into the medical field next and talk about the other treatment options that are available to you through the medical fields. You have to be able to go see a specialist to access these things, and most people will first visit their family doctor, their general doctor, a physician, they might even see, a nurse practitioner, or physician's assistants for this. If you show up to one of these people with your knee problem, and you tell them that your knee started hurting, it's been swelling, you can't walk for very long, or you feel stiff when you are standing.

There are different reasons why your knee might hurt, they will evaluate you and figure out what's going on so that they can give you a diagnosis. They may order x-rays, they may do them there in the office or send you somewhere. They may also order an MRI If they feel that that's the next best step, and more often than not, they will prescribe you drugs and that's their specialty. A physician is an MD which is a Doctor of Medicine. Their specialty is telling people what drugs to take or not take.

The common drugs that are prescribed for a knee problem are steroids, muscle relaxers and opioids. These are prescription pain medications, different from the over the counter pain medications, although some doctors will definitely tell you to start with the over the counter stuff. They will tell you go get a bottle of Aspirin or Tylenol, and start there, or get some ibuprofen start there. Or they may prescribe you the prescription dosage of those medicines, or they may just give you the prescription medications that you can't get over the counter.

Some of the most common steroids that they will prescribe are prednisone or prednisalone. I apologize if I'm mispronouncing all these medications, if you are in the medical field out there and you are like, oh, he said it wrong. I'm a physical therapist, I stay out of that place in the medical field. I'm just covering it right now just to give people a good example of what they will encounter. But I am never prescribing these to patients. I just hear about them and I know these are commonly used medications.

My specialty is in helping people avoid having to rely on medications. It's okay to use them for a short while, of course, but you don't want to be taking these long-term, it damages parts of your body that you need for the rest of your life.

Another type of medication that people will often get prescribed are muscle relaxers. Some common ones are Flexaril, Somasenaflex, and Rowbackson. If you are taking one of these, you might find that you are pretty drowsy, when you take these. They are very much like tranquilizers, they do make your muscles relax. But not just the muscle that is hurting your knee, all of them will relax. A lot of people don't function too well on these muscle relaxers. They feel sleepy all the time. They will use them to sleep usually, but some people will take them during the day as instructed by their doctor, and I've had patients come in and tell me I can't work. I can't be with my family. I can't do anything while I'm on these muscle relaxers. My knee feels better but I've lost all these other parts of my life because I'm having to take this medication right now.

Another medication that is often prescribed for knee pain is antidepressants surprisingly. Now of course these are used for depression, but they have found that there is pain relieving effects in many antidepressants. Some of the common ones that are prescribed are selects a Prozac, Zoloft, and Cymbalta, and certain dosages are known to relieve pain in some people. Once the doctor has determined which medication, or combination of medications that they want to prescribe you.

Of course, you decide if you want that or not, you have to figure out what's best for you, then they might refer you to a specialist. When they are talking about a specialist or they are usually talking about a surgeon like an orthopedic doctor, another name for it would be an orthopod, an orthopedic surgeon, an orthopedist, as well. And these specialist types of doctors usually do orthopedic surgery, so they are doing different types of knee surgeries and other surgeries to another type of specialist.

You might get referred to a pain management doctor, which can do some procedures as well, but are trained in pain relieving treatments. That might include medicine injections, those are the guys that bring out the big medication. If you end up seeing a pain management doctor, they might be the type of doctor that prescribes opioids.

Just a quick word about opioid pain medications. If you know anything about pain medication in the medical field, you might be aware that there has been a controversy in the use of them in the prescription. They can be addictive because they are derivatives of opium. Some people feel like they need them to function. They are very good pain relievers, but they can be dangerous and addictive. Always think about that and talk to your doctor about that and make sure that you are following best practices with the doctor on using these opioid medications.

But I'm not here to tell you don't take them completely. You have to decide for yourself what's best for you. Because it's your body, it's your life. You have to think about what's at stake. I always tell patients, if you are pretty grumpy right now, because of your knee problem, or you are pretty limited, or you are just in a spot where you have to get around, and your knee is not letting you, maybe some medication is a good idea in the short term. But please, please, please be working on a long-term solution so that you are not having to rely on these pain medications.

So, back to the pain management Doc's, some common opioid medications that they might prescribe are Coding. Fentanyl, Vicodin, Percocet, and these drugs are used for a variety of different problems, but one of those might be your knee. If you go see the pain management doctor, you might get prescribed an opioid drug.

Other things that pain management doctors can do are pain injections, there are different types of medicines that they will inject into your knee. They do some procedures as well. One of the common procedures that are done, in pain management clinics, are something called RF a radio-frequency ablation, which basically is where they go into your back and burn a nerve, using radio frequencies that connects to your knees so that you don't feel the pain. It's essentially shutting off the nerve or cutting off the nerve that feels pain in your knee.

It has mixed efficacy. In other words, it sometimes works sometimes doesn't. I think it's a pretty questionable technique. Of course, I'm not a pain management doctor so I'll never tell a doctor not to do it. That's their field. That's their decision, of course. And of course, as a patient, you have to decide if you want that done. But whenever patients come and talk to me about it, I always tell them, “well just think about what all the other things that are controlled by this nerve, and what's going to happen if you lose this nerve.

I don't know the research on this, there are all these questionable things when it comes to radio-frequency ablation. I would just make sure you think twice, maybe get a second opinion and see if that's the best option for you.

Now let's talk about the other types of specialists out there. The orthopods, the orthopedic surgeons, those doctors will also do injections on your knee. Commonly, they are injecting something called cortisone, which is a type of steroid that is pretty effective at relieving pain and also reducing inflammation.

A word about inflammation. Inflammation is the first step in healing that's supposed to happen in the medical field, and I think in our culture in general, inflammation is seen as bad. Absolutely too much inflammation can be a bad thing. But it is really the first step in healing in the body, and without that step it's impossible to move on to the next step. If you are constantly getting some sort of anti-inflammatory drug put into your body, you are really limiting your healing.

Therefore, it's got to be a short-term solution, because you are focused more on getting rid of the pain rather than fixing the problem for the long term. If you are fixing the problem for the long term, you have to go through some inflammation, and get to the next step to where everything can heal properly so that you can get back to life as usual.

Back to the injections. There are other things that doctors are injecting out their sindevisque is a new product that I've heard about. It's hyalaronan is what it's made out of. And my understanding of this is that it's a fluid that's injected into the knee to act as your normal knee joint fluid and cushion and help heal the inside of the knee.

It sounds great in theory, but I really can't tell you if it's working or not. You would have to talk to your orthopedic surgeon who does this kind of injection, because not all of them will do it. I know that it's covered by most insurances because it's so new. But I can't tell you any pricing on that kind of stuff, you will have to ask your doctor about it.

But it still does not account for the strength up in your hip, strength in your in your knees, strength in your lower leg, or the way that you are moving. There are all these other natural things that still need to be addressed. In my opinion, it still falls under the short-term solutions.

Other things that are injected are PRP, platelet rich plasma and stem cells. These are newer in the Regenerative Medicine Department. That's kind of a growing field. Regenerative medicine means that you are getting your tissues to regenerate, you are trying to heal your tissues. PRP is probably more commonly done. Stem cells is kind of quiet because its legality is questioned. It's controversial as to where the source of the stem cells are, which I won't go into on this podcast. It's a whole other topic in conversation. But it's hard to find a doctor that even does the stem cells, or it's just not commonly done right now. But those are options for you.

Typically, an orthopedic surgeon will try injections first, of course, you would have already tried oral pain medications, maybe other types of home remedies. What typically happens, if you don't get the relief that you are looking for, is the surgeons with all their good intent will then recommend surgery, especially if you have something that they can repair surgically or help you out with surgery.

Some of the common surgeries that are done on the knee are ACL reconstructions, which is a repair of the ACL ligament that tends to happen in younger people, but it can even happen in middle and older people, a lateral meniscus repair is a medial meniscus repairs another one. That's where they go in and fix the big chunk of cartilage inside your knee. They might also do a partial discectomy, which is where they take out a chunk of cartilage from your knee.

Some of the more experimental surgeries out there are micro-fracture, where they will drill small holes into areas where there is less cartilage in the knee, where the cartilage has worn down, or it might be bone on bone in that area. That surgery is tough, because it does take a very specific rehabilitation afterwards. Because the idea is that, from those drills, those holes that they drill into the bone, they are trying to stimulate the cartilage to grow back and that just takes a long time.

The more common extreme surgeries that are done are partial knee replacements and totally replacements and those are done. Gosh, there is probably tons of them done every day. They have gotten really good at those. They are pretty effective surgeries, if you have severe knee arthritis, and you just can't bend or straighten out your knee. Usually it's been a problem for over a decade, maybe decades, then that's when surgeons will recommend doing a replacement type of surgery on your knee.

I have seen this next one just once and I question it definitely. Now, I'm not a surgeon, nowhere near it. I never want to be a surgeon. But I don't know that I've ever allow it. I'd have to have a heck of a good reason to allow a surgeon to do this on me. But I had one patient that had a knee problem. This has been years and years and years ago it was a different town.

She was just obsessed with finding the root of the knee problem, and before she got to physical therapy, where I was working. She had seen several doctors, seen several physicians, seen several specialists and tried all kinds of medications. She was young, she was in her early 30s, and what they were telling her was that there is nothing on her MRI that looks like it's repairable. There is no surgery that they recommended.

She continued to persist, and one day she walked in and said I had exploratory surgery, which means they went into her knee surgically put a camera in there to look for what was wrong. Now I was in charged with helping her recover from the cuts that were made, and the procedure that was done on her knee. She still had knee problems afterwards, they didn't find anything.

I don't know that I would recommend doing that exploratory surgery you have to of course, talk to your doctor and and figure out if that's the best choice for you. But that's another option that I've seen done.

All right let's get into physical therapy next. We are done with talking about the home remedies. We talked about family doctors and the medications they can prescribe. Then we talked about specialist surgeons and pain management doctors. Now let's talk about physical therapy, a very common treatment done for knee problems. There are all kinds of types of physical therapy. Let me start with the most common that's exercise based physical therapy.

Before I keep going, realize that most PT clinics don't really specialize, they don't really tell you that they are exercise based or whatever they are focused in. Most clinics do a bit of everything. It depends on which therapists you work with, and which clinic you are at. Even within a one business. It has multiple locations, they may have equipment at one location that they don't have another location. What you do in treatment will tell you which type of therapy you are doing, and you have to decide if that's right for you, or if you need a mix of things. You got to figure that out.

But by and large, just about every physical therapy clinic is going to make you do some sort of exercise, and that's generally good. Exercise is known to help knee problems. But like I said earlier, if you have been trying stretches and exercises at home and you found that it hurt you. Same thing in physical therapy, you have to communicate with your physical therapist about what exercises they might have you doing that is bothering your knee, making it swell afterwards, or just not letting you walk normal the next days after you do a physical therapy visit. They will usually send you home with exercises as well. You got to communicate with your therapist about if that's helping or hurting, or what the expectations should be because sometimes it might need to hurt a bit, especially if you are recovering from a surgery.

But mostly, especially if you haven't had a surgery, it should feel better and better each time you exercise. But an exercise based physical therapy session will pretty much have all exercises, you will go in and you will do a bunch of different exercises. That might be bands, involve like big, colorful rubber bands, there might be machines involved, you might get on a treadmill, elliptical, there is weight machines you might use. There are all kinds of things that you might do to rehab your knee. For a lot of people that's beneficial. It just depends on your type of knee problem.

Another type of physical therapy that is seen out there is aquatic physical therapy. The premise with aquatic physical therapy is that when you are in a pool, when you are in water, especially when the water is up to your chest or higher up to your neck, for instance, the buoyancy of your body in the water takes pressure off your knee. When you exercise in the water, you are exercising with less pressure on your knee, and also the resistance of the water as you move your leg, the water pushes against you, so that there is a small strengthening effect that happens with your knee. I think that's really cool.

For some people, that's what they need. This tends to actually work really well in people that are very obese and trying to find some nice relief. Because if for instance, you weigh 300 pounds when you are supposed to weigh, under 200, or if you weigh more than that, and if, for whatever reason, the weights there if it's some thyroid issue, or if it's just a health problem that you haven't been able to successfully address, that's okay. But you need knee relief right now so that you can get to exercising and help with your weight problem. Aquatic physical therapy might be a great alternative for you. So, give that shot and that might be the best place to start rehabilitating your knee.

Another version of this but that doesn't involve water is anti-gravity physical therapy. That means there are machines out there that can take weight off of. You usually get strapped in, but there are all different kinds. The popular ones right now will put you on a treadmill. So there is devices out there, I forgot all the name. There are so many Ultra G is the one that comes to mind.

But the idea with all these different machines is that there is some contraption, either clothing or harness that you wear that attaches to the machine. Depending on the settings of the machine, it lifts you, and you can usually set the poundage. For instance, if you weigh 200 pounds, you can tell the machine to take off 40 pounds. Now you only weigh 160 pounds, or whatever it might be, and then you would walk with only 160 pounds rather than 200. Depending on the settings, and how you are doing the exercise, that can be very beneficial for your knee as well.

Some of the more up and coming treatment options through physical therapy are blood flow restriction therapy and dry needling. Now with blood flow restriction therapy, this is probably the newest one there. What is happening is they are trying to increase strength in certain muscles. What they are doing is putting a strap around your thigh. This strap has a bladder in it that you can pump air into, so that it constricts your thigh and therefore restricts blood flow. That's why it's called blood flow restriction therapy.

Then the idea is you exercise so that you make that those thigh muscles work. It deprives the muscle of the blood and oxygen that's in the blood, which sets up a situation where the muscle might strengthen faster than normal. It's a really cool concept. It's new, it hasn't been fully researched, at least in my opinion. It hasn't really taken as being super popular and something that is going to help everybody or help a lot of people. I have not incorporated it in treatment. I don't think that it's a good long-term solution.

You might think, Well, I do you need more strength, and yeah, you probably do if you got any problem, I'd say 9 out of 10 people tend to need more strength in certain muscles. But the key is, with this blood flow restriction therapy, you can only strengthen certain muscles and only do it in a certain way. You are limited on the number of exercises you could do, the way the movements occur. It's not teaching you proper movement and it might be strengthening muscles that don't need to be strengthened and could actually harm your knee.

For example, in many knee problems, I see people that have way too dominant quadriceps muscles, the muscles on the front of the thigh, and blood flow restriction therapy tends to help people get stronger quads. Well if you have dominant quad muscles and then you go further strengthen those quad muscles, it's likely going to aggravate your knee over time. You got to be careful with that and as an expert physical therapist, I can tell you that that is not common knowledge, and even physical therapists may not grasp that and that's the field that should know is surgeons they may get that but their specialties doing surgery. Doctors and medicine may grasp that to a bit, but their specialty is medicines.

In the exercise and movement realm, in physical therapy, it's probably the lesser researched of the two there are a lot of people that are figuring out how to do this, and more research is still being conducted. It's a growing field and research. I'm not saying don't go try it, I'm saying go try it. But make sure that you pay close attention to what your symptoms are, how you are feeling, and if it's helping you or not, and if it's not helping you it might be because of that you are strengthening muscles that don't need to be strengthened.

The other up and coming thing is dry needling. Dry needling is really interesting. It's a lot like acupuncture, as far as the needles that they use, and the way that the needles are put into your body. But it's very different from acupuncture in the response that happens. Now, I love acupuncture, I've gotten it myself. I think that it's fantastic and I recommend it to clients as an alternative to using pain medications. I occasionally get clients that say I have allergic reactions to certain pain medications, so I'm just going to take them, I'll deal with the pain but if the pain is that bad I'll tell them go see an acupuncturist and they might be able to help with some pain relief and, and the ones that have worked with it did a great job.

But dry needling is different from acupuncture. In acupuncture, the needles go in, and they do other stuff that's I'm not familiar with. It's Eastern medicine. I don't know how it works exactly. I'm not even going to try to explain it, but somehow it works. It's not painful. It tends to be relaxing in fact, when the needles that are going into your skin. Acupuncture feels just like some pressure, occasionally a little sting. I can tell you, I've had paper cuts that are 100 times more painful than the most painful acupuncture needle I've ever felt. It really is not painful. I've never been to acupuncture that I've regretted going through, that I was in agony. It always felt fantastic. I feel great.

Dry needling is different though. When you get poked with a dry needle. They are sometimes pistoning the needle, which means they are pulling the needle in and out like a piston in an engine, and they are trying to make the muscle spasm. If you have ever had a muscle spasm like in your back, or a cramp happen in your leg, that's what they are  trying to get to happen in your body part that they are dry needling. It hurts! You are going to feel the muscle contract really hard. You are going to move and strain for a few seconds while the cramp happens, while the muscle spasms, and then they take out the needle, they might do a few different body parts just depends on how experienced the therapist is at doing dry needling and what their goal is.

But after the effects of the spasm were off, typically, there is relief in pain. But I always question if this is a long-term treatment? I would have to say no, it's definitely a short-term pain relief solution. It's a great way to avoid medications that are hurting your organs. If you are taking those for a long time, it's something else to do just to get you through a part where you have to exercise and is painful, or to get you through a part of your life that you just can't be in pain, because you are being grumpy or you got to work. It is a pain-relieving technique.

Let's go to the last one. I'm biased. I'm a manual therapist, I'm going to talk about manual therapy. But I truly believe that this is a fantastic way to long-term cure any problem. When I say manual therapy, I'm talking about the way that I practice, which is in combination with some of the things, I'll use exercise, I'll use strengthening, I'll use some stretching as well. I talk to the patient about modifications in their life, the way they exercise, the way they sit, stand and walk.

There is a combination of things that I'm using, but if we are talking about manual therapy, alone just to define it. What that is doing for the knee is it is hands on techniques by somebody who's trained in manual therapy, and getting them to move the joints, or move soft tissues as well. It could be muscles, tendons, ligaments that are not moving properly, so that they can make the mechanics of the knee operate better.

Depending on your knee problem, if, say for instance, you have a cartilage issue or a meniscal issue in your knee, this can be extremely beneficial, and many times can create some pretty instant relief. It may not solve the problem for the long term, I think it definitely is a short-term solution. But when used in combination with strengthening the right muscles, learning how to walk better, learning how to run better, changing your exercise routine so that it's helpful rather than harmful for unique problem, that as part of a neat treatment plan.

In that, like what we do here at El Paso Manual Physical Therapy, is what allows an individual to eventually not need the manual therapy, the hands-on treatment anymore. To be able to self-manage, and confidently go exercise, confidently go take care of their home and work, and all the things that they have to do. Without feeling like they are going to make their knee worse, or end up having to have surgery someday, that they could have avoided. So those are all the big things that can help you with knee problems.

That was a pretty exhaustive list, I did not think that it would take that long to go through all this, but I was as exhaustive as I could be, in talking about all the things that you could possibly do for a knee pain problem.

El Paso, I hope that you are doing well, if you have any problem out there. If you are looking for more tips and guidance, you can head over to our YouTube Channel you will find tips guides that you can download, and get sent to your email inbox immediately, to start working on some things at home. Some more specific advice on exercises and stretches, and other things that you can do.

If you think that you might want to hire us to help you, or at least have a one-time visit with us, to figure out if we can even help you, you can do that. The best way to get started is by giving us a call at 915-503-1314 and we'll be happy to at least talk to you on the phone and meet with you in person of course.

I just wanted to do this podcast to go over everything that I've ever heard, and known about that, can help out your knee problem so that you can know where to start to figure out what you have tried, and what maybe things that you haven't tried. Things that you are not comfortable trying, the upsides and the downsides of everything, so that you can make the best decision possible about how to proceed with fixing your knee problem. Have the best day ever. Bye.

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Meniscus Tears – Everything You Need To Know


Hey there El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, Physical Therapist, and I'm the owner of El Paso Manual Physical Therapy. I wanted to talk to you today about meniscus tears. We have had lots of clients in the clinic, over the past few weeks coming in with knee problems, and they specifically have meniscus involvement.

Now I'm going to use a bunch of different words, talking about the meniscus. I'll try my best to make sure I delineate the differences between them all. So when I say meniscal involvement, for example, that's just any problem related to the meniscus, because there are different types of ways that the meniscus can get injured, which we'll go into. But just follow me here. In case you are having trouble following all the different terms, don't worry, I'm trying to make this as simple as possible, for people that are not in the medical field and may not understand medical terms.

But I'll have to use a term every now and then just to make sure that I'm communicating clearly. I encourage you to go Google stuff and go look it up type in the word that I'm saying here, but like I said, I'm going to explain it as clearly as possible.

I'm going to tell you everything you need to know about meniscal tears. If you have one right now, you are going to probably find yourself in some of these symptoms I'm going to talk about, as well as some of the issues that are surrounding meniscal tears and treating them.

If you have never learned about a meniscal tear, let me just start with answering the question of what the meniscus is. I get asked this all the time. A meniscus is a chunk of cartilage that sits between your thigh bone and your shin bone. It's in your knee and you have two in each knee, you have a pair in each knee and the pair is differentiated by the inside one, and the outside one. In the medical field that’s called the medial meniscus. That's the inside one, and the lateral meniscus, that's the outside one.

The job of these two chunks of cartilage, in each of your knees, is to cushion the thigh bone on the shinbone, and make sure that movement happens. Normally in the knee, because if you ever look at the structure of the bones in the knee, they don't really sit on each other perfectly well. Well, the meniscus helps to fix that problem, it develops what's called congruency because the meniscus is cup shaped. They allow the end of the thigh bone to settle onto the top of the shin bone, the tibia.

The main job, like I said, is to cushion the femur onto the tibia, the thigh bone onto the shin bone, and of course what's above the thigh bone while the rest of your body your hips, your torso, head and arms. Because it's supposed to cushion it, it acts a lot like a disk in a spine. If you think of your spine or somebody's spine. There are chunks of cartilage between each of the bones in the spine, and their job is to absorb forces and cushion everything else above, and below it and allows certain movement to happen. So that's a meniscus.

The next question I usually get, from people coming in for treatment is, why does the meniscus tear? Why is my meniscus torn? How did it happen? Some people have an accident, maybe playing sports growing up, they were playing soccer or football or volleyball, basketball, one of those and they had a knee injury that went undiagnosed. They got better from it. They never felt like they had to go to the doctor. But they have never quite been the same from that injury there. They tend to avoid exercises that aggravate it. They just been babying it essentially for decades.

You do have some more extreme injuries where we are playing those same sports or something similar or car accidents or other accidents. People blow up their knee, they tear the meniscus, they tear the ACL, or other structures in the knee. They might end up having an operation afterwards because it was a massive injury. Those people can also end up with some meniscal injury later on in life.

There is another group of people that never had a sports injury growing up, never really had any injuries whatsoever. And then they get to middle age, they are in their 50s, 60s, maybe a little older than that, and they start having knee problems. They go to the doctor, get an MRI and find out that they have a meniscal tear. That's always a shocker for them because they are wonder how did they get this? They have never had any knee pain ever. They have never done anything that could have aggravated it, and they chalked it up to old age. They think well, I'm in my 60s now so I'm feeling older and this is what happens to old knees.

But let's talk about what really causes a meniscus tear. Those are just the perceptions that people have, the stories that people give here in the clinic. But when I look at a meniscal problem, somebody that is coming in and they are telling me about their knee problem, the way that the pain presents, I have to differentiate, is it more of an arthritis problem? Is it more of a meniscus problem, a ligament problem or some other cartilage in the knee? Because there is lots of cartilage in the knee.

There are other structures too, that that could be causing knee pain. Certain nerves can cause knee pain. There is actually a nerve that is called the saphenous nerve. It runs on the inside of your leg, and there is a massive branch off the saphenous nerve that lies right on top of the meniscus and could mask meniscus pain for some people. I have to be able to differentiate, is this a saphenous injury or a meniscus injury or is it both, and then decide how to treat that problem so that the person can get back to doing what they want to do.

But in a true injured meniscus, where there is a tear and there are problems with it, the structure of the meniscus is disrupted. A lot of these people can function without any problems. They may not even know that they have a meniscus tear.

Then there are some other people that have knee pain. They go get an MRI, they get checked out, and they are told that they don't have a meniscus tear. When we see them here in the clinic, they have knee pain, obviously, they may even have swelling and other problems that look a lot like a meniscus tear. But what I believe they actually have is an irritated meniscus, which you can't really pick up on an MRI or X-ray too well, and it's confounding for the medical field.

People don't know what to do with these types of patients that have knee pain, that doesn't show anything on any sort of imaging, any sort of MRI or X-ray. The way to think about a meniscus irritation is, just think of your skin, if you scratch your skin, not too hard, but hard enough to get it red, where you leave a red mark. That would be skin irritation. Your skin is just angry because you scratched it. That redness will go away within a few minutes, maybe at most, a few hours, maybe a day at most. It won't take long to recover from that before your skin will look normal again. But if you scratch yourself pretty hard and you break your skin, some blood comes out while you have an injury there, that needs to take some extra time to heal properly, and that's going to take you some more time.

In a true injury on your skin, you have to start the inflammation process, you have to send certain cells to the area, your bloods got to clot, you have to eventually form a scab, under the scab, over time, a scar will form the special cells to do that, that's called proliferation. And then over the course of a week or two, sometimes three, then the scab will fall off and you have a nice new little scar that formed to protect your skin and close it up. Now that's got to happen in just about every single tissue in the body. It just looks different depending on the tissue. That happens on bone, that happens on cartilage, on ligaments, on muscle, but obviously you don't see it because it's under your skin.

Whenever you look at your body, you are pretty much looking at skin everywhere. So, in a meniscus if you have a tear, it is really slow to heal, because cartilage is one of the slowest healing tissues in the body. I think in the meniscus, in my opinion, from my personal experience in treating people with this, this type of problem, it's the absolute second slowest, only second two discs in the spine. Discs in the spine can take a really long time to heal. But the good news about both discs and the meniscus inside the knee, the cartilage in the knee is that it does heal. If you put it in the right environment, you take the proper steps, it can heal. I've seen it happen many times and people are always super happy to reach that point.

The next question that you probably are wondering about, because you are thinking, well, do I have a meniscal problem or is it one of these other things you mentioned, arthritis, that weird saphenous nerve, other types of cartilage in the knee. Let me go the way that a meniscus tear feels in individuals. Whenever we spot them here I can, I can tell you exactly how they present. I categorize these people into three different types, mild, moderate, and severe meniscus tears.

In mild, there might be a little bit of swelling, these people tend to still be active, they get pain. Not every day, it's more so a couple times a week, and it tends to be associated when they are very active. A lot of these people are younger usually, they are in their 40s, sometimes 30s. You see some older people with it too. These are the people that are definitely in better shape and haven't had any injuries, and they tend to get a mild meniscus injury later in life. But they eill be running or playing sports. Being active with families. Some of them just like to go walk their dog and they will push their activity a little too much and that will set off their knee problem.

They will come in saying, I've been walking or jogging for years, and I started to train for this event where I had to do extra and then my knees started to swell up. But I gave it a day or two, the swelling went away, I felt fine again, and then I went back to do that exercise, and my knee swelled up again. And it's just concerning me because I'm getting older, and I want to be able to do this activity. I've never had any problem and I don't want to have to stop doing this exercise because it's keeping me in shape.

That's the typical mild presentation for a torn meniscus, or it could even be a meniscal irritation in these people. In fact, a lot of these people don't get MRIs. It's not that bad for them. Some of them barely get any attention from doctors though. They might go see him for a visit and then get sent straight over to physical therapy. They never actually get an MRI. Which is a good thing in my opinion, because if you have a tear, it leads you down a path that may not be the nicest. Ignorance might be bliss in this in this situation.

Plus, they get better once they come into the clinic and get treatment. They start improving, they don't feel like they need a MRI, or any sort of imaging, because they are happy with the results.

One person in particular, we had a woman in her 50s come in, she's ran for years and years, three, four or five times a week she runs on a treadmill at home. She is not into competition or anything like that. She just runs for her own benefit. She does other exercises as well some aerobics type of exercises. But she started to have knee pain all of a sudden, during and after running. Then she was flared up for a week or two. Nothing that stopped her from doing what she wanted to do. But she had to think twice about getting back on the treadmill because she knew that she would flare up again.

After we address certain things in her hips and her muscles around her legs, we even had to go up into her back, and down into the foot as well. She got back to running and she didn't have any problems at all, it stopped the swelling, we got it back 100%. So that would be a case of a mild meniscus injury. The people that come in at that point, I think are super-duper smart because they are definitely getting ahead of the problem. Ideally don't want to wait until it's more moderate or severe. But I'm going to go into moderate and severe next.

If you find yourself in one of those categories, don't take it the wrong way. Our medical field is just crazy if you have any injuries. We'll talk about it just let's keep going here.

Let's get into the moderate part. If you have a moderate meniscal problem, you think you might have a torn meniscus, the way this is going to present, you are going to definitely have swelling, you are going to definitely have limits on your activity, the problems might present daily. These people to tend to complain about going up and down stairs, usually going downstairs is rougher than going upstairs, and they started having trouble sleeping at night. Because of the knee problem. They also tend to say that mornings are pretty rough. They don't like to wake up and get up out of bed in the morning because those first few steps, getting up out of bed to head over to the bathroom. The knee feels stiff, it doesn't want to move well, it might pop and click a lot. It takes 15 minutes, 20 minutes, and some people closer to an hour to kind of loosen up the knee and kind of get back to normal.

When it's at that point, these people typically have stopped exercising. They are concerned that they are getting unhealthier. They are putting on weight and that's feeding into the knee problem as well. A lot of times they've been seen a doctor already, they might have had some sort of treatment that just didn't work out for them. They might be using a brace or something like that, and we'll talk about what to use, and what not to use here in a second but just bear with me.

If you think that you have a moderate knee meniscal tear, it usually is still salvageable quite a bit, you can usually get in the 90s, as far as percentage improvement, if we are talking, zero to 100%, these people tend to get 95% better, 97% better. They tend to do really, really well, they might just have some very mild limitations that they might not even worry about. Most importantly, they don't need to have a surgery or some sort of invasive procedure, and they can stay healthy the rest of their lives.

Let's talk about a severe meniscal tear. These people will have all the symptoms of the moderate meniscal tear, the ones that just covered, their swelling will tend to be constant. Of course, going up and down stairs is a nightmare for them. They avoid it at all costs. I've had people come in and say I sold my two-story house because I could not go upstairs anymore. And I live in a one-story house now and I avoid stairs at all costs. I always use the elevator the escalator. These people tend to walk with a limp. They have changed their walking pattern over time. Some of them will use a cane, they tend to be older because this has happened over time.

One of the classic symptoms that severe meniscal tear will have is joint locking. What this looks like is their knee will get stuck. They will sit down, or go to get up, and of course you have to bend your knee during that process, and when they are about to transition either into sitting down or getting up, their knee will get stuck. They are sitting down, their knee won't want to bend all the way. Most people, when they sit in a kitchen chair, your knee will bend about 290 degrees, and it'll get stuck at 20 degrees or 30 degrees and they feel like they can't bend it to 90 degrees, it's painful, and it just feels stuck or locked. Usually they can shake it a certain way, kind of wiggle it around, and then it'll make a noise, it'll pop and unlock. Then they can bend their knee just fine.

Then the opposite will happen when they stand up, they will go to stand up and the knee will kind of stay bent. They usually have trouble balancing once they stand up, and they shake their leg around, and move it around, and then it'll pop, and then it'll go straight, and they can walk normal again. By normal i mean they are normal which is painful and with a limp and with swelling and all that. The thing behind this is that there are  a flap of the meniscus that's impeding motion within the joints. That's why these people can shake it loose and twist and turn their knee and it'll move better.

But if it's that bad, you have a severe meniscal problem more than likely. Now, the way that the meniscus will feel in most people, as far as pain, is that they tend to have pain on the inside of their knee. If you were to reach down and you feel your kneecap and then slide your hand towards the inside of your knee, there are  usually some bumpy spots there, depending on how much tissue you havegot, and that's where it tends to hurt for people.

Some people do have pain on the outside of the knee as well, and some people report pain on the back of their knee. There are  something called a baker's cyst that can develop at the back of the knee. When you hear the word cyst people, I think the mind picture that most people get is like a bubble that needs to be taken out or drained. The way I think of this is the joint is just very swollen inside the knee, there are  an active inflammation process happening, and extra fluid is being developed to deal with it.

Sometimes, I think the body is trying to build some cushion inside the knee as well. So, it's generating fluid, and it's a genetic thing. In my opinion, I think some people are just predisposed to react that way to different types of the injuries including a meniscal tear. That Baker cysts is a problem, because they will have trouble bending their knee and it's unsightly for some people. If they get really big, they just get really concerned with it. But the problem needs to be addressed, the meniscus problem needs to be addressed, and usually the baker cysts will reduce or become less of issue.

The medial meniscus, the inside knee meniscus is the one that tends to get affected more often. But you do see the lateral meniscus problem happen to a lot of people as well, and there are  ways to test both here in the clinic. But regardless of which one is affected, the treatment options are typically the same, and we are going to go into all that here in a second. But what you'll see with a meniscus problem is, there are  usually other knee problems happening at the same time. You'll typically see some knee arthritis developing, it's called osteoarthritis. There are usually some cartilage problems in the back of the kneecap, on the front of the femur, the thigh bone, and there could be some ligament problems as well.

There are some major ligaments inside the knee. I'll just go over them really quick. One of the top four are called the ACL, PCL, MCL and LCL. And these are structures that connect the bones to each other and hold the bones together. These four ligaments, their job is to make sure that the thigh bone stays attached to the shin bone. If they get elongated or torn, then that can cause stability problems in the knees. The connection between the two bones won't be as stable as it should be, which can cause the meniscus to get irritated because the meniscus will take some weird forces.

Let's talk about what happens to an untreated meniscus tear. We got lots of clients coming in here, of course they are getting treatment and some of them delay a long time on getting treatment, and the symptoms kind of worsen. And then we have the ones like I was telling you about earlier, where they come in when it's mild, and they haven't had any major limitations yet, and they haven't had a chance with all this other stuff to develop. But what tends to happen in people with untreated meniscus tears, of course, the meniscus problem gets worse over time. They move from mild to moderate to severe, and with all the problems that develop they will progress through arthritis way faster than normal.

About arthritis, arthritis is happening, and everybody constantly think of it as aging just like you get gray hairs and wrinkles on the outside of your body. The thought process osteoarthritis is that you get it on the inside of your body as well, and you age on the inside of your body as well, and it looks like osteoarthritis, so the joints change a bit. You might get different little structural changes in other tissues as well. For some people, they start developing small bone spurs. They start developing the cartilage might thin out, they get spots on their cartilage, the joint surfaces looking even, and it might not actually be painful at all.

In older people, I think, I'll have to dig up the research again, but it's in the 90s. I think once you are over 80 years old, it's like 93% chance that you are going to have some sort of arthritic change, or disc herniation in your back. I haven't seen the research on knees, but the rates go up. Of course, when you are younger, you still have a chance of having all that stuff happening, but it is painless and a lot of people. But if you have a meniscus tear, and you have other issues on top of that, like loose ligaments or cartilage issues in the kneecap, and you havebeen moving inappropriately for a while, you haven't been exercising like you probably should be, because this knee problem is slowing you down. Then it's going to allow for a faster progression.

Just think of it like your overall health. If you don't take care of your health, you are going to probably not live as long as somebody who does take care of their health. Your joints are the same way. If you don't take care of your joints, they are not going to last as long as if you do take care of them. People with meniscus problems in their knee, they tend to eventually develop hip problems. They can develop hip arthritis, they can get pain in the hip joint itself or around the hip joint. They will also get lower back problems. A lot of times we get ankle and foot issues as well. The foot changes the strength in their foot is usually affected and that can cause toe problems like hammer toes, bunions, other issues with the foot that that can be prevented.

Loss of arches in people that leave this untreated for a long time meniscus problem and then the arthritis gets out of hand, they will eventually likely get an knee replacement because the knee problem will continue to get worse. Of course, once they have that locking, like you get in severe meniscal tear that completely changes the mechanics, people really slow down. They don't want to move as much because of the locking and that makes arthritis progress way faster. If years go by, decades go by, then it's just a matter of time before they start getting told by their doctor that they need a knee replacement.

If it's that bad, if they've had joint locking for a long time and in their knee doesn't even move and have all the motion that is supposed to have a knee replacement a fantastic option for those people. The only concern I had is how are you going to move after that. You have to make sure you take care of your leg health, and get your activity back so that you can keep your body healthy, and make sure you don't have to have another knee replacement in a matter of time.

Now we are heading into the final part of this podcast here, we are going to talk about what treatment options there are for a meniscus tear. We will also go through the entire list of things that I see people do, and probably all the options that you are thinking of as well. I'm happy to entertain more if you leave us a comment on this podcast or get in touch with us. Let us know what other options are out there, I want to get a comprehensive list going.

Prior to getting any sort of medical treatment, we often see people trying home remedies.

The top things that people try, which is the easiest one, is just giving it time. They just rest it, they avoid moving a whole lot. They will avoid walking more than they need to, just to rest their knee. This is a very short-term solution, especially if you got an irritated meniscus it's going to feel better with off time. It absolutely will usually feel better because you are not standing on it, you are not putting weight through it, you are not using the meniscus like it's supposed to, so it has a chance to heal.

The problem is, if you haven't fixed the underlying problems that got to the meniscus tear, the meniscus problem in the first place. As soon as you get up to move again and you get active again, because you are feeling better, you are going to flare up again, we see people do that all the time. That's why they have the often symptoms where they say, Well, sometimes it flares up, and then a couple weeks later, I'm okay. Then another two or three months after that, it flares up again, and then it goes away. And then it flares up and it goes away. And eventually after going through this cycle enough times the pain gets worse and it stays more constant, or you don't get as much relief from the rest, because the original root problem hasn't been addressed.

The other things people will try at home, will be over the counter medications. Things like Ibuprofen, Tylenol, and Naproxen. There are a bunch of different medications you can get at the pharmacy over the counter. A lot of people try anti-inflammatory medications. The idea is to reduce the inflammation in the meniscus so that it can help with healing, and it's a pain reliever as well.

This is good for most people in the short term, they do get some relief. But after a while the drugs can become dangerous and this is not a good long-term solution. Ibuprofen is known to affect the lining of stomachs instantly, and for most people they can tolerate it pretty well, but I think the cutoff is six to eight weeks. If you are using ibuprofen consistently around the clock. After six to eight weeks the rate of people having major stomach problems, they get a hole in their stomach lining that spikes tremendously, which can lead to internal bleeding, which for a lot of people, they they need to go to the hospital for that. In some severe cases there is deaths that occur, especially in older populations, which is the people that tend to get these knee problems anyway.

If you are at home right now and you have been taking ibuprofen for a while, I strongly suggest you find an alternative, or take a break, or talk to your doctor about it and see what other options you have. Make sure you start to build a long-term plan to treat this miniscule problem because over the counter pain medication is not a long term plan.

Other things that people try are pain creams, you got your BenGay, Icy Hot, Biofreeze the rub that stuff all over their knee, and that tends to work pretty well in the short term as well. It's a pain reliever, it's not fixing the root problem, which we'll talk about here in a second.

The other the last most common thing that we see is people try knee braces. They will go to the store and buy a sleeve that slides over their foot and ankle and comes all the way up to their knee. These sleeves usually have a little opening for the kneecap to tell you where to line it up and leave some space for the kneecap. Some of these braces will be a little more heavy-duty, where they have metal brackets that are on the inside or the outside of the knee. A lot of people report that they have relief with these knee braces.

If you haven't tried a knee brace yet, and you are looking at trying to just get some relief, go for the knee brace that's definitely a way to get off the pain medication, if you havebeen using pain medication for a long time. It still is not going to solve the long-term problem, but I love the knee brace because it's not that dangerous for you to use. It's a safe way to get some instant relief, and most people report a little less swelling, they can sleep a little better at night.

But it only lasts so long because the problem is, knee braces tend to make your muscles weaker. Your body is smart, it can sense stability coming from the outside. The muscles will get lazy and you start to atrophy or lose muscle over time. A knee brace is just a short-term solution, you have to figure out a way to eventually not have to rely on the knee brace.

The other thing about knee braces is their main job, especially the heavy-duty ones, the ones with the brackets, their main job is to stabilize the knee and if you don't have a ligament problem, then it's not going to make a huge difference for your meniscus problem. You might need to get that checked out by an expert to know if you have more of a ligament problem, or meniscus problem, and get proper advice on how to use the knee brace.  Because what I see a lot of people do, that come in where they need brace. I ask them this question I say, well, who gave you the knee brace first of all? Was it just on your own that you got that, or did somebody recommend that you use one? Was it a medical professional? And then what's your long-term plan for this knee brace because, if you are in your 50s or 60s, wearing a knee brace right now, I would not want you to be wearing a knee brace into your 70s and 80s or beyond, you eventually need to get out of that thing, but you need to have a plan.

The last step in your plan cannot be I'm going to be in this knee brace the rest of my life. Those knee braces are uncomfortable, they slide down, they get stinky, you have to wash those things everyday probably, especially in the summertime, and they just don't allow for normal movement. Ideally, you want to be without the knee brace as soon as possible, but you have to get to a point where you can wean yourself off and be able to do your everyday functions without a knee brace.

Okay, let's talk pain medications, prescription strength pain medications. Let's say you have gone to the doctor for this knee problem, they will usually recommend some sort of prescription strength pain medication. There are a ton of different types out there. It depends on which doctor you see, what their specialty is, and what their background is. They will recommend all kinds of pain medications, and these are all short sighted, for the most part, they are just doing their best to help you out with the pain that you are dealing with right now.

Understand that medications do not make your muscles stronger, they do not make your cartilage healthier, or your ligaments healthier, or your meniscus healthier as far as the actual structure. In fact, a lot of these anti-inflammatory medications, they are stopping the first stage in healing. Inflammation is actually a normal thing. That's why our bodies do it. It's the very first stage in healing, and it needs to occur in order for proper healing to happen.

If you are relying on anti-inflammatory medications, like some doctors will prescribe a steroid pack which limits inflammation. It's an anti-inflammatory medication, it is stopping the healing process in your entire body, and that's why they can't give you too much of it, because they know the long term effects of it, but it may provide you some quick relief, which most people are looking for that are visiting the doctor.

That might be a good thing for you, especially if you need to just kind of get through the week or get through the month. Or you don't want to be mean or grumpy with people because of your knee problem because that tends to happen, and you just want people to sleep at night, you are losing a lot of sleep. There are definitely some benefits to using some high-power pain medications, but they cannot be your long-term solution. You cannot rely on those for the long term, you are only going to get worse in your meniscus problem.

The next way the doctors will help out with medications is they will give you injection medication. The most common injection that people get is a cortisone injection into the knee, sometimes they'll do two or three all at once. It just depends on the doctor and how they do it. That is pain medication injected directly into the joints space, or the space where the meniscus is. They tend to be pretty effective in reducing pain. A lot of people have this sensation where they feel instantly better, after the injection site heals, maybe a day or two.

They might need a few days to recover from the injection, but then they feel massive relief. They feel like they can walk again, be active again, do all the things that they want to do. But you have to keep in mind, if you just got an injection, or you have had one not too long ago, or you are going to go get one soon. You have to keep in mind that it is not healing your meniscus. In fact, it's preventing your meniscus from healing. It's just masking the pain and you have got to make a plan to fix this meniscus for the long term so that you are not relying on injections for the long term, or other pain medications.

They will limit you on how many injections you can get per year, especially these cortisone injections. Because the doctors are very aware of the research, insurance companies are very aware of the research. If you get more than three or four per year, I think that's usually the limit. I'm not a physician, I'm a physical therapist, if I'm off, if you are in the medical field, or you know about all these limitations, and you are like, this guy doesn't know what he's talking about. You are probably right. I don't keep up with that part of the medical field. I keep up with my specialty very well.

I'm giving you the information that I hear from doctors and what I learned going through school, and what I keep up with here and there. The laws change, and the best practices change over time, and that's completely normal. But what I hear clients saying is, they limited me to three, they limited me to four. I'm like, good, you shouldn't get more than that because it's going to mess up your meniscus in the long term or other similar structures. So, you cannot rely on those cortisone injections.

Other things that people will get injected is PRP that stands for Platelet Rich Plasma. This is part of the newer, I think they call it functional medicine or it's non-medicinal, and it's supposed to be the natural stuff. They are injecting you with platelet rich plasma, they have to take some blood from you. They put it in a centrifuge, one of those things that spins really fast, and they pull up the plasma from your blood and it's got tons of platelets in it. Which is a sum of certain structures that are in your blood, and they inject that into your knee and the idea is that it helps your knee cartilage heal faster. I've seen mixed results with people getting these. I've heard some people say that it definitely helped out their pain, and then other people say didn't do a thing.

The other thing that people get injected with is, and this is less popular, but it's up and coming are stem cells. You might have done some research because maybe you have a meniscus tear. You have known it for a while. You had an MRI a while back, and maybe you have been dodging surgeons, because they've been wanting to do an operation on you, and you are thinking of alternative solutions. I'm sure stem cells has probably crossed your mind once or twice. It's still controversial, the source of where they get the stem cells is very controversial. I won't go into that. Even the efficacy or the likelihood to be helpful for you, is mixed.

I have had some clients, that said that they had stem cells injected, and said that it made a big difference. And I have had others that said they had it injected, and saw only minor difference, or no difference. It's so new that we don't know much about it. Right now, there isn't much research. Not many people are doing it, and that that's all we know about it right now.

What I can tell you regarding all these injections is, they are not fixing the strength of the muscles, which usually needs to be addressed. They are not dealing with joint mobility, how well the joint moves, the quality of motion, the way that you move overall, the way that you walk and move. But that's something we fix here in physical therapy, which I'll talk more about in a second. There are still a lot of root problems that are not being addressed with these injections, and I think that's why people get mixed results because they get some relief instantly. But they continue to be weak and continue to not move well, and that sets them up to have the pain return. It's not a good long-term solution to the problem.

Okay, two more things. We are to talk surgery next. A lot of people get a surgery to fix their meniscus, they will do a meniscectomy, often a partial meniscectomy, which means that they take out a piece of the meniscus, usually a flap or a torn chunk. The idea is that the tissue is not going to heal, so they cut it out, get it out of the way. Because the assumption is that that is what's causing the pain. But what we know about the meniscus, as far as its ability to generate pain, the outer edges of the meniscus, where tears are less likely to happen. The outer edges are where you have the most nerve endings and where it's likely to be more painful. The inner edges are where you have much fewer nerve endings and that's where the tears tend to happen. It's a little controversial right now doing these partial meniscectomies, because there are actually a few studies coming out of England.

England, they have a national health care system, where it's run by the government, it's socialistic versus here in the US it's capitalistic. But as a result of them being of England being a national health care system, the government is very into figuring out what works and what doesn't, because they want to save costs. So, what they are what they are doing is something called placebo, partial meniscectomy.

What is happening is, they are getting people that have known meniscal injuries, they get them through MRIs, they get their MRIs done, and they find them meniscal tears, and they are putting them into these studies where they split them in half. Half the group goes into where they get normal surgery done. They are the normal partial meniscectomy be done, and then the other group goes into the placebo, partial meniscectomy. Both groups have surgeries. There are  interesting words in the studies, they say they even move the knee the same way in the placebo, they have the same tools, they put them under anesthesia, the same people are there, they take the same amount of time to try to account for every variable possible to make it exactly like a normal surgery. But the one difference is that they do not actually cut the chunk of the meniscus out that they were looking at cutting out.

They leave the torn meniscus alone. Then they close them all up, and after the course of six months, up to a year, what they found was that there was no difference in improvement between both groups. Both groups improved a bit, but not one group improve more than the other. Now they are thinking well, is this meniscus surgery even doing anything? Now they haven't done studies like that in the US, but I think it'll be interesting if they ever do.

For those people that have meniscus surgeries, what I would consider if this surgery even needed? Is that the best place to go? You open yourself up to a bunch of risks possibly, if you ever have a surgery, there is a chance for infection. You have all kinds of risks, and for some people, it is the best thing. I'll even tell some clients that this this is pretty bad, I can't help you with this, you need to go talk to a surgeon, ad I'll be straightforward and honest. But for a lot of cases, coming in a lot of people with meniscus problems, I'd say you know, 9 out of 10. What I'll tell them is I can help you out, and if it's real severe, I'll say well, let's give it a month with treatment., and if you are improving some, maybe you'll be happy with that level of improvement, we'll have a good idea for how much you can improve. Because you might be okay with getting 70% better if that's your max because at least you can walk around and do your normal things. 100% improvement may not be realistic for you, even if you had a surgery, who knows.

If you are out there and you have already had a meniscectomy, a partial meniscectomy, and it didn't improve, and you are one of those cases, unfortunately. Or if you are thinking about getting a meniscus surgery, or you are just learning about this for the first time, and you even know there was a meniscus surgery out there. Let me tell you about the outcomes of this.

A lot of people will improve, they get better, but then over time, they tend to regress, they get worse again. What we know for sure in the research is people that get meniscus surgeries are more likely to have osteoarthritis develop quicker in their knee. I think it's for obvious reasons. There is a chunk of your meniscus missing. So, the knee joint just doesn't move normally again, and it's going to age faster. It's really a short-term solution in my opinion to get a knee surgery, it might be the best decision for you depending on your situation. You have to weigh all those problems with you all those all those risks, all the factors to make the best decision moving forward.

But what the surgery is not fixing. Let's talk about that. Next is your strength, your joint mobility, the way that you move, the how you sit, how you stand. There are a lot of things that we look at here in physical therapy. Here at the clinic, we go into extreme detail about what you are doing, that led up to this meniscus injury. Because that's the question that needs to be answered. If we can fix the problems that led up to this meniscus injury, then you have an excellent shot at recovering for the long term. Even if you have had a surgery, you are going to have a surgery. It allows you to stop using the pain medications. avoid having to get injections. Stop having to worry about your knee all the time, you can get your sleep back, you can be able to go up and down steps just fine.

I'll tell you a story. We recently had a woman who came in for her hip. She actually had a hip surgery that didn't go too well but was having knee problems, and it looked like a moderate meniscus injury. In figuring out what was going on with her hip, and what we found in her was that her glute muscles are very weak. She just was not using them well. And it's counterintuitive because she's got a big butt. You would think she's got lots of glute muscle, and she has some pretty good strength, but she just wasn't using it well, and the strength that she had wasn't enough for the activities that she was doing. She was on her feet quite a bit, walking around every day for her job.

She doesn't have adequate strength to do what she needs to be doing throughout the day. And then she also isn't walking the best, so we had to figure out how to teach her. We taught her how to walk better way to figure out the problems there. We taught her how to strengthen her glutes better, and how to progress and to what level to progress to, and it's been amazing to see the benefits, we are five weeks in, now this week's upcoming is a sixth visit.

She is already sleeping better. She's walking much better. She stopped relying on insoles. She used to get insoles all the time. She feels like she doesn't need them anymore. The number one thing that we talked about recently though was, she's got a two-story home, and she was saying that she has to grab the rails to pull herself up with her arms to take weight off her legs, her hip and her knees. Because it was hurting so much. That was the first visit that I saw her. She flies up those steps now and can go down the steps with little to no pain, and she's still got tons of improvement to make.

This woman is set on getting back into the gym and doing the treadmill, being able to jog, being able to lift weights, and I think she's going to be very capable doing it. We just got to go a little farther and her progress to get to that that level.

So that's the root problem that we are fixing in here, we have got to find out where you are weak, where you are strong, there are usually something called a muscle imbalance happening. Muscles on one side of the body will be relatively strong, and on the other side of the body, they will be relatively weak. That stuff you can't pick up on an MRI. You can't see it on an X-ray, physicians aren’t trained to fix that or even identify it.

I think some doctors will have an idea of that happening, but they are not sure what to do with it because their specialty is medications, surgery, injections, those kinds of things. And that's cool. You need that sometimes. But if you are looking at fixing your movement, your strength, getting that long term, natural cure, because you take that with you, you can only get medication for so long and injections, and you ideally don't want to have more than one surgery. You are going to get one, you want to be going back for surgery all the time, doctors won't even let you do that.

You want to have fixes that you have control over, and that's what we teach here. It's heavy in education. We teach you what to do, and how to do it, when to ramp it up, or when to ramp it down, how to read your body, how to know what's normal, and what's not normal as far as sensations, and what you should be doing. We coach people through that process so that they can get to the point where they feel super confident that they are doing the right things, and that it's only helping their knee and not harming their knee.

There you go, guys. We talked about everything there is about meniscal problems. We covered what it is, what the meniscus is itself. How does a meniscus tear? What does it feel like to have a meniscal injury? We went over the mild, moderate and severe levels of meniscal tears, and what happens to an untreated meniscal tear. Of course, more issues are going to happen up in the hip and down in the foot. Then also the treatment options. We covered everything from what people try at home, and then what you can get done using the medical field, and what's going to help you for the short term, and what's going to help you for the long term. I hope this podcast was helpful for you. If you know of somebody that's got a meniscal injury, please share this with them. I want everybody to have the best information possible so that they can make the best decision about their own health moving forward. And I hope you have a wonderful day. Have a great day. Buh bye.

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