Treatment of Knee Pain
Prolotherapy for Knee Pain
Published medical studies from Caring Medical doctors and other researchers have shown that Prolotherapy can result in clinically documented and sustained improvement of pain, function, and stiffness in knee osteoarthritis.1 In the Journal of Prolotherapy, our doctors studied 80 patients that they treated one or both knees with Prolotherapy. In total 119 knees were treated every three months with Prolotherapy. The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy. 2
Common Knee Injuries and Disorders treated by Prolotherapy
- Anterior Cruciate Ligament (ACL) Partial and complete tear
- Articular Cartilage Tears
- Baker’s Cyst
- Chondromalacia Patella
- Collateral Ligament Injuries
- Knee Tendon Bursitis
- Meniscal Tears
- Osteoarthritis of the Knee
- Osteochondritis Dissecans
- Osteonecrosis of the Knee
- Patellar Tendinitis
- Patellar Tendon Tear
- Patellofemoral Pain Syndrome
- Quadriceps Tendon Tear
- Rheumatoid Arthritis of the Knee
- Runner’s Knee (Patellofemoral Pain)
The knee functions to allow movement of the leg and is necessary for normal walking. The largest joint in the body, the knee joint has three compartments. The knee joint has an inner and an outer compartment. The joint is made up of the lower end of the thigh bone (femur), which rotates on the upper end of the shin bone (tibia) forming the main knee joint. The knee cap (patella) slides in a groove on the end of the femur. The patella joins the femur to form a third compartment called the patellofemoral joint.
A joint capsule surrounds the knee joint and large ligaments attach to the joint providing stability and strength. The medial and lateral collateral ligaments attach the inside and outside of the joint, and the cruciate ligaments cross within the joint.
There is a thick pad of cartilage between the joints formed by the femur and the tibia called the meniscus, which functions to absorb the load of the body, as well as to provide a smooth surface for motion of the knee. Because the knee is a weight-bearing joint, each meniscus takes the load during weight-bearing activities. Overweight individuals are therefore more prone to develop knee pain.
Fluid filled sacs called bursae help the joint surfaces to glide and reduce friction on the tendons as they move with the knee joint. 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 tendon insertion.
The quadriceps muscles assist with extension and the hamstring muscles help with flexion of the knee.
All of these structures of the knee are necessary for normal knee function in performing everyday activities.
How does knee pain develop?
Like all types of joint pain, knee pain can appear either suddenly or acutely, or it may go on for a while as chronic knee pain. The most common cause of chronic knee pain and disability is osteoarthritis. Other forms of arthritis can be culprits as well, including rheumatoid arthritis, traumatic arthritis and gouty arthritis. Osteoarthritis afflicts most of us as we age, steadily wearing away the smooth and resilient cartilage that caps the ends of our long bones and is essential for normal joint function. Other causes of knee pain include pseudogout, bursitis, tendonitis, sports injuries, degenerative joint disease and chondromalacia patellae. Referred pain, which occurs when a ligament injury or weakness in one part of the body causes pain in another part, may also be involved.
Another common reason for severe knee pain in the elderly is pes anserinus tendinosis which, when left untreated, may contribute to developing arthritis. The pes anserinus tendon flexes the knee and stabilizes the inside of the knee. Eventually, these tendons become lax and are no longer able to control the tibial movement, adding to the chronic knee pain.
Meniscal injury is also a frequent cause of knee pain. Upon examination, meniscal injuries are suspected if the patient reports a “catching sensation” in the knee or if the knee must be manually maneuvered by the examiner to produce full range of motion.
In diagnosing the cause of knee pain, it is important to take a good history, listen to the patient, and carefully examine the knees. A patient who has knocked-knees stresses and weakens the medial collateral ligament on the inside of the knee. When injured the MCL refers pain down the leg to the big toe. Alternately, those with bowed legs apply additional strain on the outside knee ligament, the lateral collateral ligament. When injured, the LCL will refer pain to the lateral foot. The anterior and posterior cruciate ligaments help stabilize the knee, preventing excessive forward and backward movement. When these are injured, pain is referred to the back of the knee.
The feeling of a loose knee is reason enough to suspect ligament injury. When these ligaments are weakened and lax, arthritis begins to form.
The regenerative approach to treating chronic Knee Pain
Prolotherapy offers hope to those suffering from various types of knee pain. Instead of increasing risk of degeneration, as with steroids and eventually with surgery, Prolotherapy treatments are regenerative. Prolotherapy heals the structures that are damaged from acute injury and chronic conditions. Prolotherapy gets to the root of the problem and alleviates knee pain by stimulating soft tissue, tendon, ligament and cartilage repair.
Prolotherapy works along with the body to naturally heal these structures that have become weakened from injury. The body heals by inflammation. Prolotherapy solution is injected into the affected and injured structures of the knee, stimulating a mild inflammatory response.
Comprehensive Prolotherapy to the knee involves multiple injections of a dextrose-based solution to the affected structures on the outside of the knee as well as an intra-articular injection (inside) the knee joint. This triggers the immune system to initiate repair at those sites, as the local inflammatory response causes the blood supply to dramatically increase at the injured area. The body is alerted that healing needs to take place and reparative cells are sent to the area of the knee that needs healing. The body also lays down new collagen at the treated areas, thus strengthening the tendons and ligaments, repairing the meniscus, and boosting cartilage growth. In some cases, Cellular Prolotherapy may be necessary as a more aggressive approach to heal these structures. The qualified and experienced Prolotherapist will know when this is necessary and will discuss any recommended treatment options.
Patients are encouraged to maintain movement and activity during the treatment process. It is therefore not necessary to stop working or stop your normal activities of daily living. Prolotherapy is a safe and effective treatment for eliminating knee pain of various causes.
1. Rabago D, et al. Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled. Ann Fam Med. May 2013; 11(3): 229–237.doi: 10.1370/afm.1504
2. Hauser RA, Hauser MA. A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois Journal of Prolotherapy. 2009;1(1):11-21.