Health Upp According to the Knee Pain Centers of America (KPCA), knee pain is the most common musculoskeletal complaint in primary care, accounting for 33% of all visits. In fact, 25% of patients over age 45 experience frequent knee pain, and that statistic is steadily on the rise. Lifestyle factors play a significant role, especially as we age.
Learn about the causes and types of knee pain conditions, and how regenerative technologies are changing the way physical therapists diagnose and treat chronic knee pain.
Common Causes of Knee Pain
The knee’s complex architecture is uniquely designed to manage load transfers between the ground and the lower kinetic chain, with the capacity to mediate loads up to three times the owner’s body weight. This capacity for load transfer is a key feature of bipedal knee mechanics in humans, enabling us to walk upright and carry loads.
In the 21st Century, obesity, prolonged sitting and sedentary behavior can cause the structures that support and stabilize the knees to weaken, making them vulnerable to injury and pain. This is exacerbated by metabolic disorders that cause chronic systemic inflammation and insulin resistance, leading to knee osteoarthritis. In knee OA, inflammation combined with high levels of blood sugar cause erosion of the knee cartilage and subchondral bone – the smooth layer of bone tissue that covers the ends of bones directly beneath cartilage. According to the Osteoarthritis Action Alliance, 88% of people with OA are 45 or older.
In younger populations, knee pain often arises due to traumatic injury or repetitive stress from sports, exercise and occupation. Those types of injuries affect the supporting structures of the knee, such as menisci, ligaments, tendons. Activities like football, soccer and basketball that involve jumping, pivoting and rapid directional changes have a high prevalence of knee injury in teens and young adults.
For runners, patellofemoral pain syndrome (aka runner’s knee) is a common overuse injury that causes pain at the front of the knee and around the kneecap. In many cases, runner’s knee is related to inefficient gait mechanics that place excessive load on the knees’ supporting structures.
Factors that contribute to knee pain include:
- Lack of physical activity: The human body is designed to move, and failure to frequently load supporting structures leads to weakened and unstable joints.
- Too much sitting: Sitting with the hips and knees bent at 90 degrees creates serious muscle imbalances that affect joint alignment and function.
- Obesity: Carrying extra body weight puts excessive stress on the knee joints.
- Metabolic disorders: Chronic systemic inflammation and type 2 diabetes are key contributors to knee osteoarthritis and cartilage degeneration.
- Poor diet: Failure to provide the body with the nutritional building blocks it needs to build and repair tissue leads to tissue degeneration over time.
- Advanced age: As we get older, our bodies make less of the elements required for musculoskeletal health, such as growth hormones, NAD, and hyaluronic acid that lubricates joints and fascia.
- Chronic dehydration: Your muscles, fascia, joints and brain all depend on large amounts of fluid each day to maintain optimal function.
- Repetitive overuse: Continually subjecting your knees to overload without ample recovery time increases your risk of injury and pain.
- Participation in sports and activities that place large demands on the joints for load transfer can dramatically increase your risk of knee trauma.
The Problem with Conventional Knee Pain Treatment
It often arises from issues that involve the entire lower kinetic chain, and from metabolic issues that have their roots in lifestyle factors. Yet the medical standard of care for knee pain focuses on treating the locus of pain, without considering other causal factors. Early treatment typically involves rest, ice, compression and elevation, along with NSAIDs to manage pain and inflammation. When pain persists, corticosteroid injections and narcotic pain killers are often the next echelon of treatment, along with physical therapy to enhance mobility.
Only when other treatment approaches have been exhausted is knee replacement surgery recommended as a last resort. This treatment protocol has been the standard of care for decades, with advancements in knee surgery being the primary upgrade.
This treatment approach falls short on many fronts:
- Treatment often centers on pain management, without considering other factors that contribute to knee pain.
- Knee surgery is typically delayed as a last resort, and patients often suffer for years before finally getting a surgical resolution.
- Patients are often advised to avoid loading the knee, but disuse can actually accelerate cartilage degeneration.
- Chronic knee pain makes it difficult to exercise, making it hard for patients to strengthen their joints and manage their weight.
Advanced Solutions for Knee Pain
Recent advancements in research and technology have paved the way for innovative therapies that halt the degenerative process of knee osteoarthritis, accelerate healing of damaged tissues, and restore functional pain-free movement. Regenerative therapies act at the cellular level to repair tissues, and halt and reverse cartilage erosion. For best results, they should be guided by high-resolution ultrasound.
Effective regenerative solutions for knee pain include:
- Shockwave therapy and other vibration technologies that deliver acoustic or electromagnetic waves to the treatment site, to stimulate tissue healing by attracting stem cells and growth factors to the site..
- Orthobiologic injection therapy, such as platelet rich plasma (PRP) and Alpha-2-Macroglobulin (A2M), where highly concentrated platelets and proteins from the patient’s own blood are injected into damaged tissues to promote cell regeneration. A2M is especially effective for stimulating cartilage regrowth.
Advanced physical therapy solutions for knee pain include:
- Fascia manipulation and dry needling, to target densified fascia and myofascial trigger points that interfere with muscle action.
- Personalized physical therapy designed to correct the underlying causes of knee pain. Each patient has a unique anatomy and rate of healing, and injuries often involve multiple tissue types. Holistic physical therapy treats the whole patient, not just their symptoms.
Get Advanced Knee Pain Therapy in NYC
Many patients go from doctor to doctor, trying without success to resolve their knee pain. Regenerative therapies and advanced physical therapy can help you completely eliminate your knee pain and halt cartilage erosion. If you are looking for knee pain therapy in NYC, you can get the most advanced solutions at NYDNRehab in Midtown Manhattan.
Resources
Lee, Hyun Jae, et al. “Intra-Articular Injection of Stem Cells for the Regeneration of Knee Joint Cartilage: a Therapeutic Option for Knee Osteoarthritis—a Narrative Review.” Biomolecules & Therapeutics 33.1 (2024): 86.