Everything You Need to Know About Knee Pain

Knee Anatomy00:31-03:31
Kinetic Chain and Knee Pain03:32-06:53
Knocked Knees Xray06:54-10:33
Osgood Schlatters10:34-12:19
Arthritis and Cortisone 12:20-17:17
Knee Pain and Knee Scraping18:57-20:27
Knee Replacement20:28-21:38
Supplement of the Month Traumeric21:39-23:05

Dr. Clayton Roach: [00:00:06] Let’s get to what we’re talking about tonight, which is the need and I think it’s a logical progression when we talk about the hip and what can happen at the knee. And I know for a fact that some people listening tonight have problems

Dr. Clayton Roach: [00:00:25] Because we know you. All right. Go ahead. Better. Yeah.

Dr. Ben Boudreau: [00:00:31] So what we see here essentially is two different kinds of views of who’s taken on x-ray. The view on the left-hand side is a lateral view and the view on the right-hand side is a Posterior view. And so what I’d like to really summarize over here is. There’s the femur at the top at the superior aspect. Which is the longest bone in your body. And then below is the tibia. Which just lies below, there’s a little bone in the back called the fibula because there are actually two bones in your lower leg and then there’s a little round bone, just anterior to the femur. And that’s called your patella. It’s your kneecap. So pretty cool there. And so what I want people to pay attention to is that this is a joint that moves in one direction. It’s a pivot point, so it moves, so it’s a hinge joint and so it moves in one direction, flexion and extension. As well, it’s got. Exactly. The anterior posterior. And so you want to make sure that you have equal spacing in between bones as well.

Dr. Ben Boudreau: [00:01:54] And so just like that, that arrow there points to the joint between the femur and the tibia. So you want to make sure that space is nice and wide and. Now, you can anybody see the patella, where is the patella at Dr. Roach, where is that patella?

Dr. Clayton Roach: [00:02:20] Right. I actually see a brighter white outline right here and you guys are now becoming X-ray specialists. You can see these shadows if you hallucinate enough. One thing I wanted to point out to Ben on the side of you over here, you can see the tendon over here. That’s about this wide. Right. And it goes over the patella and attaches to the tibia. And that’s actually where if you type the reflex, your leg will kick. So that’s the tendon right over here to put a T here for tendon. And then that tendon is basically an attachment for your quadriceps muscle, the big muscle in the front part of your thigh.

Dr. Ben Boudreau: [00:03:04] Yes, and that’s great, and so what you’ll also find, as well as you’ll find fat pads that lie beneath the patella, which are supposed to absorb a lot of the shock and provide a little bit of cushioning for the patella as it slides up and over the femur each time that you flex and extend that knee. Yeah. Good. That’s essentially the normal anatomy of the knee joint.

Dr. Clayton Roach: [00:03:31] Yes. All right. I’m going to start on this one, buddy. Sure, go right ahead. The one on the far left, guys, is what we’ve been talking about, which is called the kinetic chain. All right. So what we see here basically is just a review of how various parts of the body that are not in the proper biomechanical alignment can have an effect on the next part of the chain. I always give an analogy that I’m talking to patients about this. It’s almost like a theatrical show. And if somebody forgets their lines, it messes up the next person and it messes up the next person. And all of a sudden the whole show is affected and the crowd starts to boo. And the crowd booing is basically

Dr. Clayton Roach: [00:04:19] For the body.

Dr. Clayton Roach: [00:04:20] Your body’s starting to be dysfunctional. And you start to at one point because of the internal things that are happening, not happening, you start to have an external manifestation of all of these, you know, dysfunctional areas.

Dr. Clayton Roach: [00:04:34] And we get to one day call that pain. So what do you think came first, the dysfunctions or the pain? And I’ll give you a clue what came first, the cavity or the toothache. Right. And many times people make the mistake of thinking that because the pain started yesterday, that that’s when the problem started. And we sometimes have to have a come-to-heart conversation that the problem has probably been there a long time, as you can tell from this image over here, that you could have had a long-standing issue for a long time.

Dr. Ben Boudreau: [00:05:07] Yeah, exactly in the way that I like to

Dr. Ben Boudreau: [00:05:10] Bring the kinetic chain back to the knee joint and I explain this to patients all the time, is that the knee joint is a lot like the middle child in the back seat of a car. So legs for a few of the parents out there who can understand this analogy. So you’re driving your car down the road and you’ve got three kids in the backseat and somebody starts crying. And so you turn around and you see the kid that’s sitting in the middle seat, he is just in tears. And then the kids on either side of him are just looking out the window, minding their own business. Right. That’s the idea with the knee joint. And so there can be dysfunctions above in the low below and seeing that the knee joint is in the middle, it can begin to suffer for some of the issues that are happening both above and below that joint there. And the guy in the middle is just getting the elbows from the guys beside him, right? That’s exactly right. The knee is getting the elbow. The knee is rarely the driver and most of the time the passenger. Yeah. And so since we sort of talked about the kinetic chain, which is the furthest left photo there, commonly what you see in people who have kinetic chain dysfunctions as they start to develop and

Dr. Ben Boudreau: [00:06:28] A lot of arthritis there on the outside of the knee, just because of that Vargus force that knocked knee effect begins to close the joint space on the lateral side. And it causes a lot of wear and tear on the cartilage, which eventually leads to the arthritic changes that start.

Dr. Clayton Roach: [00:06:51] So what we’re talking about, knocked knees is and you see this, we see this a lot with more females and they have what’s called a large what’s called a Q angle. And it’s basically the angle here and here. So the larger the angle, the more pressure you’re going to have on the outside part of the knees, and this type of dysfunction can start very, very young, right? I actually saw that Ben, a lot of volleyball players. Because of the way to go down on their knees and the way they always prepped when the other team is serving their crouching down on their knees, getting ready to receive the ball, and you see that a lot.

Dr. Ben Boudreau: [00:07:35] So I want to point out

Dr. Ben Boudreau: [00:07:38] The idea that

Dr. Ben Boudreau: [00:07:39] Because the knees are knocking to the center, to the middle aspect, the patella is trying to stay central. And so, Dr. Roach, could you take the stylus and just circle the patella

Dr. Ben Boudreau: [00:07:54] So people can see how far lateral on the outside the patella is staying? So you see how we’re just outlining the shadow of the patella, you see how far off center it is, it’s supposed to glide in the center of the femur. But because the knees are not the patella is now staying laterally and the muscles now have to work harder to track that patella, and it can lead to patella tracking issues as well.

Dr. Clayton Roach: [00:08:24] So let me expand on that a little bit. Most of you will be able to see, but imagine that there is a groove and the Patel is gliding in that groove. So the patella has a groove over here.

Dr. Clayton Roach: [00:08:38] That is convex and the femur has a groove that is concave, so the Patel is basically supposed to glide in that groove. So as soon as it starts to hang out on. The outsider, what appears to be the outsiders, because these are inside now, the underneath the patella is now grinding against the bone and that’s what starts to erode the cartilage underneath the patella. And then we get the call that was called patella femoral syndrome.

Dr. Ben Boudreau: [00:09:12] Correct.

Dr. Ben Boudreau: [00:09:13] And so now that we sort of talked

Speaker1: [00:09:15] About knee valgus, right, and so we talk from the foot start there, the foot becomes flat-footed pronated, and then the knees begin to churn in

Dr. Ben Boudreau: [00:09:26] And they knock

Dr. Ben Boudreau: [00:09:27] Together. And then we talk about hip last week. And so we’re moving on to the last photo, and at the beginning of this Humpday, I sort of gave you guys a fun fact about how when we’re born, we’re born with three hundred bones. And then as we age, those bones begin to mature and we then end with two hundred and six bones. And so when a child is growing, a lot of these growth centres are in the process and then children have growing pains, etc. We call this growing pains. And so the patella will begin to pull if it’s not aligned properly on one of these secondary growth settings, it can actually pull it away from the tibia. And so if we look down at the example with the furthest right photo you can see there. How that area of the tibia is actually being pulled away because before the bonus fuse, it’s made of cartilage and it’s softer than the bone. And if the patella is being tracked properly and there isn’t proper alignment, you can actually have a condition called Osgoode Schlatter’s. So let’s kind of review the anatomy here. So here’s the patella. Here’s the femur.

Dr. Clayton Roach: [00:10:42] Here’s the tibia and here’s the fibula. OK? Right here, there’s what’s called a tuberosity. OK, so it’s an area of bone and there’s a growth center there and here is the tendon. That basically is the attachment for this quadriceps muscle here. And that tendon attaches right in through here. And as you can see, there’s a little loose and little black line right there. OK. And if I can get my razor, I’ll actually erase it so that you can actually see. And now you can see the black line right there, so that’s actually a piece of bone that’s coming off another piece of bone. And that is very painful. So you see that a lot with teenagers and especially teenagers that have kinetic chain problems, things happen. You got knocked knees, everything that’s happening. And all of a sudden they’re playing a sport like a basketball. We have to push off with their legs and they’re having to contract their quad. And now it’s pulling on that bone and really, really hard. So, again, as Ben said, that condition is called Osgoode Schlatter’s and very, very common with teenagers.

Dr. Ben Boudreau: [00:12:17] Ok. And so next up here, we have knee osteoarthritis. Everybody knows about knee arthritis, it’s that painful clicking, popping sensation in the morning especially. And then after 30 minutes or so, things begin to get loosened up. And it’s not so bad in the afternoon. And then once you hit the evening, it’s kind of back to where it started again. And that’s what it looks like. And so we can see that there’s see our joint spaces on the right side. That’s a normal knee. That’s normal anatomy. They’re beautiful spacing. And then we look to the. Left-sided image and we can see that that joint space is not as nice as when we started. Hey, Doctor Roach

Dr. Clayton Roach: [00:13:04] Yeah, so basically what you’re going to see almost a hundred percent of the time, you’re going to see arthritis on the middle side of the knee. So if your pain is on the middle side of the knee on the inside. That could be arthritic pain because it’s typically that side that’s going to collapse first and then the side here, as you can tell, is still fairly big, right. And then what happens? Because the inside starts to collapse. You start seeing people instead of being knocked at me. They’re actually Bow-Legged. Because the inside is collapsing, the old side is open, so they almost walk with round legs, OK? And that’s because of the destruction that’s happened on the inside part of the knee. So here’s what you do. Not going to take a little break. If you know someone that has knee pain, arthritis, pain, he has had a knee replacement, even yourself. Share this video, because what we’re going to talk about next and how things kind of evolve is very important and they might want to hear this. All right, so. I want you guys to kind of slip your mind a little bit and not see arthritis as the cause of an issue, but the effect of an issue so many times what people will do to have arthritic pain and they go to the doctor and the doctor is going to recommend to get a cortisone shot. OK. And part of this process and the rubbing in the muscles working harder. Yes, it is going to create

Dr. Clayton Roach: [00:14:47] Inflammation and inflammation is going to create pain. By the way, there’s never any pain with throat inflammation. If there’s pain, you know, there’s inflammation because that’s what creates the signals to the brain that there is pain. So what happens? You get a cortisone shot without really understanding where all this came about. Is the cortisone shot going to create better mechanics? No. Is it going to create better mechanics? No. Is it going to create better theoretical no rotation and movement so that you’re better able to dissipate the ground reacting forces? No. So really, with cortisone, what has changed? Nothing other than obliterating the inflammatory process, creating a Metabolic hormonal shift in that area that actually leeches calcium away from the bone, which means that upon repeated cortisone injection, you can actually get generalized osteoporosis in that area. And yes, you may feel better and you may feel better for two months, you may feel better for three months, but in the end, what has changed other than something that is not good for you, like perhaps getting osteoporosis if you do it long term, really nothing. And then what do you do when you feel good? Well, you go well and you do your thing and you don’t get any signals that you shouldn’t be doing that and you make the area worse.

Dr. Clayton Roach: [00:16:17] So always be careful. In terms of what interventions? You say yes to it because it could have a dramatic effect on your long term. I had a lady, she had four repeated cortisone injections in her shoulder, one day it was windy. She opened her car door. The car door basically opened up because of the wind, completely shattered her shoulder because she had regional osteoporosis caused by repeated cortisone injections. So, guys, be careful, don’t say yes to everything and make sure that you question why is that there in the first place? Is there anything that I can do to offload what’s going on in the knee by fixing other things and maybe reduce the pain so you don’t have to go to those extremes like a cortisone injection or perhaps prolong the knee replacement So cortisone shots can lead to a bad reaction. Absolutely. Sorry, go ahead Ben. Went off on a little tangent. Love that.

Dr. Ben Boudreau: [00:17:19] And Angela is here. Angela is in the house. Yeah, guys. So basically looking at the image here, you can see that there’s a reduction in joint space. You can see sclerosis again, which is the bony reaction to having that rubbing over time and a response to the lack of cartilage that is there. Now, you can also see that there are changes beginning to happen on the other side as well. There is where the IT band passes over, which is a muscle that rides along the side of your hip down into your knee. It can also cause rubbing against the side of the femur, the lateral side, and cause pain at the knee joint. And so it’s always just like that. Exactly. And so it’s always best when you’re treating the Vinnie to always look at the hip, make sure that you are dissipating those forces properly and that you’re finding the actual cause of the pain and not just treating a symptom.

Dr. Clayton Roach: [00:18:19] Yeah, and people that have a 90 band issue most of the time are going to be hip-related. And if you want to learn to make sure you look at some of the other conversations we’ve had on Humpday Wednesday nights, but if you do have a night band issue that’s really pulling over here, you’re going to start to get a condition called Runner’s Knee and you don’t really need to run. It’s almost like tennis elbow or golfer’s elbow. You need to go to play tennis. You can get a runner’s knee, which is a lateral knee pain because of unsolved kinetic chain issues. Yeah, so there’s a common here, bendable knee scraping, so that’s a layman term for people that have arthroscopic knee surgery where basically they remove the debris inside the knee, which, by the way, now they don’t do a whole lot because what they find out was when you scraped the knee inside the body, wants to rebuild that bone and many times or rebuild that bone at a quick rate and sometimes the bone can grow kind of weird. And now you have all kinds of bony growths that have grown back into the knee joint and actually made things worse. So what they found out was that Miss Scopes. They didn’t really provide long-term benefits, so they’re really not doing a whole lot of those, just like they’re not really repairing meniscal tears that are small unless you’re an athlete and you’re really, really pounding those knees every single day.

Dr. Ben Boudreau: [00:19:50] Now, I was going to say as well, with the knees scraping, you can clear it out, right. And you can remove parts of your knee out. But still, at the end of the day, your knee is going to go back, because if you’re not correcting any of those issues that we’re getting, it’s going to assume that same position, the body is going to build itself that same way. So if you did have it in the past and you had that arthroscopic knee surgery done, start addressing some of these biomechanical changes. If you have that knee strengthening some of your glutes, you can get that hip external rotation. OK, so then when we got here, a little bit of hardware tried to go through the airport with this type of thing.

Dr. Ben Boudreau: [00:20:32] Yeah, yeah. It’s a little bit of hardware.

Dr. Ben Boudreau: [00:20:34] So as you can see there, we have the metal femoral cap that goes right on top of the femur there. Once they remove the condyle that’s been severely affected by the changes or what else may have caused that issue in the first place. And then you see the plastic or polyethylene tibial cap again, which is replacing that tibial plateau.

Dr. Ben Boudreau: [00:21:02] And that’s what you see there, this is what a knee replacement looks like on an X-ray. Yeah.

Dr. Clayton Roach: [00:21:09] Knee replacements are actually, you know, like they do these dentists pull teeth, right? I mean, these have evolved the law. The materials they use have evolved a lot. And I have to say as patients do fairly well. But guys, you know, this is not one thing. You wake up in the morning and on your vision board, you say one day I want to have a knee replacement. You definitely want to try to avoid these. And the way you do that is to do some of the things that we’re recommending here in terms of preventing this issue. Next, we have our supplement of the month. I think it kind of goes hand in hand. What we’re talking about. We have a product called Traumeric from Orthomolecular that basically is going to be great in terms of antiinflammatory and inflammation can be found in a lot of places. It can be finding it found in your GI tract, which is why a lot of people have some GI issues, gastrointestinal issues. And Traumeric is kind of the brand name. And it comes from turmeric, which is also called curcumin, which is a very, very. Huge antioxidant, but also an anti-inflammatory. So definitely this can be very useful for people to have inflammatory issues. It also contains bromeline, which is actually a pain inhibitor and actually reduces a lot of the pain quercetin, which is an antioxidant rootin. So this is a great product that, you know, a lot of times that people have just regular osteoarthritis. You know, obviously, if your rheumatoid arthritis is a little bit more advanced, this might not cut it, but definitely something for osteoarthritis. As a matter of fact, they actually show a picture of the knee there. So this is meant to be for the knee conversation.

Dr. Clayton Roach: [00:23:05] Again, our goal with this is to speak to the masses and hopefully get some information across. Across Nova Scotia and Canada, wherever you guys are listening from, so that way you can have better, better answers and you can ask the questions and you can have better outcomes. Right, because life is all about quality of life. It’s not about how long you live. It’s about the quality of life that you have while you’re living is living with the quality of life, is not really living. A patient telling me that this morning while she was crying. So people are in need of this information and you never know how far-reaching B.J. Palmer getting started chiropractic care said you never know how far-reaching something you need things to do today will affect the lives of millions tomorrow. I love that quote and why we’re doing this. Any closing thoughts, Ben?

Dr. Ben Boudreau: [00:23:58] Don’t forget to like and share these conversations with your friends, families, private groups, exercise classes, people who you’re close with, that care about their health and that you care about them, gives them the opportunity to, like, share and listen in on these conversations were to real people. We’re here to listen to you and we appreciate you guys tuning in each and every single week for Humpday conversations with Dr. Roach and Dr. Boudreau.

Dr. Clayton Roach: [00:24:28] What’s up? Listen, if you like this episode, you’ll probably like the other ones. Chances are pretty good. So here’s what you need to do. You need to like us and follow us on Facebook. Following means,you get notified when these two guys are alive. Next, family, friends, you need to share these episodes because you never know. You might help them because they need this information as well.

Dr. Ben Boudreau: [00:24:45] And guys, if you ever miss an episode, make sure you subscribe to us on YouTube. That way, you can watch the episode over and over and over again.

Dr. Clayton Roach: [00:24:51] Guys, we love you and appreciate you. Take care.