Knee pain — stop the suffering

On average, we take between 4,000 and 7,000 steps each day, exerting a force two to seven times our body weight, directly through the knee.

by Dr. Fred G. Arnold — 

The knee is the largest and most extraordinary joint in the body and combines an enormous range of motion with rotation, great strength and stability. On average, we take between 4,000 and 7,000 steps each day, exerting a force two to seven times our body weight, directly through the knee. More than any other joint, the knee is responsible for ending more athletic careers than any other part of the body, and it is where the most common painful bone and joint problems occur.

Complaints of knee pain are common in all age groups. There may be a specific injury or only a vague history of repetitive injury. Occasionally, no specific event can be recalled. The number of people needing knee-replacement surgery is 245,000 annually, and that number is directly correlated to people who are developing arthritis.

These individuals are likely to be those who have received cortisone injections; arthroscopy; the rest, ice, compression, elevation (RICE) treatment; and anti-inflammatory medications. Unfortunately, these treatments accelerate cartilage breakdown tremendously, and also accelerate the arthritic process.

Anatomy of the knee

The bones of the knee, femur and tibia meet to form a hinge joint, which is protected in front by the patella (kneecap) and cushioned by articular cartilage that covers the ends of the tibia and femur, as well as the underside of the patella. The lateral meniscus and medial meniscus are pads of cartilage that further cushion the joint, acting as shock absorbers between the bones.

Ligaments on each side of the knee help to stabilize it. These ligaments are called collateral ligaments and limit sideways motion. The anterior cruciate ligament (ACL) connects the tibia to the femur at the center of the knee. Its function is to limit rotation and forward motion of the tibia. (A damaged ACL is replaced in a procedure known as an ACL reconstruction. See: www.scoi.com/aclrecon.htm.) Located just behind the ACL, the posterior cruciate ligament (PCL) limits backward motion of the tibia.

These components of the knee, along with the muscles of the leg, work together to manage the stress that the knee receives as we walk, run and jump.

Benefits of prolotherapy for knee pain

Prolotherapy,  [(also known as regenerative injection therapy (RIT), ligament reconstructive therapy or sclerotherapy)], is a recognized orthopedic procedure that stimulates the body’s natural healing processes to strengthen joints weakened by trauma or arthritis, or when ligaments and tendons are stretched, torn, fragmented or become hypermobile and painful. Other conditions responsive to prolotherapy include neck pain, shoulder and back pain, elbow problems, wrist and hand conditions, hip pain, tailbone pain, knee pain, ankle and foot problems, headaches, temporomandibular joint (TMJ) problems and tennis elbow.

Prolotherapy research

Prolotherapy is a proven treatment for painful knee conditions. Numerous scientific studies clearly illustrate the benefits of prolotherapy for painful knees.

In a 2008 study published in the Archives of Physical Medicine and Rehabilitation, prolotherapy is demonstrated by ultrasound and magnetic resonance imaging (MRI) to cause tissue growth and the repair of tendons, ligaments and medial meniscus (cartilage).

In 2000, a study by Alternative Therapies found that prolotherapy injections of dextrose were clinically and statistically superior to bacteriostatic water injections for osteoarthritis of the knee. There were substantial improvements in joint pain, joint swelling, range of motion, ligament tightening and tendency for knee buckling.

In 2009, a study by International Musculoskeletal Medicine documented the nonsurgical repair of a high-grade partial or complete ACL tear using prolotherapy injections and home exercises.

Besides degenerative joint disease (DJD), other knee conditions responsive to prolotherapy include: chondromalacia patella, rheumatoid arthritis, Baker’s cyst, loose bodies, pseudogout and Osgood-Schlatter disease.

Prolotherapy treatment approach

Prolotherapy is a very effective treatment for painful knee conditions. Before receiving treatment, each patient should be individually evaluated with a personal history and physical examination, including observation of their gait. Palpation of ligaments or cartilage that produce pain is usually associated with weakened tissues and can at times be more beneficial in identifying the problem areas than diagnostic testing.

The patient also should be questioned about back and hip pain, since knee pain may be referred from the low back or hip regions. On an individual basis, further evaluation may include diagnostic ultrasound evaluation, X-rays and/or MRI before receiving prolotherapy.

In cases involving chronic pain, a comprehensive treatment approach may include rehabilitative exercises, nutrition and specific supplements to maximize health and the ability to heal.

A patient is normally reassessed in two to four weeks, and the injections are repeated at decreasing intervals as their condition improves. It is not possible to predict the exact number of sessions required, since each patient’s condition is unique in terms of their ability to repair and regrow new tissue.

Most patients require four to six treatments for a mild to moderate condition, with some patients requiring more or less than that. Depending upon each patient’s individual pain level, prescription pain medication may be provided. Most patients do well without pain medication or by just using over-the-counter Tylenol®.

Summary

Prolotherapy is a safe, reasonable and proven orthopedic procedure that has provided significant relief to thousands of patients for painful knee conditions. Prolotherapy provides relief of painful conditions when other treatments have failed, because it treats the cause of the problem: weakened ligaments, tendons and degenerative conditions. Strengthening weakened ligaments and tendons, and rebuilding knee cartilage slows down and even reverses the degenerative changes associated with painful knees.

Prolotherapy helps to prevent knee surgery and treats pain without the negative effects of pain medications. Prolotherapy should always be considered when other treatments have failed or when surgery has been recommended.

References:

Hackett, George Stuart, M.D., Hemwall, Gustav A., M.D., Montgomery, Gerald A., M.D., Ligament and Tendon Relaxation Treated by Prolotherapy, Beulah Land Press, Oak Park, Il, 2002.

Reeves, Kenneth D., M.D., and Hassanein, Khatab, Ph.D., Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity, Alternative Therapies, March 2000, Vol. 6, No. 2.

Grote, Walter, et al., Repair of a complete anterior cruciate tear using prolotherapy: a case report, Int Musculoskeletal Med, 2009 Dec 1;31(4):159-165.

Fred G. Arnold, D.C., N.M.D., specializes in prolotherapy/pain rehabilitation services. He is a Diplomate of the American Academy Health Care Providers and is one of the few physicians in the nation with both a naturopathic medical degree and chiropractic degree. 602-292-2978 or www.prolotherapyphoenix.com.

Reprinted from AzNetNews, Volume 30, Number 2, April/May 2011.