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Knee-habilitation: A common sense approach to handling pain

In the early 1990s, I used to run extensively at Cal Poly San Luis Obispo with my friend Garrett Akahoshi. Logging upward of 50 miles per week, we ran easily and were in great shape. Fast forward 20 years and we both are involved in helping people recover from running and sports injuries – Garrett runs Peak Physical Therapy in Cupertino.

Now in our early 40s, we must stretch, occasionally ice and be constantly vigilant to keep our formerly pain-free bodies functioning. The same is true for many readers of this blog.

Questions & Answers with Garrett Akahoshi:

I’ve asked Garrett, who earned a master’s degree in physical therapy, to answer a few questions.

Q: What’s the most common knee injury you see in your clinic?

Akahoshi: Patellofemoral Syndrome. It’s an over-use knee injury. In most cases, it involves the patella tendon or iliotibial band.

Q: What’s the current thinking on treating knee pain?

Akahoshi: Traditionally it was thought that strengthening the quads would help the knee track properly and therefore reduce pain. Newer research now shows that the gluteal muscles (maximus and medius) actually control what the knee does. Because of where the “glutes” attach and the force vectors they create on the leg, they keep the knee in proper alignment with running and jumping activities.

Q: What’s the fastest way to recover from knee surgery?

Akahoshi: The first priority after surgery is to reduce/control swelling. Then restoring normal range of motion and strengthening follows. Strengthening is focused on the quad muscle. The job of the quad muscle is to straighten the knee. A person must have good quad strength to return to walking. If quad strength is not achieved, a person will always walk with a limp, because he/she is unable to straighten the leg fully.

Quarterbacking the knee

If you suffer from knee pain, following is the five-step approach I recommend.

 1. Evaluate the problem

It’s important to identify what kind of knee pain you have and your options. Knee pain ranges from mild arthritic pain to severe bone-on-bone pain where no cartilage remains. An evaluation from an orthopedist or physical therapist is a great place to start.

 2. Treat the pain first

Knee pain should be addressed first, before strengthening should be employed. It could be argued that strengthening resolves the pain, but this is not always the case. You need to be able to handle any rehabilitation program before you can succeed at it.

 3. Undergo one treatment at a time

Pick a therapy and stick with it. Patients often ask me if they should get a cortisone injection or acupuncture. I recommend doing one or the other so that they can know what’s working. The same is true for combining physical therapy with another treatment approach.

4. Consider knee surgery a last resort

My favorite expression here is: “The only minor surgery is someone else’s.” Only consider surgery when you’ve exhausted all options. Start with physical therapy, acupuncture and anti-inflammatory herbs or medications. Also consider losing weight to reduce joint load and limiting inflammatory foods like sugar and alcohol. Also consider a cortisone injection before surgery if your doctor thinks it could help.

5. Stay strong

Regardless of your philosophy, the body’s approach is “use it or lose it.” That means you’ll need to stick with whatever approach you’ve taken to maintain your balance, stability and strength.

Herbal anti-inflammatories

A host of herbs help reduce joint pain and inflammation. My top four are boswellia, turmeric, ginger and celery seed. Boswellia is an Indian herb that is remarkably effective in reducing inflammation.

Celery seed is the hallmark herb for small-joint (hands and feet) osteoarthritis. As always, you’ll want a high-quality extract like those offered by companies like MediHerb (Australia), Gaia (North Carolina) or HerbPharm (Oregon).

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