So with knee injuries, if we don't know what
to do, if we just want to help the person
feel better because there's nothing we
can do, we generally prescribe RICE
Rest, Ice, Compression and Elevation.
We also found that supports and
enhance proprioceptive sense
helps a person self regulate
and treat themselves better.
That's why knee braces or
ace wraps which will give you
30 minutes to 2 hours of
enhanced proprioceptive sense,
a better knowledge of how your functioning
is and allows you to function easier
and flow smoother than
you would've otherwise
That's why when we have
a person playing sports,
you want to tape them up or wrap them
up just before they go into the game.
otherwise, you're gonna
lose some of the benefit.
We also often prescribe stretching,
strengthening and stabilizing of the knee joint
in order to enhance functioning.
When that doesn't work, we move to medications.
NSAIDS do tend to decrease the amount of swelling
NSAIDS do tend to decrease
the amount of swelling
and the symptoms from a overused
or somewhat injured knee.
Acetaminophen doesn't decrease the
swelling but it works with the brain level
to stop you from thinking you have
pain so you can continue functioning,
continue playing and also
give yourself time to heal.
Injections into the knee, more often take fluid
out from an overuse injury than injecting in
but on two to three occassions a year, somebody
is using their knee in a bad way or has pain,
you can give them steroid injections.
Lidocaine works on a short
term basis for severe pain
and there are these called supplements
that you can get people to enhance
the shock absorbency or
gliding ability of the knee.
but those tend to give
time limited benefit
and do require multiple injections.
From the osteopathic medicine perspective,
evaluating for somatic dysfunction of the knee
and one joint above and one
joint below are important.
noticing motor patterns, seeing if the knee is affecting
the ankle functioning and the hip functioning
and to promote homeostasis and fluid
functioning of the musculoskeletal system
When you have somebody come to you for knee
pain, the demographics are gonna help a lot.
Children and adolescents are gonna have
knee pain which is often overuse or growth.
It could be a patellar subluxation tendonitis or jumper's
knee or Osgood-Schlatter from age or hormonally related.
Arthritis is possible but less likely, and you
always have to worry about the outlier
who may have a bony tumor or growth
and osteosarcoma and exostosis,
some kind of bony growth
causing pain as well.
Patients younger than 45 also get patellar
syndromes and are also at risk for trauma
of both ligamentous and meniscal
nature, although, less likely in kids.
And it's often common that hip
pathology contributes to knee pathology.
People with abnormal angles or abnormal functioning
will tend to develop knee pain as well
Over 45 years of age, by far the most
common problem is degenerative arthritis.
The knees worn out,
you may have avascular necrosis,
you may have a meniscal tear but it's
wear and tear of the knee that causes it.
And also think of hip pathology - one joint above,
one joint below can contribute to knee pain
The angles of the knee and the hip and the
ankle all should be taken into account.
When people complain about the knee pain, you can
often localize it by asking more about history.
Is it the front of the knee? Which is more likely to
mean that the person is involved or is it tendonitis?
In the younger patient you'd
worry about Osgood-Schaltter's.
Is it the back of the knee,
where you could have ankle pain that's being
referred higher or you can have a cyst in that area.
If the pain is medially, you worry about
a chronic medial collateral ligament
or you worry about the bursas
being swollen from overuse.
If it's lateral pain, you worry about the lateral
collateral ligament or a fibular head dysfunction
When you wanna treat
patellofemoral pain syndromes,
first thing is rest.
If overuse is the most common cause, then rest
of the knee is the most common treatment.
We also have ergonomic aids such as splints,
bledsoe brace is gonna prevent overextension
It's also going to give you an enhanced sense
of functioning or proprioceptive awareness
We also will treat with analgesics
and taping and wrapping.
Physical therapy and OMM focuses on
correcting abnormal mechanics and use
and teaches people to protect their
knees, how to use it,
when injury is more likely and what
they need to do to not get injured.
If the disease is severe and
the pain is longstanding,
it may take longstanding exercises to
strengthen the quadriceps and the hamstrings.
and soft tissue techniques can give short term
benefit as well as enhancing flexibility.
For the anterior knee, you wanna worry
about osteochondritis dissecans as well,
patellofemoral pain syndromes,
acute articular cartilage injury,
bony tumors, as a rare but we need to
worry about, chondromalacia patella,
patellar fracture or illiotibial band syndrome
which is a common running injury that occurs.
Those are the major knee problems and again,
when you have people complaining of knee issues,
always examine the knee for
biomechanics, for normal functioning,
look one joint above, one joint below and see
how the knee is affecting the whole body
and concern that it may throw a person from
neutral mechanics into non-neutral mechanics
and have other
effects further away.
You're gonna see a lot of knee complaints
again, witnessing and sharing what's going on
can be very helpful to earning a person's trust
and helping prevent further deterioration
or further issues later on.