Knee pain has many causes, some originating in the knee and some stemming from hip or ankle weakness or instability. Sprained or torn ligaments and tendons or simple muscle imbalances are common causes of knee pain. If left untreated eventually this can lead to meniscal tears and cartilage degeneration. Nerve entrapment or injury is also another possible cause of knee pain. Often times knee pain is a combination of these types of pathology and associated injuries in the hip or ankle.
A combination of history, physical exam and diagnostic imaging such as X-Ray, MRI, or Musculoskeletal ultrasound can help to reveal the extent to which any or all of these types of pathology are occurring.
When ligamentous laxity is the underlying cause of knee pathology, Regenerative Injections such as Platelet Rich Plasma are essential to restoring structural stability to the joint. Subtle chronic tendon strains can also present obstacles to rehabilitation by preventing the proper recruitment of the muscles that stabilize the knee joint, which can prevent physical therapy from being effective. Once the tendon and ligament injuries have been healed with regenerative injections, then strength training the muscles that support the joint, restoring proper movement patterns that coordinate the muscles of the hip and ankle and regaining flexibility of chronically tight muscles is essential to maintaining a healthy knee joint.
With larger tears of ligaments, tendons, or the meniscus or moderate to severe arthritis, surgery has typically been required. At the San Francisco Institute for Integrative and Regenerative Medicine, we have pioneered advanced Adipose Derived Stem Cell enriched Fat graft injections that can provide a scaffolding upon which the body can regrow new tissue. This technique is currently being studied in a clinical trial to demonstrate safety and efficacy but many cases of have been successful without any adverse events to date.
Hip rotation is a common cause of leg length discrepancy that sets up patients to apply abnormal biomechanical forces to the knee. Addressing hip rotation through a combination of osteopathic manipulation, physical therapy and regenerative injections can be essential to addressing this common underlying cause of knee pathology.
In some cases knee pathology is caused by more systemic degeneration from poor nutrition, food sensitivities, microbiome imbalances, hormone imbalances, metabolic disorders, poor sleep quality, chronic stress or bad ergonomics in physical activity or work activities. Looking deeper at the system in which musculoskeletal injuries occur requires expertise in Integrative and Functional medicine as well as knowledge of prior ergonomics and biomechanics inherent in practice of Osteopathic Manipulative Medicine.
At the San Francisco Institute for Integrative and Regenerative Medicine our approach is to first understand the underlying system causing the pathology, then choose the appropriate treatment. Allowing the patient’s condition to dictate the treatment ensures that each patient is receiving a treatment that is tailored to their needs and helps to optimize outcomes to achieve long lasting results.