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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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