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Knee Pain

After the knee, hip problems are certainly one of the more common problems that patients ask me about. Of course the most common condition is Osteoarthritis or “wear and tear” arthritis.

 

After I take a history, the first thing I want to do is a careful palpation exam to see if the hip capsule is positive for the “jump test”. I also want to take a careful look at the lumbar spine and particularly at the pelvis. Just because a patient feels pain in the hip doesn’t mean that that is the origin of the pain. We want to find all the pain generators.

 

Also, I like to see a standard weight-bearing hip xray (a-p of the pelvis, single view) to get a direct look at the joint surface. If there is little or no joint space and the patient is close to a “bone-on-bone” situation, we are generally going to lean towards starting the regenerative healing with stem cells and PRP, rather than PRP alone. In other words, because the condition is more severe, we would like to start with a more powerful approach.

 

On the other hand, if joint space is preserved, PRP may be the order of the day and quite proficient at healing joint capsules and pelvic tendon attachments. It usually takes about three PRP treatments given at 2-4 week intervals for complete resolution.

 

As is usual with all regenerative injection protocols, we ask patients to avoid anti-inflammatory medications and I suggest active rehab such as swimming and cycling. I want to move the affected region but not LOAD the muscle attachments too early. I often recommend a foam roller that patients can use on a carpeted surface to “roll out” the kinks.

I don’t feel the same way about knee replacement. For me the latter should be the very last resort. I think the vast majority of patients with chronic knee pain can do very well with a regenerative approach although many cases might end up needing stem cells to get the results they are after. Since surgery always has its’ risks we recommend that people should thoroughly explore nonsurgical regenerative approaches before resorting to knee replacement.

 

As an additional note I think it is important for many patients with knee, hip and/or low back problems to get proper orthotics (arch supports). As we age the foot arches weakens and we start to pronate as we put weight on the foot. This in turn causes extra stress on the knee, hip and pelvic/low back. By supporting the feet with orthotics we maintain the foot in anatomic position at impact and optimize the biomechanics so there isn’t undue stress on specific structures.

 

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