Treating Knee Pain
Knee Pain Treatment at ProTouch Physical Therapy
Understanding Knee Pain Treatment
Recent Center for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of knee pain from various causes, and that most people in chronic pain have multiple sites of pain. For U.S. adults reporting pain, causes include: severe headache or migraine (16.1%), low back pain (28.1%), neck pain (15.1%), knee pain (19.5%), shoulder pain (9.0%), finger pain (7.6%), and hip pain (7.1%)
According to the American Osteopathic Association (AOA), Knee pain is the number two cause of chronic pain; more than one-third of Americans report being affected by knee pain. Sometimes knee pain may be the result of too much weight on the knee joint. Other times it may be due to injury or improper technique during activity or exercise
The Anterior Cruciate Ligament (ACL) is one of four major ligaments (ligaments connect bone to bone) of the knee joint that coordinate function and promote stability of the knee joint. It runs in a notch at the end of the femur originates at the back part of the femur and attaches to the front part of the tibia. In an adult knee, the ACL prevents forward movement of the tibia. It also provides roughly 90% of stability in the knee joint.
ACL injury has an annual incidence of more than 200,000 cases with ~100,000 of these knees reconstructed annually. The majority of ACL injuries (~70%) occur while playing agility sports, and the most often reported sports are basketball, soccer, skiing, and football. An estimated 70% of ACL injuries are sustained through non-contact mechanisms, while the remaining 30% result from direct contact.
ACL injury is most prevalent (1 in 1,750 persons) in patients 15-45 years of age. It is more common in this age group in part because of their more active lifestyle as well as higher participation in sports.
More ACL injury cases occur in males due to greater numbers of male sports participants, however females have a higher risk of being injured. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high-risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes (North American Journal of Sports Physical Therapy Dec 2010).
When the ACL is injured as a result of direct contact, football is often the associated sport. Most often, the knee is subjected to a direct blow to the lateral side (Outer Knee) and other ligaments are injured in addition to the ACL. The most common multi-ligament injury is the ‘unhappy triad’ that includes the ACL, medial collateral ligament (MCL), and the medial meniscus.
Approximately 50% of ACL injuries occur with injuries to other structures in the knee. The meniscus (50% of multi-structure injuries), medial collateral ligament (30%), or articular cartilage (30%) are the most frequently concurrently injured structures. The lateral meniscus is more often damaged than the medial meniscus during an isolated acute ACL injury.
Other complications include knee stiffness (5-25% incidence) anterior knee pain (10-20%), Patellar tendonitis (20% in 1st year, then rare afterwards), Patella fracture (.35-1.8%).
More than 600,000 knee replacements are performed each year in the United States. With an aging population staying in the workforce longer and obesity on the rise, demand for total knee replacement surgery is expected to exceed 3 million by the year 2030.
In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery.
http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 (actual study)
Although the word arthritis actually means joint inflammation, we use the term arthritis in the public health world to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.
- Nearly 1 in 2 people may develop symptomatic knee Osteoarthritis by age 85 years.
- Two in three people who are obese may develop symptomatic knee OA in their lifetime.
- An estimated 52.5 million adults in the United States were told by a doctor that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia.
- One in five (22.7%) adults in the United States report having doctor-diagnosed arthritis.
- In 2010-2012, 49.7% of adults 65 years or older reported doctor-diagnosed arthritis.
- By 2030, an estimated 67 million Americans ages 18 years or older are projected to have doctor-diagnosed arthritis.
- An estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition; this represents approximately 1 in every 250 children in the U.S.
- Almost 44% of adults with doctor-diagnosed arthritis report no leisure time physical activity compared with 36% of adults without arthritis.
- Among older adults with knee osteoarthritis, engaging in moderate physical activity at least 3 times per week can reduce the risk of arthritis-related disability by 47%.
- Approximately 1 in 3 people with doctor-diagnosed arthritis (31%) between the ages of 18 and 64 report arthritis-attributable work limitation.
- Among all civilian, non-institutionalized U.S. adults ages 18-64, 5% (8.2 million) report arthritis-attributable work limitations. (This translates into 1 in 3 (31%) of adults with doctor-diagnosed arthritis in that age group).
- State-specific prevalence estimates of arthritis-attributable work limitation show a high impact of doctor-diagnosed arthritis on working-age (18-64 years) adults in all U.S. states, ranging from a low of 3.4% to a high of 15% of adults in this age group.