Arthritic knee pain is one of the most commonly treated orthopedic ailments. Our knees are subject to a tremendous amount of weight‑bearing forces. For example, normal walking generates about 4 times your bodyweight of pressure in each knee. The rising and falling knee pressure during walking pumps your knee tissues, facilitating movement of nutrition and waste products, helping to keep your knees healthy. If body weight and pressure get too high, however, the pumping of nutrition reduces and may create microtrauma, wearing away your cartilage and meniscus.
Common Knee Ailments
- Torn meniscus
- Ligament sprain (ACL, PCL, MCL, LCL)
- Baker’s Cyst
It is important to rule out less common, but more serious and destructive conditions that may cause knee pain such as gout, infection and cancer.
Bone on Bone Arthritis- What is it?
Bone on bone arthritic knee pain is a chronic condition that happens over many years or decades. While X Rays or MRI are needed to confirm bone on bone arthritis and the severity, we can diagnose with fair accuracy based on interview and exam.
The arthritic knee pain is a slow progression, with a gradual loss of cartilage in the knee. Cartilage lines your bones, providing a smooth and cushioned surface so your bones can articulate on one another safely and efficiently. Once arthritis begins, the process progresses and degeneration of the cartilage persists. With early intervention, arthritis may be stopped or even reversed. Once moderate to severe, treatments with donated umbilical cord tissue are effective to nourish, support and regenerate the years of wear and tear.
We find that physicians use the term “bone on bone” rather loosely, and oftentimes patient bones are not actually touching and treatment may still be effective, to avoid knee replacement surgery.
Bone on Bone Arthritis – What Causes it?
Movement is life, and motion is lotion. If a joint is not moving enough, or suffers imbalance forces causing microtrauma, arthritis may begin. Tissues such as cartilage, meniscus, ligament and tendon do not have a good blood supply. We need blood to carry nutrients and oxygen in, and cellular waste and carbon dioxide out. If something interferes with the exchange of nutrition in these tissues, the tissue begins to degenerate, causing arthritic knee pain.
Factors Affecting the Progression of Arthritis:
Bone on Bone Arthritis- What to do About it?
While each patient is different, treatments and outcomes are mostly based on the severity of the arthritic knee pain, and the general health of the patient. It’s important not only to treat the symptoms, but uncover the causes and contributing factors so they can be fixed for better long term outcomes. It’s important to take an arthritic joint through pain free ranges of motion frequently, and light repetitive activity is beneficial. Walking on a flat surface at a controlled pace, stationary cycling, and pool exercise are better activities to focus on.
- Hyaluronic Acid Injection – This is a gel-like substance, injected into a moderate to severely arthritic knee, for cushioning and lubrication. Relief can last weeks to months. We recommend reserving these injections for patients needing temporary relief as they prepare for either knee replacement or timing to have regenerative procedures, since they are only temporary relief for arthritic knee pain.
- Steroid Injection – Steroids such as cortisone work primarily by reducing inflammation for fast relief. Only 2-4 may be performed in one area per year, since the steroid damages the joint tissue. Used in and of themselves, steroid injections have poor long term outcomes for arthritic knee pain.
- Regenerative Procedures – Platelet Rich Plasma (PRP) can help to heal damage in joint tissues. PRP is extracted from a vial of your own blood. First, the blood is drawn, then placed in a spinning centrifuge which layers the constituents. The platelets contain substances called growth factors which help your cells repair and regenerate. Severe arthritis does not respond to PRP as well as mild to moderate arthritis, among other conditions.
- Umbilical Cord Tissue (UCT) also heals joint tissue and is more potent that PRP. UCT is donated tissue from a healthy mother and baby. There is no harm to life when these tissues are collected and processed. Unlike donating blood or organs, UCT does not need blood type matching and cannot be rejected, making it very safe. Cord tissue has growth factors, just like PRP, but higher concentrations. UCT also has stem cells, cytokines and exosomes, all highly capable of nourishing, supporting and helping your tissues regenerate and heal. We have high success rates helping patients, even after being told they should have, or need knee replacement surgery.
- Therapy Options – Chiropractic treatment, exercise and massage therapy are important to reduce joint restrictions, correct imbalances with posture, unlevel hips or muscle tightness for the treatment of arthritic knee pain. Creating balanced muscle strength and flexibility can be challenging because arthritis often causes compensations, and essentially shuts down certain muscles from working properly. Therapy also helps accelerate healing and improve function so you can do the activities you want to do. Graston Technique is a specialized instrument treatment to break down chronic adhesions and scar tissue that restricts your normal function and causes pain. This technique works well for patients that did knee replacement but still have pain.
- Bracing – Knee bracing is helpful for arthritic knee pain. Braces called unloader braces shift the knee joint to reduce pressure on areas with more arthritis. Most patients experience arthritis worse either towards the inside, or outside of the knee. The worst area will have less cartilage and be more collapsed. Unloader braces shift the knee so the healthier cartilage absorbs more weight, reducing pain and enabling better healing.
- Functional Nutrition and Supplementation – We all heal from within. Having proper nutrition and the use of supplements can hydrate dry and painful cartilage, reduce painful inflammation and help with regeneration and stabilization. Laboratory testing is important to evaluate you as an individual so we know what recommendations are best for you.
- Foot and Ankle Orthotics – Knees depend heavily on proper functioning ankles and feet. Flat feet, for example, cause feet to rotate inwards when walking, twisting and causing higher pressure at your inner knee. If one foot is flatter than the other, custom orthotics will balance your feet and ankles for better ergonomics, reducing wear and tear on your knees.
- Medical Weight Loss – Losing weight is not easy, or everyone would be thin. We offer prescriptions for medications that help curb appetite. Vitamin B12 injections with Inositol on a weekly basis help to increase metabolism and weight loss, as well.