Expert: Dr. Victor Dolan, DC, DACBSP - 6/2/2009

Question
QUESTION: Hello:

For the last four weeks, I began having knee pains. I especially feel the pain when I straighten my foot and I feel pain where the knee bends. I was wondering what it could be, whether its ligaments or cartilage tears, or muscle pains. Its not that painful that I can't walk. However it still hurts everytime I bend the knee. I am not a sports player, so I don't think it came from any sport related injury. What do you think it is and what can be done about it. Thanks so much.

ANSWER: Staten Island Knee Pain,  Staten Island Sports Injury,  Staten Island Arthritis




Hello Abe,

I am sorry about your knee pains.  I could use more information, and if my answer is off base, please do not hesitate to re-contact me here at AllExperts.com :
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm

I assume that your pain is in one knee, not both.

I assume you have not banged/ twisted/ sprained/ strained/ injured the knee, now or in the past (you deny sports activity, you mention no prior injury- even 5, 10, 20 years ago).

You have not mentioned if the pain is on the outside (lateral knee), at the Knee cap (patella), at the inside (medial knee), or in the back of the knee (posterior), or if it feels DEEP- 'inside' the knee.

The knee hurts when you bend the knee.  So it hurts when you sit down on your buttocks in a chair, and the knee bends 90 degrees to allow the foot to hit the floor?  or does it hurt when you bend the knee walking, or going UP stairs, or going DOWN stairs?

Does it hurt at night in bed?  worse in the morning, worse in the evening, worse with rest, worse with activity?

All of these questions, plus actually physically touching, feeling, palpating the knee would be necessary to be most accurate. Examination would include 'putting the knee through it's paces'- bending , stressing, placing pressure, twisting the knee joint.

"....hurts everytime I bend the knee....." does not help us Doctors, we need more information.

Like someone saying 'my chest hurts'- - - -  is it a fatal heart attack coming, or is it a bruise from an argument when someone poked their finger into the chest??  '....Hurts...' can be something terrible, complicated, or simple, self- limiting.

Do you have a swelling anywhere?  Do you have a swelling on the back of the knee?  Perhaps a 'bakers cyst' - this may need draining at an Orthopedic MD office.  Swelling or pain at the knee cap, above or below the patellar- perhaps a bursitis or a tendinitis- a visit to the Doctor of Chiropractic, Physiatrist MD, physical therapist could be in order.

Pain superficial on either side of the knee?- perhaps a collateral ligament stretch (sprained medial or sprained lateral collateral ligament)- a visit to the DC or PT could treat this effectively.

Pain deep inside the knee?  - then perhaps cartilage damage; anterior or posterior cruciate- particularly if the knee feels 'loose' or 'sloppy'; perhaps a medial or lateral meniscus- especially if the knee clicks or ever 'locks' on you.

OsteoArthritic degeneration if you ever injured the knee- years ago- culminating in degeneration of the joint= arthritic deterioration of the joint= common after injury.

I have tried to 'hit the high points' of the knee complaint.  I hope this helps, but you do need a 'hands-on, in-person evaluation for better information.  After an examination, Xray may be needed.  After Xray an MRI may still be necessary for full evaluation.

My best guess,,,, if you are over 40 years old, or if you carry extra weight, or if you EVER injured the knee, this may be an arthritic joint.

I recommend you visit the local Doctor of Chiropractic, preferably one with additional credentials- such as a DACBSP (like me).  Chiropractors do have additional training and credentials (see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf)



I hope this helps. If you need further info, do not hesitate to recontact me
here at:
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm



Thank You, Good Luck.

Dr. Victor Dolan, DC
Email NewsLetter:      http://drvictordolan.chiroweb.com  



---------- FOLLOW-UP ----------

QUESTION: Hello and thanks for your response. I will try to explain my question more clearly  so you can get a better picture and give a clear answer.

To start, I'm 26, 189 lbs. (on the way down), and never had any injury on my feet, and have now pain only on the right knee. I have never injured my foot, nor was it ijured by any sports related injuries recently. I work in a office all day, so my knees are basically used to sit stand up, and walk.
As to where I feel the pain, is a little hard to explain, I would say I feel it more from the back, but all the way to the front as well, but the real pain is from the middle of the knee.
It hurts when I straighten and when I bend my knee. If I stand for a while then When I bend, it will hurt and vice versa. However, I would say, that the most intense pain is when I sit and move my foot to the right, so that I rotate it to the right and twist it a drop, then it really hurts. Another point, when I say, "pain" I don't mean that i scream or gasp or anything the like. I can live with it, but it is still painful.
The pain is when I bend the knee or make it straight. It could be in bed, or at the desk. Didn't notice that morning, or night any lesser or more painful.
No swelling there either. Knee does not lock, or click or make any noises.
One important thing that I have to note is the following. When I sit in the office, I often fold one foot and sit on it. However, not like I'm kneeling, I place one foot on the chair to the side, so for example the right foot I would place so that the end of my foot is on my left and then sit down placing my left foot over the right foot. This (what I think) might have caused something to move a drop, which causes the pain. I stopped since having the pain, but wonder whether this is a cause.
Hope this gives you a clearer picture, so you can help me somewhat with the information I need. Is it something that I should ignore, or is it something that I should not even push off checking out. What kind of problem do you suspect it is. Any therapy I can apply by myself. Anything I can do to check to know exactly what it is.

Thanks so mush for your response and time, again.

Answer
Staten Island Knee Pain , Staten Island Chiropractic





Hello Abe,

Thank you for getting back to me with more information.

Again, I am sorry for your pain.

".....I place one foot on the chair to the side, so for example the right foot I would place so that the end of my foot is on my left and then sit down placing my left foot over the right foot. This (what I think) might have caused something to move a drop, which causes the pain. I stopped since having the pain, but wonder whether this is a cause......"- this position, this habit may have brought this on.  Try to assume that posture again,,,,, does it elicit the pain?? -->> if it does, this could have caused your problem.

Is the condition getting better or worse?  If you stop that position (see above) and your complaint seems to be decreasing, well , , ,
do not do that position anymore,,, wait and see- if the pain decreases and disappears, then you do not need any attention.

If your pain is staying the same, or worse yet, increasing- you certainly HAVE to go for an evaluation.

My Staten Island Knee Pain patients, indeed ALL of my pain patients get the following handout in my office:




PAIN  IS  YOUR  BODY  TELLING  YOU  SOMETHING  IS  WRONG



PAIN     

Pain  is a  ‘red light on the dashboard’.

Pain is your body telling you that something is wrong.

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?  

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?



    NOTICE  ON  PAIN  RELIEVERS:

 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;

The  American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse.  These medications cover up the pain, and cause the problem to worsen.



Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.


Vertebral  Subluxation          (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.

  Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.




Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.




The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine


----------- Pain, if it is unexplained, if it stays a long period, if it is intense, strong, severe, if it causes you concern , , , see an appropriate health professional!




In the meantime, perhaps this information handout would be of help:


P.R.I.C.E. =    
P  protection.   R rest.   I  ice.   C  compression.   E  elevation.


Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??

You should certainly get to the Doctor or trained health professional to be examined  if you think it  is  bad  enough.

   BUT  in  the  meantime,  some  simple  steps  may  help.   

        PRICE.


The  PRICE  protocol will usually help just about any musculoskeletal injury.

P = Protection;  protect the area from further injury- stop what you are doing, can you pad  or bandage the area ? Tape the area? Do something to protect the area !

R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to repair the area

I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the injured area for 30 minutes; then back on again

C = Compression;  to help prevent swelling compression may be helpful- for example if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body parts may not be applicable to compression.

E = Elevation; again to fight swelling and pain, raising the injured body part above the  heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part



PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion

Sometimes  a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!

         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.

A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.


This is a serious condition identified by its five parts:
    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
    Myopathology:
         Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
         Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.  Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint.  CORRECT the subluxation !!!!

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine







"....What kind of problem do you suspect it is....." This may just be a generalized sprain/strain given the twisty position you USED to sit in/on.  You have no trauma, now or in the past, so it is probably not arthritis nor cartialge damage.


"....Any therapy I can apply by myself....."- see above.  Hurts???, I like ICE.  Ice 10- 15 minutes on, 1/2 hour off, as often as possible.  Ice over the painful part.


"....Anything I can do to check to know exactly what it is.....", I can only recommend seeing a health professional for a good examination.



I hope this helps. If you  again  need further info, do not hesitate to recontact me
here at:
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm



Thank You, Good Luck.

Dr. Victor Dolan, DC
Email NewsLetter: http://drvictordolan.chiroweb.com