ARE YOU TIRED OF LIVING WITH KNEE PAIN?

BY FRED ARNOLD, DC, NMD

The knee is the largest and most extraordinary joint in the body. The knee combines an enormous range of motion with rotation, great strength, and stability. On an average we take 13,000 steps each day, exerting a force two to seven times our body weight directly through the knee. The knee above any other joint, is responsible for ending more athletic careers than any other part of our body and is one of the most common painful bone and joint problems.

Complaints of knee pain are common in all age groups. There may be a specific injury or only a vague history of repetitive injury. Occasionally, no specific event can be recalled. The number of people needing knee replacement surgery is 245,000 surgeries each year and is directly correlated to the number of people who are developing arthritis. These individuals are directly related to the number of people who have received cortisone injections, arthroscopy, RICE (rest, ice, compression and elevation) treatment, and anti-inflammatory medications. These treatments accelerate cartilage breakdown tremendously, and thus also accelerate the arthritic process.1

Anatomy of the Knee
The bones of the knee, the femur and the tibia, meet to form a hinge joint. The joint is protected in front by the patella (kneecap). The knee joint is cushioned by articular cartilage that covers the ends of the tibia and femur, as well as the underside of the patella. The lateral meniscus and medial meniscus are pads of cartilage that further cushion the joint, acting as shock absorbers between the bones.

Ligaments on each side of the knee help to stabilize the knee. These ligaments are called collateral ligaments and limit sideways motion. The anterior cruciate ligament, or ACL, connects the tibia to the femur at the center of the knee. Its function is to limit rotation and forward motion of the tibia. (A damaged ACL is replaced in a procedure known as an ACL Reconstruction. The posterior cruciate ligament, or PCL (located just behind the ACL) limits backward motion of the tibia.

These components of your knee, along with the muscles of your leg, work together to manage the stress your knee receives as you walk, run and jump.

Benefits of Prolotherapy for Knee Pain Prolotherapy (aka Regenerative Injection Therapy – RIT), also known as ligament reconstructive therapy or sclerotherapy, is a recognized orthopedic procedure that stimulates the body's natural healing processes to strengthen joints weakened by trauma or arthritis. Degenerative Joint Disease (DJD) is probably the most common condition involving painful knees. When knee trauma occurs, either through a single event or repetitive trauma, ligaments of the knee are sprained and stretched. The injured ligaments become relaxed, resulting in chronic instability and degeneration with boney changes and thinning of the cartilage. When left untreated, post-traumatic arthritis or degenerative joint disease (DJD) occurs. Prolotherapy targets the weakened ligaments, tendons and thinning cartilage to strengthen and regenerate the soft tissues of the knee relieve chronic pain secondary to degenerative changes.

Prolotherapy is a proven treatment for painful knee conditions. Numerous scientific studies clearly illustrate the benefits of prolotherapy for painful knees.

In a 2008 study in the Archives Physical Medicine and Rehabilitation, prolotherapy is demonstrated by ultrasound and magnetic resonance imaging (MRI) to cause tissue growth and repair of tendons, ligaments and medial meniscus (cartilage). 4

In 2000, a study by Alternative Therapies, prolotherapy (Dextrose) injections were clinically and statistically superior to bacteriostatic water injections for osteoarthritis of the knee. There was substantial improvements in joint pain, joint swelling, range of motion, ligament tightening and tendency for knee buckling. 2

In 2009, a study by International Musculoskeletal Medicine documented the non-surgical repair of a high-grade partial or complete anterior cruciate ligament (ACL) tear using prolotherapy injections and home exercises. 3

Besides degenerative joint disease (DJD), other knee conditions responsive to prolotherapy include Chondromalacia Patella, Rheumatoid Arthritis, Baker’s Cyst, Loose Bodies, Pseudogout and Osgood-Schlatter Disease.

Other areas of the body responsive to prolotherapy include hand pain, wrist pain, neck pain, headaches, TMJ problems, shoulder pain, tennis elbow, back pain, sacro-iliac pain, hip pain, ankle sprains, and foot pain.

Case Histories
Case 1: Involved a 30 yo female with recurring low back pain for the past 6 years. The patient had been treated with acupuncture and chiropractic care. Examination of both knees revealed tenderness of the medial cartilage and medial collateral ligaments on each knee. Prolotherapy injections were given interarticular and to the ligaments on each side of the knee. The patient received 4 treatments and reported significant improvement to her knees and her low back.

Case 2: An 83 year old lady reported pain to her left knee for the past 8 months that was becoming progressively worse. The patient had difficultly climbing stairs. Examination revealed tenderness of the medial and lateral ligaments and medial meniscus. An ultrasound was performed that revealed severe arthritic changes and a large tear of the left medial meniscus. The patient had been treated on 7 occasions and reported significant improvement.

Case 3: A 34 yo male with 8 years of pain involving both knees. He reported various sports injuries and a history of both knees buckling and difficulty walking. Examination revealed weakness of the ACL and significant tenderness of the medial meniscus and medial collateral ligaments. Six (6) specific injections were provided every two weeks and the patient reported significant reduction in pain and complete resolution of buckling involving the knees.

OUR UNIQUE APPROACH
Prolotherapy treatment is a very effective treatment for painful knee conditions. Dr. Arnold individually evaluates each patient thoroughly with a personal history and physical examination, including observation of the gait. Palpation of ligaments or cartilage that produces pain is usually associated with weakened tissues and can at times be more beneficial in identifying the problem areas than diagnostic testing. The patient is also questioned about back and hip pain, since knee pain may be referred from the low back or hip regions. On an individual basis further evaluation may include ultrasound evaluation, X-rays and/or MRI before receiving prolotherapy. In cases involving chronic pain, Dr. Arnold will use his expertise to provide a comprehensive treatment approach that includes rehabilitative exercises, nutrition, and specific supplements to maximize your health and ability to heal.

Each patient is reassessed in 2-3 weeks and the injections are repeated at decreasing intervals as the patient’s condition is improved and resolved. It is not possible to always predict the exact number of sessions required, since each patient’s condition is unique in terms of his or her ability to repair and re-grow new tissue. Most patients require 4-6 treatments for a mild-moderate condition and some patients require only 1-2 treatments for resolution of their symptoms. Dependent upon each patients individual pain level, prescription pain medication may be provided. Most patients do well with no pain medication or use over the counter Tylenol.

SUMMARY
Prolotherapy is a safe, reasonable and proven orthopedic procedure that has provided significant relief to thousands of patients for painful knee conditions. Prolotherapy provides relief of painful conditions when other treatments have failed for it treats the cause of the problem: weakened ligaments, tendons and degenerative conditions. Strengthening weakened ligaments, tendons and rebuilding knee cartilage slows down and even reverses the degenerative changes associated with painful knees. Prolotherapy helps to prevent knee surgery and treat painful knee conditions without the negative effects of pain medications. Prolotherapy should always be considered when other treatments have failed and practically when surgery has been recommended.

References:

1. Hackett, George Stuart, M.D., Hemwall, Gustav A., M.D., Montgomery, Gerald A., M.D., Ligament and Tendon Relaxation Treated by Prolotherpay, Beulah Land Press, Oak Park, Il, 2002.
2. Reeves,Kenneth D, MD, and Hassanein, Khatab PhD, Randomized Prospective Double-Blind Placebo-Controlled Study of Dextrose Prolotherapy for Knee Osteoarthritis with or without ACL Laxity, Alternative Therapies, March 2000, VOL. 6, NO. 2
3. Walter Grote, Rosa Delucia, Robert Waxman, Aleksandra Zgierska, John Wilson, David Rabago, Repair of a complete anterior cruciate tear using prolotherapy: a case report, Int Musculoskelet Med. 2009 Dec 1;31(4):159-165
4. Fullerton, BD, Arch Phys Med Rehabil, 2008 Feb;89(2):377-85

With over 20 years of clinical experience, Dr. Fred G. Arnold D.C., N.M.D specializes in Prolotherapy/Pain Rehabilitation services. He is a Diplomate of the American Academy Health Care Providers, member of American Academy of Pain Management and he is one of the few physicians in the nation with both a naturopathic medical degree and chiropractic degree. 602-292-2978. www.prolotherapyphoenix.com.