Chronic Knee Pain and Tendons
Below the knee cap, on the inside of the knee, are the attachments of three tendons: semimembranous, semitendinosus, and gracilis. Together, these tendons create the pes anserinus area.
Our Medical Director, Ross Hauser, MD, remembers coming across a classic pes anserinus case while on rounds as a new doctor in the hospital. A 35-year-old nurse, told him her rheumatologist diagnosed her with arthritis and had prescribed anti-inflammatory medicine. When he examined her knee, he found that she had full range of motion. Full range of motion of the knee makes it unlikely arthritis is the cause of knee pain. On further examination, Dr. Hauser was able to elicit a positive “jump-off-her-chair sign” when he pressed his thumb into the pes anserinus area showing pes anserinus tendonitis. Ross told her about Prolotherapy injections for knee pain but she never chose to have treatment. We suspect she probably still suffers from the pain, because “arthritis” was not the cause. Even in cases where arthritis is the cause, it is never caused by an anti-inflammatory medication deficiency. But in most instances like this, the rheumatologist will recommend various NSAID medications or even rounds of cortisone injections. Interestingly enough, if someone takes these anti-inflammatory medication long enough they will GREATLY increase their risk for getting arthritis. We can assume that maybe her rheumatologist was talking about the future?
Prolotherapy for knee pain
When Dr. Hauser gives a presentation on knee pain, he enjoys asking the audience, “What is the number one reason for severe knee pain in the elderly?” The overwhelming response is “arthritis,” which is incorrect. The number one reason for severe knee pain in the elderly is pes anserinus tendinosis which, when left untreated, may contribute to developing arthritis. Even in cases of significant arthritis, crippling knee pain is most often due to pes anserinus tendinosis or bursitis. This condition is easily treated with Hackett-Hemwall Prolotherapy, which is the Prolotherapy injection technique given into and around the entire painful or injured area (many injections vs. one or two injections). In our experience at Caring Medical, the Prolotherapy success rate for knee pain is over 90%.
The pes anserinus tendon, also known as the inside hamstring muscles, flex the knee and stabilize the inside of the knee. Most of us have very weak hamstring muscles that are very short because we sit for a large portion of our day. Many patients, especially those with fallen arches, are prone to strains in these muscles. The tibia tends to rotate outward to compensate for the fallen arch. This outward rotation of the tibia places additional stress on the pes anserinus tendons. Eventually, these tendons become lax and are no longer able to control the tibial movement, adding to the chronic knee pain. An arch support may be prescribed to reestablish the arch.
In our experience with many of these types of cases, Prolotherapy injections along the arch of the foot will also prove beneficial. Prolotherapy injections into the pes anserinus attachments to the bone strengthen the tendon attachments and resolve the chronic knee pain.
If you are suffering with chronic knee pain and looking for a permanent solution that doesn’t just mask the problem, our Comprehensive Prolotherapy treatment may be your answer. We have a tremendous amount of experience and high Prolotherapy success rate treating knee pain and would love to help you too!