Knee X-ray

New research coming out of Tufts University School of Medicine has determined that men and women that are at least 65 years of age or older with knee osteoarthritis (OA), and who practice Tai Chi, increased their physical performance and experienced less pain. Osteoarthritis is a prevalent form of arthritis that causes a wearing away of joint cartilage. Chiropractors provide therapy for quite a few men and women suffering from OA in a number of places in the body, including the knee joints. Second only to spinal problems, knee pain and disability is one of the most prevalent abnormalities of the musculoskeletal system. In fact, an astonishing 4.3 million individuals in the U.S. over 60 years of age have been diagnosed with knee OA, according to the CDC, and it anticipates that half of the people in America may suffer from symptoms of OA in at least one knee by age 85. The consequences of knee osteoarthritis are pain, mobility limitations, dysfunction and disability, and a reduced quality of life.

You may be asking why so many men and women develop OA. Excessive stress over a period of time is a major factor in the majority of musculoskeletal problems that develop as we age. It follows that as people get older they are more susceptible to developing OA in their knees, as well as other joints. Abnormal function of the knee, improper gait, compensatory foot mechanics as the result of foot pain, and overload of the knee joint all produce undue stress on the knees. Eventually arthritic changes in the knee joint occur. Many chiropractors suggest such natural, drug-free practices as Tai Chi, in addition to their chiropractic treatment. Tai Chi (Chuan) is a traditional style of Chinese martial arts that features slow, rhythmic movements that generate mental relaxation, as well as an enhancement of balance, an augmentation of strength, and more flexibility.

Though in good health otherwise, the 40 adults with confirmed OA that were selected for the Tufts study were on an average 65 years of age and overweight. Patients were picked at random to engage in 60-minute “Yang style” Tai Chi sessions twice weekly for 12 weeks. Each session included a 10-minute self-massage and a review of Tai Chi principles, 30 minutes of Tai Chi movement, 10 minutes of breathing technique, and 10 minutes of relaxation.

Tai Chi practice includes the kind of range of motion, flexibility, muscle conditioning, and aerobic workout that is compatible with prevailing exercise advice for osteoarthritis. Furthermore, researchers found that the “mental aspect” of Tai Chi encouraged a sense of well-being, life satisfaction, and perceptions of health that helped the participants to deal differently with chronic pain. Compared with the control group, the group practicing Tai Chi exhibited a significant decrease in knee pain.

Full findings of the study are published in the November 2009 issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

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Besides spinal conditions, knee pain and disability is one of the most common ailments of the musculoskeletal system. Problems with the knee can be classified into three categories: 1) poor mechanics or overuse of the knee joint, 2) traumatic injury from events such as sports and falls, and 3) problems due to arthritic changes in the joint. 4) faulty foot mechanics due to foot pain.

Patella Femoral Syndrome ( Knee Cap Pain )

Poor mechanics of the knee joint and the associated stress upon the soft tissues of the knee is by far the most common cause of non-traumatic pain. The most common part of the knee affected by this is the patella or knee-cap. Often the patella does not move smoothly or does not move sufficiently on the femur during bending of the knee causing abnormal stresses upon the tendons cartilage and ligaments. This condition is often called chondromalacia patella or CMP though a better term is patella femoral syndrome. The problem usually originates when there are imbalances in the quadriceps muscles of the thigh which attach to and move the patella.

The associated pain is experienced during activity, especially stair climbing, running, jumping and after getting up from prolonged sitting. Women are more predisposed to this problem for anatomical reasons and also the use of high heels.

Repetitive Knee Strain – Overuse Injury

Imbalances in other muscle groups that attach to the knee can also lead to pain and dysfunction. As an example, the muscles on the inside of the thigh when strained and tight can cause pain on the medial or inside side of the knee.

Lower back problems especially in the sacroiliac joints, are one of the main reasons for imbalances in the muscles associated with knee movement and subsequent knee problems. Foot problems that cause gait abnormalities such as pronation, are another cause of mechanical knee pain.

The main treatment for mechanical or overuse injuries to the knee is to re-establish proper balance of the muscles, restore proper movement to the patella and other joints of the knee, and correct any subluxations of the sacroiliac joints and foot problems. In certain cases, a brace is used to help with the alignment of the patella or to stabilise the joint. Chiropractors are ideally trained to provide the proper diagnosis and management of these problems.

Trauma

Traumatic injuries often occur during sports that involve running and jumping, such as football and basketball, and with activities such as skiing. When the knee is stretched or twisted beyond the strength of the ligaments that hold the joint together, tearing of these tissues can occur causing a sprain. The muscles that move the knee can also be torn during injury causing a strain or pull of the muscle. As with a sprain, a muscle strain can vary from a minor injury that requires little care to a severe injury requiring surgery. The knee also contains two special “cartilages” – the menisci – between the tibia and the femur that provide for smooth movement and cushioning. These cartilages can also be torn during trauma and often require surgical repair or removal if damaged severely. Traumatic knee injuries can cause severe pain and swelling and require immediate evaluation and attention. In most cases a qualified chiropractor can manage these conditions, though there are some injuries that do need the expertise of an orthopaedic surgeon. In any case, it is important to stabilise the injured joint and ice if possible until you can get the injury evaluated. Please see the section on sports injuries for additional information regarding this topic.

Treatment

If poor mechanics or traumatic injuries are not corrected at an early age, the tissues of the knee joint especially the cartilage will eventually begin to wear out. As a result the bones rub upon one another and changes such as bone spurs can occur. This painful condition is known as degenerative joint disease or osteoarthritis and is often progressive with age. Common treatment often involves medications such as NSAIDS (non-steroidal anti-inflammatory drugs) though conservative treatment such as chiropractic can be helpful in alleviating some of the pain. There is some evidence that nutritional substances such as Glucosamine and Chondroitin can be helpful in the long term management. People can often help themselves by keeping their weight down, doing exercises especially in the pool, and wearing cushioned shoes or insoles.

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