Knee Pain - Freedom Physiotherapy & Pilates
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Knee Pain

Hey, everybody. For all of you who are sick of hearing about back pain, today we're going to have a bit of a rant about knee pain. It's a very, very common problem that we see in physiotherapy practice. It's a very common problem that presents to general practitioners, and again, we're going to bust some myths today.

Knee pain is very, very common. We see it a lot in teenagers, but right through life, right up to, you know, people in their 80s and 90s. But believe it or not, the vast majority of knee pain does not need an X-ray. It does not need an MRI and it does not need surgery.

One of the things we need to understand about knee pain is how it comes about and what to do about it. Quite simply, people who succeed in getting rid of knee pain or controlling knee pain, and this is what I observe in my practice, and certainly the research backs this up, and there's been a little bit of this in the media lately as well.

Most commonly, if you present with knee pain, you will be given an X-ray. But believe it or not, it's next to useless. It doesn't help you. It doesn't help diagnose you either. Certainly you'll see things like, you know, a bit of wear and tear, some arthritis and whatever. But, on the whole, the vast majority of X-rays for knee pain are a complete and utter waste of time. Certainly, there are some specific cases where it's a good idea to do an X-ray, but that's also based on your history, how old you are and how your pain might present. But I would guess that well over 80%, 90% of knee pain presentations don't need an X-ray, and they certainly don't need an MRI.

MRI, or Magnetic Resonance Imaging, is overused in knee pain. It will certainly show some beautiful three-dimensional pictures of your cartilages and ligaments and whatnot. But at the end of the day, the only reason I do an MRI for a knee problem is that I am absolutely certain this patient needs surgery.

Now, after 25 years of practice, I've suddenly realized that a lot of people who have had arthroscopic surgery, which is where they put a little camera in your knee and the surgeon goes in and does a nice little cleanup, trims the cartilages and whatnot, is not required, and certainly long term studies have shown that whether or not you have a knee cleanup or not, it doesn't make any difference. The patients who do the best with knee pain, now, this is knee pain due to arthritis, which is wear and tear, or torn cartilages, or due to a kneecap problem where the knee is not tracking properly in its groove, the people who do really, really well are the patients who are taught and actually perform a long term program of exercises to improve balance, to improve calf strength, quad strength, hamstrings and hip strength. So people who work on strength and balance, but also work on their aerobic fitness, their overall fitness.

The way to get rid of, the way to control, knee pain, is not through surgery. It's not through having scans, and it's certainly not through anti-inflammatories or pain killers. The way to really succeed is to improve your strength, your fitness. Weight loss does help, and getting in the water, swimming, walking in the pool, low impact exercise like cycling. Hopefully you're getting the message that knee pain is about exercise, it's about lifestyle change, it's about fitness, it's about strength, balance and coordination. It's not about expensive, unnecessary scans. It's certainly not about medication, and very rarely is it about surgery.

Just as a side, we all know about knee reconstructions for athletes, ACL ruptures. We used to tell people that the ACL doesn't regenerate, that you have to have a reconstruction, and that's the only way to get back to sport. But what we're noticing today with some recent research is that, for some people, the ACL does regenerate, and there are a lot of professional athletes getting back to sport without surgery. What they are doing is an intensive physical rehabilitation program.

It's a longterm commitment. The most difficult thing about getting rid of knee pain is getting motivated and working at a longterm process. It can take you up to a year, or even two years, to change your knee pain, okay? So it's not a quick fix. The most challenging thing for a physiotherapist, or anyone working with clients with knee pain, is engaging and educating and then motivating people to do the things they need to do to take control of their knee pain.

So if you'd like to discuss what some people may perceive to be a controversial approach to knee pain, that is a natural approach, we're very happy to talk to you. We do a free 15-minute telephone consultation, or if you want to come and talk to me in person, we offer a free half-hour discovery session where you can tell your story and we can outline some potential solutions for your knee pain problem. Thanks for watching.

Joshua Hayter, MAPA, B.Physio
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