Following many years of running half marathons and 10km runs, something had to give. It seems to be my right knee. I have been suffering pain and other issues for some time. I decided to research a different view on how knees should be treated. Mitchell Yass, a pain specialist, has other alternatives. He says: “In 95 per cent of my patients, the cause of knee pain is muscular, and appropriate targeted and progressive resistance exercises can resolve the cause and stop the pain.”
Dr Yass acknowledges that, generally, pain killers are prescribed, or even, as a last resort, knee surgery. There are instances when neither of these work satisfactorily. Of the approximately one billion people worldwide suffering from chronic pain, the vast majority follow the same process and end up in the same place. However, in almost all cases, the cause of pain is unrelated to the structural variations found on X-rays and MRIs. Herniated discs, stenosis, pinched nerves, meniscal tears and arthritis are present in abundance without ever eliciting pain.
The giant pain phenomenon we see today is based on this one false premise: that the structural variations identified on diagnostic tests are the cause of pain. Dr Yass offers five reasons why MRI and X-rays can be wrong about knee pain. The knee is such a complex structure, it is very difficult to identify precisely where the pain is coming from.
The pain is usually not in the same place as the structural abnormality. One of the claims made is that arthritis, or a meniscal tear, is the cause of pain around the kneecap.
The knee comprises two joints: one between the thigh and calf bones and one between the kneecap and thigh bone. If pain were due to a meniscal tear, it would be felt at the side of the joint along the ‘joint line’, which has no connection to the kneecap-thigh bone joint, making any supposed association between arthritic changes or meniscal tears and kneecap pain simply false.
The giant pain phenomenon we see today is based on this one false premise: that the structural variations identified on diagnostic tests are the cause of pain
Joint position is based entirely on the pull of the muscles surrounding them. The muscles that attach to the joint determine the location of the joint surfaces. For example, the kneecap is positioned primarily by the force applied to it by the quadriceps (front thigh muscles known as quads). If the quads become too strong in relation to the hamstrings (thigh muscles at the back of the upper leg), the hamstrings will shorten and pull excessively on the kneecap, causing increased compression and pain around the kneecap. Strained quads can have the opposite effect, which can allow the kneecap to float about too freely and perhaps press sideways on the outer bands of connective tissue of the joint, causing pain around the kneecap.
If this occurs, try stretching your quads by bending the affected leg at the knee and pulling the foot in towards your buttocks. By stretching the shortened quads in this way, it should decrease the force on the kneecap and limit the compression, which should decrease the pain. If this is satisfactory, then it is the muscle imbalance that is the cause of the pain.
If heat reduces your pain, the cause can’t be structural. Some people find that a hot shower, hot pack on the knee or a hot bath reduces the knee pain substantially. This proves that the cause of the pain is muscular.
Heat doesn’t ease arthritis or a herniated disc; however, it does make muscles more flexible, and such lengthened muscle fibres disperse the pain receptors along the muscle. Once the heat is removed, the muscle becomes short again. This causes a concentration of pain receptors and feelings of pain return. This is why pain is more intense at night and first thing in the morning. If the pain is muscular, appropriate, targeted and progressive resistance, exercise can resolve the cause and stop the pain.
The range of motion at the joint is the best determinant of joint function. If your tests show very little cartilage in your knee joint, it may be assumed that bone is rubbing on bone. However, Dr Yass has shown, with his patients, that the tiniest amount of joint space allows the joint to function properly without pain. However, this space cannot be identified on an X-ray. If there is bone on bone, there will be a major loss in range of motion; a bone hitting another bone stops the motion from going further.
MRIs and X-rays rarely identify the cause of pain. One study from Boston University looked at MRIs of 991 people, aged 50 to 90. Of those with knee pain, 63 per cent had meniscal tears, while of those without knee pain, 60 per cent had the same sort of tears. Similarly, a radiographic study from Keele University in the UK, of adults with knee osteoarthritis concluded that X-rays are ‘imprecise guide to the likelihood that knee pain or disability will be present’.
In conclusion, with the help of a practitioner, exercises may solve knee problems is some people.
kathrynmborg@yahoo.com