Treating Knee Pain

Knee problems are very common; it is estimated that frequent knee pain affects about 25% of all adults. It may be caused by arthritis, an injury that hasn’t healed properly, overuse, or sometimes there is no obvious cause for the pain. For information on knee pain caused by arthritis, please click here.

Knee problems often take a long time to heal, and it is not uncommon for someone to experience some degree of pain and stiffness the rest of their life. The main reasons for this slow healing or lack of healing are

• The knee tissues
• Alignment of the knee

The Knee Tissues

Muscles have a very good blood supply, and generally heal quickly. Bones also heal fairly quickly (usually around 6 weeks). However connective tissues such as tendons, ligaments and cartilage have a much more limited and indirect blood supply, meaning they are relatively poor in blood vessels compared to muscles. (Tendons get their blood from the connected muscles, attached bones, and outer tissue layers, while ligaments get their blood mainly from surrounding joint membranes and outer covers.) This low blood supply makes them heal very slowly after an injury. Apart from the bones, knees are mostly made up of these connective tissues.

So if a footballer injures a muscle or bone, they will be back on the field in a month or two, whereas if they have a significant tendon or ligament injury they may be out for the rest of the year.

Alignment of the Knee

In some ways the knee is a very simple joint, as it only moves the lower leg backward and forward in one direction. (On the other hand, the shoulder joint allows the arm to be moved in almost any direction.) The knee is actually very strong while it is moving backwards and forwards, but will start to play up if it is bent or twisted out of alignment. It is a little like having bad alignment on one of the wheels of your car- after a while your tyre will wear out or get damaged.

The main causes of misalignment of the knee are the joints above and below it, i.e. the hip and the ankle. Try standing up and turning your hips to one side; it is likely you will feel a strain in your knees. So if your hips are rotated or one hip is sitting higher than the other, this will often result in knee problems, especially on the inside of the knee.

Ankle issues that affect the knee are often due to an old ankle sprain that hasn’t healed completely. The ankle may feel completely fine with normal use, but if it is pressed carefully where the original injury occurred there will still be a tender spot there. On a subconscious level the mind recognises there is still an problem with that ankle, and will favour it a little when you walk. This will cause an increased pressure plus a more uneven pressure on the opposite knee, eventually causing damage. (So in most cases, the pain is in the opposite knee to the old ankle injury.)

Sometimes the ankle itself is fine, but if there is a misalignment of the foot with the lower leg bones it can have a similar effect.

If the alignment issues are not properly addressed, the knee will continue to be a problem, or any improvement will only be temporary.

Treating Knee Problems

This often involves a number of steps.

• Correcting any alignment problems
• Reducing any inflammation
• Treating the knee itself
• Stimulating repair of the tissues

Treating the Knee Itself

There are a large number of acupuncture points that can be used, depending on exactly what is happening with the knee. A few examples include

Stimulating Repair of the Knee

Tendons and ligaments are notoriously slow to heal, and in many cases they are never as good as they used to be. Sometimes there may be ongoing pain or discomfort, or the area gets sore with use, is easily damaged again, or the injury starts to play up again as the person ages. This poor healing is often due to the poor blood flow to these tissues.

However, having high doses of the right nutrients needed to repair tendons and ligaments can make a major difference to how quickly and well the damage heals. (As an example, a lady who had an old ankle injury which still caused her pain years later. She tried every therapy she could for her ankle, but none of them helped. But when she started taking the right nutrients, her ankle finally came good.)

An experienced naturopath will be able to determine the correct nutrients and dosage to help repair the damage. These nutrients will often be ‘practitioner-prescribed only’ products, which will have a stronger effect than over-the-counter products, and can only be prescribed by a therapist trained in their use. The naturopath may also prescribe natural anti-inflammatories if inflammation is an issue.

Acupuncture can also help by increasing the blood flow (and nutrients) to the area.

In Summary

To properly address knee problems it is important to address all of the factors involved. We find that a combination of acupuncture and naturopathy normally produces the best results.

(Disclaimer – Please be aware that each person’s body is different, so individual results may vary. If you have an appointment at our clinic, your therapist will conduct a detailed assessment of your condition, and they will be able to advise you on how successful your treatments are likely to be. A result is not promised and/or guaranteed from the act of receiving a treatment.)

Free Assessment

We are currently offering a limited number of free Comprehensive Assessments. (Terms and conditions: the Assessment is a completely free service, with no obligations whatsoever.)

The Assessment helps to identify:

• What is going on in your body
• What is working properly, and what is not
• What is causing the problem
• The best way to sort it out

If you would like to book in for an Assessment, please give us a call on 3376 6911, or you can book online using the link at the top of the page.

Be well, and have a great life!

(Illustration 289 above is from 'Kiiko Matsumoto's Clinical Strategies Vol. 1.)

Case Study- Unusual Shoulder Pain

Mitch (not his real name), had strong pain at the front of his left shoulder. He  was normally quite active, including swimming and going to the gym, however the pain was stopping him from doing anything other than gentle exercise. The shoulder had been a problem for over a year, and started after he had been doing a lot of swimming.

Mitch booked in for acupuncture at our clinic. The most common causes of shoulder problems are

• Misalignment of the pelvis- your shoulders usually follow your hips, so if one hip is too high that shoulder will usually be too high, or if the pelvis is rotated the shoulders will usually be rotated in the same way. This misalignment causes some muscles around the shoulder to be too tight and others too loose, eventually causing pain.
• Neck issues, especially misalignment of the lower vertebrae in the neck
• Tightness in certain muscles at the back, front or top of the shoulder, or the upper back

However none of these areas were too bad, so Mitch's case was unusual. We checked his neck again and found a small tight area at the bottom of the front of his neck, between the scalene and sternocleidomastoid (SCM) muscles. Tightness in these muscles can compress the brachial nerve plexus and the subclavian artery, causing a condition known as Neurovascular Compression Syndrome. The pressure on the nerves and artery is what causes the pain, which can be felt in the person's neck, shoulder or arm. In some ways, it is a little like getting sciatic pain in the leg caused by pressure on a nerve in the lower back.

Once we were able to diagnose this as the cause of Mitch's shoulder pain, we provided an acupuncture treatment (using a point on his arm and one on his abdomen) to treat the compression of the relevant nerves and artery, which resolved his shoulder pain.

This case illustrates the importance of always identifying the case of the problem and treating that, instead of just addressing the symptoms.

(Disclaimer – Please be aware that each person’s body is different, so individual results may vary. If you have an appointment at our clinic, your therapist will conduct a detailed assessment of your condition, and they will be able to advise you on how successful your treatments are likely to be. A result is not promised and/or guaranteed from the act of receiving a treatment.)

Common Causes of Hip and Lower Back Pain

Hip pain is often caused by a problem with the alignment of the body. It can often be caused by a misalignment of the feet (such as an old ankle injury) or from the lower back. We frequently find that our clients have hips that are twisted, tilted or raised on one side. Because your spine is supported by your pelvis, if your hips are not in the correct position your spine will have to compensate, so it can cause problems almost anywhere along your spine, but especially in your lower back or neck. Just as the hips are used to balance the lower body, the shoulders are used to balance the upper body, so if the hips are out often the shoulders will be out as well.

Have a look at the picture to the right- you can see this person's right hip is about one grid square higher than her left, and  because her hips are on an angle, the spine in her lower back starts going up at an angle to the left. It then has to bend back to the right to try and straighten her up. Also look at how her right shoulder is slightly to the left of her right hip, but her left shoulder is way to the left of her left hip. (If you look carefully, you might be able to see how tight the muscles are in her lower back, and in her upper back between her shoulder blades. Her right shoulder is also slightly higher than her left.)

Another possible cause of hip problems is the liver. The liver is on the right side of the body, underneath the lower ribs, and sometimes if the liver gets congested or irritated, the muscles over it can become tight, particularly below the right shoulder blade. (You can see a little of this in the above photo.) This can then pull the right hip up or the right shoulder down, putting the body out of alignment, and could cause lower back, hip, neck or shoulder problems.

So for structural problems,

• Most muscle or joint pain occurs when the body is out of alignment, and correcting the alignment will often resolve the pain
• Congestion in the liver can cause a distortion in the body, which may lead to neck, shoulder, back, hip, knee, or sciatic problems
• There may be other factors that have to be addressed as well, especially inflammation
• Sometimes there is not much improvement until all of the important causes are addressed
• Even when there is no more pain, if there are still alignment issues, it is a good idea to have additional treatments to correct these, otherwise the problem will tend to recur

With the right diagnosis and treatment, the majority of back, neck, hip and shoulder problems can become a thing of the past.

Sport Injury Treatment: Four Keys to Successful Management

The health benefits of regular exercise and physical activity are hard to ignore. Exercise improves the heart and lungs, boosts circulation, helps clear toxins from the body, reduces stress, controls weight, boosts energy, promotes better sleep, reduces high blood sugar, and helps prevent many significant health problems. However, sport injuries can happen, preventing you training at the level you have worked hard to get to. And if the injury doesn't repair properly, you can develop an on-going problem or experience chronic pain. Sometimes, the fact that the injury hasn't fully repaired doesn't show up until much later in life, when the injury starts to resurface.

For effective sport injury treatment Brisbane-based Centenary Natural Therapies Clinic recommend the following 'four keys':

1. SPORT INJURY PREVENTION

• Stretching - tight, tense muscles are far more likely to get injured than those that have a bit of 'give', so make sure you warm up or cool down properly. Muscles need time to adjust to the demands of the activities placed on them. If you plan on going for a run, then a slow increase in intensity will prepare your joints and muscles for what they are about to do. Take at least 3–5 minutes after any exercise to stretch your muscles. This is an ideal time to enhance your flexibility as your muscles are more pliable, which will help prevent injuries.
• Alignment - any alignment issues in your body will cause muscle tension, as your body tries to cope with the distorted structure. And an alignment issue in one part of the body will often affect other areas as well, so that a foot that rotates in too much when you walk or run will often cause knee or hip problems. If there seems to be excessive tension in some of your muscles, it is important to get your alignment checked and corrected. If you don't, injuries are likely to occur in that area. When performed by experienced therapists trained in this area, remedial massage or acupuncture (or a combination of both) can be used to correct alignment issues.
• Supplements to keep the muscles supple - magnesium is well-known for its effect of keeping muscles relaxed, and helping over-worked muscles to relax. However, if stress is causing muscle tension (as it is with most people), our trained and experienced natural therapists can prescribe the correct herbal or nutritional supplement to reduce accumulated stress in the muscles. Over the counter products are usually not very effective.
• Massage - if you perform a high level of training, regular remedial massage is important to keep the muscles supple and to correct any alignment issues that might develop. All top athletes receive regular massage to prevent and treat sport injuries. (The Brisbane Broncos will likely receive massage before and after each match.) If you are increasing the level of intensity of your exercise, such as going from a casual jogger to entering the Bridge to Brisbane run, consider having a few massage sessions beforehand. It will help your body cope with the increased demand on it.

2. SPORT INJURY TREATMENT BRISBANE

• Acute injuries - call for an ambulance if you suspect any broken bones, neck or spine injuries, abdominal injuries, or if there have been any injuries to the head, face or eyes, or any prolonged loss of consciousness. Otherwise, RICE (Rest, Ice, Compression, and Elevation) is the standard first aid for acute sprains, strains and joint injuries.
  • Stop the activity
  • Rest the injured area
  • For the first 24 to 48 hours, apply ice packs for 15 minutes every two hours
  • Bandage the injured area firmly, extending the wrapping above and below the injury
  • Whenever possible, elevate the injured area above the level of the heart
  • Avoid heat, alcohol or massage, which can exacerbate the swelling.
• Arnica cream or tablets are excellent for speeding up the healing of acute injuries and clearing bruising. And once the inflammation has reduced, therapeutic massage by a well-trained therapist is normally very beneficial.
• Overuse injuries - it is important to stop any exercise involving this area, or to reduce your exercise to the point that it no longer aggravates it. We regularly see cases where someone has injured a joint or muscle and doesn't let the area heal properly. They often end-up with a chronic problem. Most overuse injuries involve alignment problems causing strain on the area, and for the area to heal and repair properly, the alignment must be corrected. (Again, the correct massage or acupuncture treatment can work wonders.) If there is any inflammation, it is important to get rid of this as soon as possible, and acupuncture is best for this. To reduce the chances of the problem resurfacing in the future, use arnica cream or tablets, and continue using the arnica for at least one month after the problem seems to have gone.
• Chronic pain in backs, muscles or joints - There are normally a combination of factors with these conditions. Again, correcting any alignment issues and excessive muscle strain is crucial, as well as getting rid of any chronic inflammation. However the local circulation is usually affected as well, and the body's repair processes in the area usually need to be stimulated. If there is no inflammation, a combination of heat, massage and acupuncture is best. Otherwise, it is best to start with acupuncture until the inflammation is cleared. Again, use arnica to reduce the chances of the problem resurfacing in the future, and keep using it for at least one month after the problem seems to be resolved.

3. SPECIFIC AREAS

Poor alignment makes you more prone to sport injuries in specific areas of the body. But what causes the misalignment in the first place?

Backs
Some people say that backs are not well designed, but I believe the opposite, that they are too well designed! The lower back is a mechanically complex area, and there are many things that can go wrong. However, because it is so complex it is also very adaptable, so if there is only one issue with your back, you will often hardly notice it. If there are 2 things wrong with your back, it will probably feel stiff sometimes. When you have 3 things wrong, you are likely to get pain occasionally. And if there are 4 things wrong, you now have a major back problem. If people experienced back pain when there was only one issue with their backs, they would get it looked at early, before any major problems developed.

As with most musculoskeletal problems, getting the alignment correct takes most of the strain off the area, relieves much of the pain, and allows the area to heal and repair more easily. Some of the issues that commonly cause lower back pain include:

• Rotation of the hips or pelvis, usually caused by turning in one direction more than the other, such as turning to pick up the phone at work, or playing a sport that involves twisting the body, such as golf or tennis. This often causes pain in a band across the lower back.
• Rotation of the L5 (lowest) vertebrae can be caused in the same way, but the hips may not be affected, and the pain is more localised around the lower spine.
• Misalignment of the hips and shoulders is most easily spotted with you standing up. One hip may be higher than the other, causing one shoulder to be higher as well. If you have this condition, you will often experience tightness inside the shoulder blades as well.
• Tailbone injuries normally cause problems with the back and neck quite a few years after they occur. The worse the pain from the tailbone injury, the more likely that it will cause back or neck pain, usually at the bottom of the spine and/or the base of the neck, and the sooner the pain will start to occur.
• Misaligned feet sometimes cause lower back pain as well. The poor alignment can be caused by flat feet, feet that turn in when you walk, or old ankle injuries where the ligaments have been stretched. Over time, the poor alignment affects the structures above it, so the knees, hips or lower back may be affected.

Necks
Necks need to be able to move quickly and easily, yet still be strong enough to support the heavy skull bone and head. The vertebrae of the neck are relatively small, which makes the neck very flexible. Because the head moves around a lot, the neck muscles often have to take some of the weight of the skull. All of this makes these muscles prone to excessive tightness, and stress also shows up very easily in these muscles.

• Both sides of back of the neck - pain here can be caused by the very top vertebrae in the neck (C1) being twisted. Often this also causes soreness or puffiness at the bottom of the back of the skull bone as well. Because the twisted vertebrae affected the blood supply to the brain, it can cause forgetfulness or mental fogginess. (Acupuncture can be excellent for this condition.)
• Right side of back of neck - pain here is often caused by stress, but can also be caused by a problem with the liver. If your liver is congested or irritated, the muscles over it will often tighten up, including those to the right of the spine just below the shoulder blade. The tension here is transmitted up the inside of your right shoulder blade and into your neck. (If the 3rd vertebra in the neck is out of alignment, it is highly likely your neck problem is caused by your liver.)
• Bottom of the back of the neck - problems in this area are usually from the bottom vertebrae in your neck shifting slightly from their correct position. Poor posture is the most common cause, followed by old tailbone injuries, which slowly create strain on these vertebrae. Another possible cause is thyroid problems, especially if this area has a thick or puffy feel. Shoulder or arm pain is a common side-effect of these vertebrae being 'out'.
• Sides of the front of the neck - your sternocleidomastoid muscle (SCM) is easily affected by prolonged stress.
• Whiplash - the trauma to the injured muscles causes them to become over-sensitive, and gentle treatments that stimulate the repair of the damaged tissue normally work best.

Shoulders

• The alignment of your shoulders is affected by the alignment of your hips or pelvis. (Try raising one hip, and you will notice how this changes the position of your shoulders.) If your hips are rotated, it will cause strain in your back, shoulders and knees. Most of the time the hips are rotated to the right, causing the left shoulder to shift forward, which creates considerable muscle tension at the front and back of the shoulder, and often down into the left arm.
• If your shoulder problem is caused by one hip being higher than the other, it will normally be quite tight inside your shoulder blades as well.
• Sometimes, shoulder problems are caused by pressure on the nerves and blood vessels from the side of your neck to the shoulder ('neurovascular compression'). This is a common cause of 'frozen shoulder'.
• If both of your shoulders are affected, the problem is normally coming from your neck (usually one of your bottom two vertebrae).

4. SUPPLEMENTS FOR SPORT INJURIES

The most common supplements we use for sport injury treatment Brisbane and other musculoskeletal injuries are:

• Arnica cream or tablets are great for speeding up the healing of any sport injuries, and excellent for bruising.
• Magnesium helps muscles to relax, and is important when there is excessive muscle tension in an area. (There are a number of magnesium formulas available, and some work well and others don't. The one we have found to be the most effective can only be prescribed by a qualified therapist.)
• Vitamin C is very important for healing and repair, and is essential for injuries to tendons and ligaments (such as sprained ankles). Without enough Vitamin C, the injured tendon or ligament may not repair properly, and is much more likely to keep playing up, or to easily be reinjured again. (The quality, dosage and frequency are all important to get results, so please speak to Peter if you would like to find out more about this.)
• Zinc is also important for healing and repair, so a high-grade Vitamin C and zinc powder is very good.
• Turmeric is a wonderful natural anti-inflammatory, and we use the highest quality liquid turmeric available. Although it is a herbal liquid, it actually tastes ok!
• Hernidisc is a 'Practitioner Prescription Only' product, designed to help the repair of damaged discs.

If you are interested in finding out about the best methods of sport injury treatment Brisbane has to offer, to help prevent or treat the injury or any other health condition, please contact our clinic on 07 3376 6911, and ask for a FREE Comprehensive Health Assessment. Based in Jindalee in the Western Suburbs of Brisbane, we can then let you know what factors are involved in your condition, and which treatments would be most effective. There is no obligation with this offer, just good information.