Some years ago, Alberta Health Services commissioned the opening of a publicly funded acute knee clinic in Calgary. Their mandate was to provide quick access to care for acute knee injuries. A good clinic with talented staff, they have been victims of their own success. Wait times soared and only those with new injures are accepted in to the clinic. The void left by this selective approach to care was part of the impetus for our creation of a private knee clinic, the first of its kind in Canada. Our name really says it all; at the knee clinic we see knee injuries of all types, regardless whether it’s a new injury or a chronic complaint that you’ve until now thought that you just had to live with. Let’s outline some of the different types of knee pain that we see daily within our multidisciplinary clinic:
- Acute pain from a recent traumatic event
- Chronic pain from a longstanding condition or old injury
- Referred pain from elsewhere (neuropathic / nerve pain)
- Pain from inflammatory conditions
- Pain from repetitive strain
1. Acute pain from a recent traumatic event can be a real shock to the system. Pain, swelling, bruising, bleeding and a loss of stability or trust in a knee are common presenting elements. Whether the injury is to a bone, muscle, meniscus or ligament, one of the first things to do at home is to ice the area. 10-minute intervals (10 on, 10 off repeated a few times in a row) can act both as an anti-inflammatory agent as well as an analgesic. Urgent care facilities or Emergency departments are a good resource in the event of a more worrisome injury…beyond that we or the acute injury clinic may be a good resource for you. When presenting to our clinic or elsewhere, it’s important for you to pay attention to your symptoms so that you can help us understand the mechanism of injury, the pain you are feeling and any changes to sensation, stability or function that you experience. We’ll even want to know about different noises that your knee may have made during or after the injury. (See our Intake Form)
2. Chronic knee injuries are increasingly common in an ageing population. From osteoarthritis with bone spurring to degenerative meniscal tears, these types of conditions can seriously impact a person’s quality of life. We hear daily from patients who went years thinking that there was nothing that could be done for their chronic knee pain. (link to patient testimonials). At our private knee clinic, we offer a broad range of non-surgical approaches to help reduce pain, increase function and facilitate a return to a more mobile, stable and active lifestyle.
3. Referred pain is often misleading and requires a thorough musculoskeletal examination be done in addition to a comprehensive history and review of pertinent imaging. Lower back or pelvis issues (including sciatica, disc injuries or sacroiliac (SI) joint conditions can all refer pain in to the region of the knee. Our talented group of chiropractors and physiotherapists can be very useful in differentiating true knee pain from referred pain, and we offer myriad treatment options to manage both.
4. Inflammatory conditions occur in most acute / recent knee injuries, but it’s important to realize that inflammation does not last. After an initial inflammatory cascade which lasts 6 – 8 weeks, inflammatory cells leave the injured area and are often replaced by an influx of degenerative cell types. Consider the case of osteoarthritis, which when translated from Latin literally means “inflammation of the bone”. We understand in 2018 that this is somewhat of a misnomer. Osteoarthritis is a quite common degenerative process and is not truly an inflammatory condition. Sadly, many family doctors’ still resort to anti-inflammatories such as cortisone or NSAIDs as a first line approach in the treatment of osteoarthritis. But how can an anti-inflammatory work for something that isn’t really inflamed? Quite simply, it can’t. We hear daily from patients who have had multiple cortisone injections in to an arthritic knee with progressively diminished benefit. Degenerative joint conditions are increasingly well managed by regenerative joint injection therapies such as PRP or stem cell injections.
5. There is a quaint expression in sport medicine that the only animals in nature to suffer from repetitive strain injures are horses, greyhounds and humans. The common denominator in these three is the human’s competitive desires and unwillingness to heed warning signs. Repetitive strain injures are defined by doing anything too hard, too long and / or without enough rest. With inadequate time to allow our tissues to repair after a hard effort, the body is compelled to initiate tissue remodelling; a less desirable process of fibrosis, scarring and improvisation. Years ago, before the advent of our private knee clinic our practice was comprised mostly of runners. Even today we see a slew of athletes in our clinic, and many of these still incur repetitive strain injures. In the knee these injures can take many forms, including ITB friction syndrome, runners’ knee, jumpers’ knee, or tendinosis / tendinitis. Interestingly, once a repetitive strain injury has been diagnosed it is not enough to just cease the aggravating factor. Rather, the fibrosis / scar tissue that has developed has to be broken down to the point that normal tissue movement can be restored. Myofascial release techniques such as Graston, dry needling, cupping or Active Release Techniques (ART) are examples of effective approaches that can be done. These treatments are admittedly not always painless, but they can be very effective.