Pain Relief Chiropractic

Knee pain is a common complaint, and patients often wonder if manual therapies provided by a doctor of chiropractic can help manage their knee pain. In many cases, the answer is yes. Let’s take a look at what the research has to say about using manual therapy to address two frequent causes of knee pain and disability: knee osteoarthritis (KOA) and patellofemoral (PF) pain.

A recent systematic review and meta-analysis (the highest regarded level of research) studied the effectiveness of manual therapy for relieving pain, stiffness, and dysfunction in patients with KOA. The review uncovered 14 studies that showed that manual therapy offered “statistically significant” benefits in relieving pain, stiffness, and improving function, with the best results obtained when treatment extended for four or more weeks. The authors concluded that manual therapy is effective and safe and offers a complementary and alternative treatment option for KOA.

In a 2021 study, researchers found that KOA patients who received treatments that included manual therapy and supervised exercise experienced more significant improvements in pain and functions than participants in a supervised exercise-only group.

In 2018, an international panel of 41 specialists released a consensus statement following their review of the available literature with respect to the treatment of PF or kneecap pain and made strong recommendations in support of the use of exercise therapy (especially when combined with hip- and knee-focused exercise) and foot orthoses to improve PF pain and/or function. Researchers also found support for manual therapy applied to the soft tissues, dry needling, and gait retraining; however, they required additional evidence prior to issuing a strong recommendation for these treatment options.

A 2020 study reported that mobilization is an effective treatment in both weight bearing and non-weight bearing positions. Another study published in the same year recommended addressing alignment, muscle imbalance, and patellar maltracking in runners with PF pain.

A literature review published in 2021 highlighted the importance of patient education (PE) with and without targeted, knee-specific exercise intervention as important components of care in decreasing pain and improving function in patients with PF knee pain. The review recommended including individualized PE to each patient that focuses on the latest effective treatments, self-management strategies (specific exercise training), and an explanation of risk factors and movement patterns that may lead to and/or exacerbate PF pain.

For both PF and KOA, doctors of chiropractic utilize a multimodal approach that may include patient education, focused exercises, manual therapies, posture correction, gait retraining, nutrition recommendations, and prescription foot orthotic fitting, if necessary.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Knee osteoarthritis (KOA) is a very common condition that is a significant cause of disability in older adults, often resulting in knee replacement surgery. There are several contributing factors to KOA, and perhaps one of the most important issues is excessive force exerted on the knee joint by improper biomechanics of the foot and ankle.

In the normal gait or walking cycle, there are two primary phases called the stance phase and the swing phase. As the names imply, the stance phase refers to the entire time the foot is in contact with the ground and the swing phase occurs when the foot is off the ground.

A 2019 systematic review and meta-analysis reported that the forces across the knee are not transmitted equally during walking, with the inside of the knee joint bearing greater loads than the outer knee joint in most individuals. This leads to breakdown of the cartilage faster on the medial side of the joint, which leads to KOA. One identified cause of this is called ankle pronation, which is an excessive rolling-inward of the ankle that occurs during the stance phase. This results in the knee knocking inward, which is technically called external knee adduction moment, or EKAM.

Fortunately, this can be addressed with the use of lateral wedge insoles or shoe inserts that try to minimize or eliminate the ankle pronation aspect that reduces the EKAM and associated excess loading of the medial knee joint.

When assessing a patient, doctors of chiropractic will expand their examination to regions of the body outside of the area of chief complaint as it’s common for dysfunction in one body part to affect another. In this case, we can see that abnormal motion of the ankle can place added stress on the knee, potentially leading to knee replacement. For the patient to achieve an optimal outcome, such issues need to be addressed.

Chiropractic treatment for the KOA patient can include manual therapies to restore proper motion to the affected joints, specific exercises to strengthen weakened muscles, and nutritional recommendations to reduce inflammation. If ankle pronation is suspected to contribute to the patient’s knee condition, then an orthotic insert may also be necessary. As with many musculoskeletal conditions, it’s better to seek care sooner rather than later. The earlier treatment can be provided, the faster and more likely there will be a satisfactory outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Patellofemoral pain (PFP) is commonly associated with running, jumping, squatting, and walking up/down stairs. It’s thought that PFP is caused by excessive rubbing between the back of the patella and groove, or track, that it rides in. Besides overuse, additional causes for PFP pain include muscle imbalance or weakness or direct trauma. The condition is most common in adolescents and young adults, usually due to overuse and/or misalignment, the latter of which is often referred to as poor “patellofemoral tracking.” This can eventually lead to arthritis, which is more commonly seen in older adults with PF pain.

Past research has demonstrated that issues in the foot can increase the risk for musculoskeletal pain in other parts of the body, including the knees. In a 2018 study, researchers examined the effect of knee-targeted exercise vs. a combined approach that included knee- and foot-focused exercise with foot orthotics (shoe inserts to correct pronation or the rolling inwards of the ankle and foot) in patients with patellofemoral pain.

Participants were instructed to perform terminal extension quad exercises that emphasized COMPLETE extension (straightening) of the knee. This exercise can be done sitting or lying on the back with a rolled-up towel behind the knees (with or without an ankle weight) and fully flexing the quad muscles for three to five seconds and repeating the process ten to twenty times, as tolerated.

The results revealed a significantly greater improvement in the group that included foot care, supporting the conclusion that better outcomes are achieved by combining foot exercise and foot orthotics with knee exercises. The authors reported that the benefits were still present four months after the conclusion of care but not a year, suggesting the importance of continuing exercise and foot orthotic use.

Doctors of chiropractic routinely perform posture assessments when examining patients with knee pain in order to identify dysfunction in the hip or feet that may contribute to their chief complaint.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The hip and knee are anatomically very close to one another. Functionally, there are several muscles that attach above the hip and below the knee joint. Hence, depending on the position and/or activity, the same muscle can move the hip and/or the knee. This close relationship crosses over in dysfunction as well, as patients with knee pain move differently, and the hip joint is ultimately affected. But which one is the real culprit, the chicken (hip) or the egg (knee)?

In a quest to answer that question, one study asked patients with patellofemoral pain (PFP) and without hip pain to perform either knee exercises or hip exercises. Each group consisted of nine men and nine women. The knee exercise group performed quadricep or knee strengthening exercises while the hip exercise group engaged in hip strengthening exercises. The specific hip exercises included hip abduction (outward resistance) and hip external rotation muscle strengthening exercises. Both groups performed their exercises three times per week for a total of eight weeks. All participants experienced improvements in pain and function; however, the patients in the hip exercise group reported greater improvements than those in the knee exercise group. These results persisted for the next six months.

Why did hip exercises help patients with PFP knee pain MORE than knee-specific exercises? Weight-bearing dynamic imaging studies (x-rays) have shown that patients with PFP knee pain frequently have a lateral or outward displacement of the knee cap as well as lateral tilt due to femur/hip internal rotation (IR) rather than just abnormal patella motion due to muscle imbalance (the “old” theory).

Other recently published biomechanical studies have reported that persons with PFP demonstrate excessive internal rotation and adduction (inwards positioning) of the hip that isn’t generally observed in pain-free subjects. Further, those with PFP tend to have weak hip abductors, extensors, and external rotator muscles than pain-free individuals.

Chiropractic care focuses on whole body care, and patients are often surprised that doctors of chiropractic frequently treat hip, knee, ankle, and foot conditions. Posture and gait assessments, which may be included in an initial patent examination, frequently reveal abnormal movement patterns, leg length discrepancy, pelvic rotation, and lower lumbar spine dysfunction that may contribute to a patient’s chief complaint. Often, treatment must address these issues for the patient to achieve a successful outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.