Back Pain Help - El Paso Manual Physical Therapy

Hi There!

This page was specially created for people in El Paso that are dealing with back pain and want to get off pain medication, avoid surgery and keep up active lifestyles.

We’ve curated all our best back pain education videos and exercises.

Scroll down to view the videos!

Get help now for back pain and sciatica.

Get This Book→

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

June 3, 2020/in Podcast/by dmiddaugh

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.

Knee Pain Treatment Options – An Exhaustive Talk

May 27, 2020/in Podcast/by dmiddaugh

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.

Top 5 Ways To Keep Cervical Stenosis From Getting Worse And Avoid Surgery

May 22, 2020/in Blog/by dmiddaugh

Would You Like To Talk With A Back Pain Expert?

Choose which one works best for you…

Click Here To Schedule A Phone Call With An Expert

Request a FREE 20 Minute Discovery Visit

Click Here To Ask About Cost & Availability

Hi There!

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

Would You Like To Talk With A Specialist?

Knee Pain Treatment Options – An Exhaustive Talk

Would You Like To Talk With A Specialist?

Top 5 Ways To Keep Cervical Stenosis From Getting Worse And Avoid Surgery

Would You Like To Talk With A Back Pain Expert?

El Paso Manual Physical Therapy

Our Online Programs