Is your quality of life hinging on knee pain? Learn about how the knee works, the surprising reasons why it hurts and how you can find long-term relief with shockwave therapy.
Welcome back to another episode (number five) of the Unpain Clinic podcast and YouTube channel, wherever you’re connecting with us from. Hi!
Today we are going to talk about the knee joint and trying to understand why you have knee pain, or what’s going on with with a knee pain when it’s not going away. Mainly just trying to understand more of the mechanism of this joint; how it works or functions and why it hurts. What you can do, even if you’re at that stage where you need a knee replacement, and what to do afterward and some other things.
So I, personally, please don’t get me wrong on this, I call knees “dumb” because there’s usually never a direct cause of the pain. So, unless you fell or you got in a car accident any other time where you hit it somewhere, then yes, it makes sense. You have physically injured your knee, and therefore, it’s hurting. But any other time, any other cases, where you end up with chronic knee pain, and you have no clue where it started and how it started. Usually, the cause is either the hip or the ankle. Because those two joints are more complex. One touches the ground and the other one controls your whole leg, and the knee joint is just in between, almost like being as a spring, just kind of minimizing the impact that can actually come from the hip towards the ankle or vice versa, from ankle towards the hip.
As a joint it is very simple, you have those two bones, close together, and it only does like flexion/extension so you can you can straighten your knee, or you can bend your knee, there’s not much rotation that happens on the knee joint, like it does at the hip and the ankle. So, what I’ve learned in my experience and what I typically see in my practice is that if somebody had let’s say sciatica problem in the past, or lower back pain/lower back problem. And they treated it once but they kind of just reduced the symptoms so they pretty much just helped their body to adapt to that dysfunction. So that’s what happens when you only treat the symptoms and you don’t treat the cause.
So now, your body is actually allowing more weight to go on the knee from the hip, like from the upper body. And then the joint, from the top starts pushing more into the bone that is underneath the joint. And the same happens now if you ever sprained your ankle and it is not treated properly. Now your body starts actually applying forces now from from the bottom up. And again, causing knee dysfunction.
Imagine this. If you take a glass of water, and you hold it, just for like, 10-15 seconds while you drink it, it’s very light and easy. But try to hold the glass of water in one spot just in your hand all day or all week or months, and years, you can’t. So the same thing happens with it with a knee joint. It can only compensate for so long; it can only handle so much. There’s a point that it is going to start wearing out. It’s going to start kind of eating, or destroying its own mechanism. And then it starts hurting, and giving your trouble, giving you difficulty or pain when you go upstairs or downstairs, and then you go and get an x-ray, and then you see some physical changes, and then they say “Oh yeah, we found out where your pain comes from. It’s this spot look: it’s wearing out. It’s arthritis, and oh yeah, you’re going to need a joint replacement, eventually. Like that’s what’s going to happen but let’s, let’s just try a cortisone shot, we’ll inject it in the area, and then the pain is going to go away. And then if you’re lucky that the cortisone shot works for you. Yes, the pain is going to stop – but you have to remember that dysfunction (that caused that problem in the first place) hasn’t been treated. So even though you don’t feel the pain. Because you had anti-inflammatory cream put on your knee, or you had a cortisone shot on the knee joint, the dysfunction is not corrected and eventually it’s going to catch you. It’s going to it’s going to hit you.
But when it comes back, it’s going to be even worse than in the this first place. Usually with cortisone shots or steroids, they make the soft tissues more fragile. Any joint in the body it’s actually supported by soft tissues. So, soft tissues, stabilize your joints, and they make them move. So, if you have a problem in the joint, most likely you have a problem in the muscles in the soft tissues. The only time when the joint really messes up muscles would be if you were in a car accident and you hit the dashboard with your knee; or you landed in your knee, you’re playing sports, it was like a high impact injury. Yes, that’s the time where the joint becomes kind of a cause toward the dysfunction in the muscles.
So, yeah, then it comes back later on. It’s just almost like there’s this alarm going off and you’re trying to cover your ears, instead of going and trying to figure out why there is an alarm in this building.
So, usually after the the cortisone shot doesn’t work anymore on the knee pain, then you’re usually gonna start looking for other alternative therapies probably, you know, physiotherapy, chiropractic, massage, acupuncture, etc. I’m glad if you’re somebody starting there, that’s great, because at least for those modalities, you’re trying to look more into the dysfunction of the joint. And then if you’re somebody that already has been through all of this and you’re still in pain, that’s where we come in.
That’s where the Unpain approach, modalities, technology and techniques come in. So, we help people that have been in pain for a minimum of three months, and have tried everything else, unsuccessfully. So, typically what we would do in those cases, if somebody comes with chronic knee pain that is having difficulty going upstairs/downstairs. Every time when they go from sitting to standing, feel pain, and grinds and it makes noise, then we will actually treat you with shockwave therapy.
That’s our tool currently in 2021. We constantly add different tools in our toolbox, but the ones that actually work together with what we already do, just to stimulate the body to heal even faster. We are trying to actually reduce the time of rehab/healing. Currently we only treat people in pretty much any condition 3-5 times and then we let the body heal, and see where, where it goes. Most clients don’t need to come back. That’s all they get from us.
So, I’m just gonna take an example of a client that had a knee problem. Both sides – bilaterally. So every time when you have pain on both sides, usually the cause is not in the joint. It’s coming usually from the core, from the lower back, and it’s affecting you down. When the pain is only on one side of the knee, most likely it’s coming from the ankle. So you sprained your ankle, and then it’s affecting more of that joint, and that’s, that’s how we kind of differentiate or that’s how we look at you.
So, a client had appendectomy on the on the on the right side, when he was very young. So, every time when you have a surgery in the body, scars can cause muscle dysfunction. They can mess up the way how your muscles actually fire and how they work. So, when you have an appendectomy, C-section, tummy-tuck, gallbladder surgery, breast segmentation, open heart surgery, you name it, in the abdominal area, your core muscles become dysfunctional and your back takes over. That’s why, if you’re somebody that has lower back pain, as well as knee pain, and you have any of those surgeries, most likely the cause is coming from those scars because they affect the communication between your nervous system and the muscles. But also they physically pull you towards where the cut is.
So, anyway, now muscles become dysfunctional the core muscles become dysfunctional, your back takes over, because your nervous system, it doesn’t let you fall. It has to keep you upright against gravity. So, it compensates. The back muscles take over, and then glute muscles take over, like you get super tight there you’re not walking properly, you’re overloading your knees, and that’s how the pressure comes down to your knees and sort of wearing on your joints.
So what we typically do is we go and treat the scar first on the first session to reactivate your core muscles. It doesn’t matter how long ago your surgery was. We actually have a question that we ask every single client at Unpain Clinic we ask “any surgery from the time you were born to today?” And people ask us like, “oh, but it was 60 years ago.” And we say “Yes, but you still live in the same body, you didn’t change the body right?” So it’s still affecting you and injuries don’t have an expiry date. So, once you get injured, it’s either gonna heal or you’re gonna adapt. So, that’s why healing properly, it’s very important.
So we treat the scar. We go and check if there’s leg length discrepancy. Is your pelvis pulling? Double check your ankles, how’s the range of motion on the ankle? But in the case where there is a bilateral knee pain, when both knees are hurting, we focus more on lower back. So, we have to go in and treat the whole lower back on the first session. Then we go down to the knee. Are the tendons thicker? Is there swelling around the knee? Is there a heat around the knee? How much are you actually straightening your leg? So, if you have knee pain just try to do that and if your knee doesn’t fully extend… imagine, if you’re just sitting and doing nothing and you’re straightening your knee, and it doesn’t extend fully. Just imagine, when you’re walking, it’s not going to extend, it’s not going to do anything different, because that’s your range of motion. And if that’s happening, imagine what you’re doing to that joint inside. You’re grinding it more and you’re hurting it more. So, when there’s actually limitation in knee extension, usually there is a muscle behind your knee, (it’s a very small muscle called popliteus muscle). It’s a small but mighty, very powerful, like your jaw muscles, your masseter muscles. So, once there’s a knee problem, and once that muscle goes in compensation, it becomes 200-300% tighter. So, that’s the muscle that that limits your knee extension.
See, we have to think holistically, we have to kind of break apart all the scenarios to determine how have you ended up with with chronic pain. So we have to go and treat behind your knee because that’s where you have more blood vessels, that’s where there could be a Baker’s Cyst. (That’s pretty much a reservoir of the lymphatic system when you have too much inflammation around the knee, it has to go somewhere. If it cannot go anywhere, then it’s going to start swelling up and that’s what pushes your skin and it stretches everything and you can actually physically see this). But before it gets to that point, there are some other reservoirs inside the body that you cannot see and those are the ones that actually fill first.
Okay, so we have to treat the back of your knee. We have to relax your hamstrings, your calf muscles and what we call the popliteal area. Then we go in the front of the knee, and check if quadriceps muscles are working properly. Are you somebody that you have been sitting a lot? Maybe you’re driving a lot or you work in an office for a living, and those quadriceps muscles, those very powerful muscles, have become so weak that they’re not stabilizing your knee from the front. And what happens when the muscle becomes dysfunctional is the tendon takes over. So your patella, your kneecap, starts kind of almost like getting thicker, and then the patellar tendon, there’s almost like a small tendon that goes from your patella, to the tibia bone, which is like the lower leg bone, that’s where it attaches and it gets thicker. So now, if we have all those structures not tracking properly, not working properly, you’re going to have knee problems.
So, wherever you are in the world, think this way (even if your practitioner doesn’t think this way): find somebody that looks at you from this perspective, so that they can go and make sure that the cause is treated. Let’s say you are lucky and you found this practitioner that can treat you this way but you already have had 20 years of knee problems, compensation, you’ve worn out the joint. It’s still okay. Even if you’re to a point now that you end up needing a joint replacement, it’s totally fine. You have to understand, even with a joint replacement, even with a knee replacement, the mechanism that moves your joints, doesn’t change – it doesn’t get replaced. And this mechanism, it’s your muscles. The soft tissues around, there are still going to be the same. So, there is a saying: “whatever you go into the surgery, that’s your starting point, after the surgery.”
So before you get knee replacement surgery, start strengthening your glute muscles, your core muscles, your quadriceps muscles; start stretching your hamstrings and your calves. Even if it doesn’t, eleviate the pain. So whatever you can do, try to get those tissues going. So, that way, after the surgery, whatever you gave prior, it’s going to help you to recover faster because now the joint doesn’t have any problem anymore. It’s a bionic joint.
But muscles have now been injured from the surgery from the cut; there’s fascia pulling and there’s another scar, there’s a lot of dysfunction. So, therefore, you have to get going, as soon as possible right after surgeries. Visits are actually really good for that for that type of rehab so try to find a physiotherapy clinic near you that specializes in knee rehabilitation, like post joint replacement, so they can get you going with exercise. About six weeks after that, you can actually find a clinic near you that does shockwave therapy for the knee or after joint replacement, because shockwave will get the healing going. So, if you’re somebody that just ended up here and you have no clue what I’m talking about when I say “shockwave therapy”, I’ll just explain a little bit.
Shockwave therapy uses sound waves. It is the same technology as they breakup kidney stones with. So it’s been used in rehab since the 90’s. It started initially in Germany. In Edmonton, Alberta, we have been doing shockwave for over 11 years. One thing that you have to always be careful of is that in the market that there are a lot of clinics that say “we do shockwave therapy”, but the tip that I want to give you every time if you want to choose the place that has the right shockwave is this: if their machine sounds like a jackhammer, it’s not a shockwave. It’s a radial pressure wave. If they don’t have True Shockwave, it’s totally fine. Go ahead and get that because there is a saying: “if there’s no rain, hail is still good.” Okay? You can still get benefits from it, but you really need true shockwave because the true shockwave what it would do is break down scar tissues and adhesions up to 12 centimeters deep in the body. That’s very important after joint replacements, because your scores now are much deeper than they previously were prior to the surgery. And then, it stimulates new blood vessel growth. So wherever True shockwave is actually applied, there is 200% to 300% more blood circulation in that area. About eight to nine weeks later, that’s the highest stem cell activity in that region. So, shockwave triggers your endogenous stem cells. So you can almost call it a stem cell activation therapy, and then your body is now triggered to repair everything that has been injured in the area.
This is the same mechanism, whether you have a knee replacement or if you just have chronic knee pain. Shockwave is just a stimulation, and it does this with virtually no side effects. And even after a joint replacement, the metals are not a contraindication for shockwave. So, knee replacements are not a contraindication for shockwave because shockwave uses purely sound waves. It’s a very short wave; it’s about 0.2-0.6 nanosecond. There’s no heat or cold released and if it hits the metal is just going to reflect. It doesn’t have the power to physically break down the metal, especially the shockwave that is used in orthopedic fields, or like for rehab.
Lithotripsy devices – the ones that are for kidney stones? I don’t have experience with them. I have no clue, but they are usually very powerful energy. So, that’s a completely different story.
So, with shockwave, we typically aim for three to five sessions – it depends on the knee pain. But the minimum is 3 sessions and maximum is 5 sessions. Then a session can be done once a week. After you finish the initial protocol (what is called the treatment phase), we suggest you let your body heal for a minimum of about 4-6 weeks. If you’re happy where things get then that’s it, you don’t have to come back. If things get much better, but still bothering you a bit, then we are here, we can still help you more. If we treat the same area, then we only have to do, like one session and then give it a couple of weeks so just kind of keep boosting the body to heal itself, more and more.
So, the good thing with shockwave therapies for for chronic knee pain is that you can combine this with any other modalities. If you’re working out, if you’re getting physio, if you’re getting chiropractic, if you getting massage or acupuncture; it does not interfere with those other modalities.
So, I don’t want to go more into the knee joint, because there’s not much more honestly. The only other way that we could talk more about the knee joint would be if we started naming the conditions and the dysfunctions. So, when you call it like patellar tendinitis or tendonopathy or chondromalacia, which is like where your patella (your knee cap) is actually a rubbing against the bones of the knee. But the mechanism of the knee dysfunction is pretty much the same because everything usually starts with muscle dysfunction first. Wearing out, giving you some signs, maybe giving you some pain; just telling you that “hey, whatever you’re doing, you’re not walking properly, you’re not doing proper things.” And then, if you don’t treat it, if you keep ignoring it, then it’s gonna get to the point that your body says hey, I need to adapt because this person (this brain, this human) isn’t listening to me to take action now. And it says “it’s okay, I’m going to catch him later on.” And then in 15-20 years or 30 years it comes and then that’s how every chronic pain or every dysfunction in the body happens.
If you wait for somebody to take care of you, that never happens. So you have to get in charge. You’re responsible for yourself and focus on your health because that’s the biggest wealth. That’s the most important thing that you have. There’s no other house for your spirit, for yourself, and your body, so take care of it. If you, if you do an oil change in your car every 10,000 kilometers are you having a massage for yourself once a month? Are you making sure what food you are putting in? Are you making sure after you eat, like how do you feel? Are you getting energized or are you getting tired and sleepy? If you’re getting tired and sleepy, then that is not the right food for you.
So, there are multiple factors when it comes to healing, and even getting injured or ending up chronic pain. We try to make it simple because it took us years of education and learning different technologies and different approaches. That’s why my goal always has been, and still is, and I’m always still looking, to see how we can make healing faster, effective and works? How can we regenerate humans as non-invasively as possible?
So, yeah, when it comes to regeneration, there are a couple other modalities from which you could benefit a lot are stem cell injections and PRP injections. And these are more to physically repair the injured structure, but they still don’t treat the dysfunction. So whatever you’ve learned so far, the only way to correct those are through a proper physio approach. Like proper muscle treatments, soft tissue treatments, self awareness, like just trying to listen to your body (how you’re walking, how you’re moving), changing the habits in your life. But, I’ve had so many clients that had stem cells and PRP injections for their chronic knee pain, and it helped them a lot.
But then I also have cases, I remember a guy who flew to the United States when stem cells just started in the United States for the knee joint. He had the treatment and he paid something like 5000 US dollars for the injections and it did not do anything. He came back, we did shockwave and we corrected the problem. But that was an example where the pain or the dysfunction, it wasn’t the degeneration in the joint, it wasn’t what they saw on the X ray, it was more of the mechanism that moved that joint.
But yeah, what we suggest because now, PRP is more available, what we suggest to clients is: do shockwave first, get the healing going; then you can boost it with whatever you want. Whether you decide to get injections and boost the healing more or focus on the nutrition of the movement, that’s up to you.
A lot of things are available nowadays so please look around before you make the decision to do surgery on your knee because every time there’s a surgery on the knee, in my experience, there’s no return. We can still do a lot in the body, not just us – a lot of great practitioners out there that can still help you if the body is still intact. But as soon as there’s a cut or there’s physical change, then it’s not as easy.
Okay, thank you for your time. I hope that this conversation, this kind of download of my knowledge to you and by sharing my experience with you it’s going to help you to get a little bit more clarity about the chronic knee pain that you are experiencing or not you but somebody that you might know. Hopefully, this will help somebody to make a decision and start changing their habits. Because without changing the habits of our life, nothing’s going to change. So, if left doesn’t work, then right.
So thank you for listening and have a great time till the next episode. Take care!