Chronic or severe knee pain<
Causes of knee pain include degeneration, arthritis, or injury (such as sports injury). In some rare cases knee pain can be caused by infection or bone tumors. The use of diagnostic musculoskeletal ultrasound (or other imaging modalities) can help better define your injury, which may be more severe than you think. This may be why you are not improving as expected. Steroid injections and other anti-inflammatory medications (such as ibuprofen) fight inflammation. However, inflammation is not typically the problem after a period of time. The inflammatory aspect of these conditions does not typically persist after 3-4 weeks. Animal studies confirm that the tissue is degenerative. Specifically it is mucoid degeneration. (Mucoid describes tissue that is like mucous, which is not a very good quality in a tendon!) There are no White Blood Cells (WBCs) in this mucoid degenerative tissue. The WBCs are present in inflamed tissue. The tendon may also have a tear, either across the tendon (transverse) or, more typically, along the length of the tendon (longitudinall or interstitial tear). Steroid injections are known to cause further degeneration of tissue (tendons, ligaments, cartilage, facia) despite often providing temporary relief of pain. Ibuprofen or other anti-inflammatory medications alter the normal healing response after an acute injury, causing abnormal healing of the tendons or ligaments…although they do provide pain relief. Ice and/or acetaminophen are good alternatives that do not cause further degeneration. For ice, consider using frozen corn or peas for 15 minutes out of every hour.
For the patellar tendon, the muscle to stretch is the quadriceps. After warming up, bend your knee back as far as it can go and hold for 30 seconds. Repeat 3 times. For a more advanced stretch, squat down and try to touch your knee to the floor.
If you can, place both feet on a decline (with your toes facing downhill). One simple way to do this is to get a 2 x 4 and place one end of a piece of plywood on the 2 x 4 and the other on the floor. If you don’t have a decline, place both on a flat surface. Place most or all of the weight on your affected leg and bend down to 90 degrees over 3 seconds. Use both legs to stand up straight. Work up to 30 repetitions, 3 times daily.
- Only consider steroid injections if stretching and exercise do not work.
- Regenerative medicine can dramatically help the healing of golfers or tennis ellbow. Read more about regenerative medicine here.