STEP 1: GET IMAGING
Many times patients come into a consultation telling me that their knee has bone on bone arthritis only for me to look on x-ray and they have 10% loss of height. If a joint really is bone on bone then you would not be walking in the clinic so understanding your ailment is important. Severe osteoarthritis can be seen on x-ray as a narrowed joint space between the thigh and shin bone along with sharp edges called bone spurs. X-rays are quick and inexpensive to tell you if there is degeneration, but they do not tell the practitioner what the status is of the ligaments, muscles and meniscus. MRI’s are designed to show you the health of the soft tissue of the knee and can give great information to practitioner on treatment options.
STEP 2: IMPROVE RANGE OF MOTION
The inside portion of each joint does not get a blood supply. This is why ACL, meniscus or cartilage tears don’t heal on their own. To maintain joint health, the knee pumps inflammation out of the joint by movement, similar to how you clean a sponge my squeezing out the dirty liquid and soaking the sponge with fresh water. When range of motion is limited, the internal structures of the knee dry out, weaken, and become brittle. This makes the knee more prone to cracks, tears and painful friction that builds up within the joint. Having chronically tight hamstrings, quads or IT bands can limit your knees range of motion and speed up degeneration and arthritis.
STEP 3: RESEARCH NON-SURGICAL OPTIONS
Many people with arthritis have limited benefit from physical therapy only due to the inner workings of the knee being dry and brittle. This causes friction to irritate the joint from within and limit what physical exercise can do to help. Think of a dry sponge and how it is difficult to bend without liquid. This is where a medication called viscosupplementation helps restore moisture and lubrication to the joint.
Think of it as a oil change. It lubricates the meniscus and dry structures of the knee so that friction within the knee is reduces and the meniscus becomes more pliable.
Anti-inflammatory steroid that reduces the swelling of the knee and helps with pain. NEEDS PART ABOUT NEGATIVE SIDE EFFECTS
PRP (Platelet Rich Plasma)
The patients blood is drawn and spun down in a centrifuge to form a thin layer 1% of blood called a buffy coat. This layer is filled with a extremely high concentration of growth factors and platelets. This layer is designed to help repair tears and damage to the body. The goal is to use the own natural healing power of your own body to heal the joint from within.
Amniotic Stem Cell Therapy
Amniotic stem cells are blank cells that have not figured out what they want to be yet. When a stem cell is injected into an area, the cell communicates with the surrounding cells and can adapt to become any type of cell (cardiac cell, skin cell, meniscus cell, etc). Stem cells have been showing amazing healing potential.
STEP 4: PHONE A FRIEND
Talk to other people who have had replacement surgeries and ask about their surgeon. Having a surgeon who is conservative and up to date with the latest techniques is important to a successful replacement surgery. In most cases a trial of physical therapy and viscosupplementation should be tried to recommended before a surgery is even recommended. Surgeons have a wide variance in their skills and detail which is shown in post operative success rates. Having friends that have had a successful replacement is a good sign the surgeon is one you want operating on you.
STEP 5: PREVENT FURTHER INJURY
Anytime there is degeneration in a knee, then the body has to compensate for the change in structure. This causes us to overuse certain muscles and develop weakness in others. Scar tissue can develop within and around the joint causing pain and limited mobility. Corrective physical therapy is designed to break up scar tissue, strengthen the surrounding musculature of the knee joint and develop proper walking mechanics. Bracing physically keeps your knee in alignment and actually unloads compressed and degenerated portions of the knee. Bracing reduces pain and provides stability to the weakened knee helping you maintain active outside of the office.