Weak at the knees

At any moment, up to a third of us are struggling with pain in our knees. In a major US National Health Interview Survey in 2006, nearly a third of adults reported experiencing some type of joint pain, with more than a sixth reporting pain in the knee.

The situation is even worse in the UK, where major surveys in Bristol and Nottingham both estimated that up to a quarter of all adults suffer with chronic knee pain, while a Greater Manchester survey brought that figure up to nearly one-third of all men and women over the age of 45.

Even in China, knees are the most commonly reported parts that hurt and, indeed, with age the world over, the incidence of knee pain is only going in one direction.

Ask your doctor why and he’ll invariably point to age-related ‘wear and tear.’ Not much can be done for these worn-out joints, says medicine, other than to make you more comfortable with painkillers and other drugs until you’re an acceptable candidate for surgery.

 

When in doubt, cut it out

First stop on the surgical highway is arthroscopic surgery, where areas of ‘redundant’ cartilage and inflamed tissue are removed. Last year, some 650,000 people in the US alone were offered this surgery, even though there’s never been evidence to suggest the procedure either cures or arrests the osteoarthritis process.

In one study of 180 patients, one group was given the surgery, another was given a similar operation and a third was given a sham operation—the patients were surgically prepared, placed under anesthesia and wheeled into the operating room where incisions were made in their knees, but no actual procedure carried out.

Over the next two years, during which time none of the patients knew who’d received which kind of treatment, all three groups reported moderate improvements in pain and function.

In fact, the group who’d had the fake operation reported better results than some who’d actually undergone the real one. The mental expectation of healing was enough to marshal the body’s healing mechanisms—and it was these that produced the physical improvements, not the surgery itself.

 

Record numbers

But so ingrained is the idea that joints simply erode away with time that your doctor is bound to start urging you to have replacement surgery once you hit age 55. Some half a million knee replacements are performed in the US every year, and this figure is set to increase by an incredible 673 per cent over the next two decades, according to the American Academy of Orthopaedic Surgeons.

The medical research claims an astonishing success rate for 95 per cent of knee operations, with the majority remaining functional for at least 10 years.

But that impeccable track record refers simply to the knee replacements that ‘take’ while carefully omitting the overall complication rate of nearly one-fifth, which can include deep-seated infections, pulmonary embolism (obstruction in a blood vessel going to the lungs), deep venous thrombosis (blood clot in a vein), nerve damage to a limb or elsewhere and even, in extremely rare cases, permanent injury to a foot or loss of a limb.

 

Unnecessary operations

The fact is, doctors rush in far too quickly to replace knees. As new research has recently uncovered, some one-third of knee replacements in arthritis sufferers shouldn’t have happened in the first place, while the need for such surgery was debatable in a further 22 per cent. The report from the Virginia Commonwealth University in the US concluded that only 44 per cent of procedures were fully justified.

Impose those percentages on the 80,000 knee replacements carried out in the UK and the 600,000 carried out in the US every year, and you come up with the incredible statistic that more than 340,000 of them may not have been necessary.

Florida pain specialist Dr Mitchell Yass, for one, is convinced even that’s an understatement. Dr Yass, like Egoscue pioneer Pete Egoscue, is one of the few outliers who believes that worn-out joints are rarely the source of pain.

In virtually every instance, what presents as knee pain is actually being caused by a muscle imbalance around the knee, creating misalignments that eventually translate into pain.

 

Muscles, not joints

Yass says he has treated more than 14,000 patients and, in 95 per cent of cases, he says, the joint itself, even when severely arthritic, was not the problem.

Egoscue specialists all over the world, who have collectively treated hundreds of thousands of patients, repeatedly demonstrate – as they have for me – that pain in a hip or knee is invariably a postural or muscle imbalance. Fix the imbalance with a few simple exercises, and the pain disappears.

Knee pain is yet another instance where doctors believe that a problem can only be sorted by some sort of heroic intervention. As with so much in life, the answer is often easier than you think.

Comments

  1. Anne

    Interesting article but perhaps you could also identify that a significant contributor to knee pain is excess weight. There is a clear link between osteoarthritis and obesity
    https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/2052-1847-5-25
    A meta-analysis of studies demonstrated that there is an almost threefold increase in the risk of developing OA within an obese or overweight population. For every kilogram of extra weight there is a 9-13% increased risk of developing symptomatic OA. Damage to the patella cartilage is linked to increasing body weight.
    Gunardi AJ, Brennan SL, Wang Y, Cicuttini FM, Pasco JA, Kotowicz MA, Nicholson GC, Wluka AE: Associations between measures of adiposity over 10 years and patella cartilage in population-based asymptomatic women. Int J Obes 2005. 2013, doi: 10.1038/ijo.2013.42
    So regardless of what medical or surgical interventions may, or may not help, everyone can improve their chances of preventing knee pain (and other joint pains) by maintaining a healthy body weight.

  2. Meg

    Thank you! I had a feeling my new knee pain is more related to musculo-skeletal weakness and imbalance, including the supporting ligaments and tendons, than just a degenerative knee, as Kaiser says. So I will look for Egoscue specialist in the Bay Area.

  3. Nseobong

    I really like this piece as I suffer from arthritis. I now know I might not need
    surgery simple exercise may help. My friend has had three operations on her knees
    yet the pain continues. Thank you for publishing this.

  4. julie

    I have Dr Yass’s book but find the exercises quite difficult to follow unless there’s someone who knows about joints etc there to help.
    I know that I have tight muscles from my (L) thigh to my knee and I’ve tried everything under the sun to walk without pain – nothing seems to work. A chiropractor who lives many miles from me did say it was a pelvic tilt causing the problem and straining the muscles but I can’t find anyone in my area to ‘fix’ it. I may just make the journeys to see this guy but it’s a long way.
    I’m just 75 and want to enjoy my older years by walking and dancing so any suggestions would be gratefully received.

  5. Rony

    Please try to eat. Kombucha, fermented tea 2 cups day, then go to toilet after
    major meal , that is 2 bowls a day.

    The longevityy country, Japan, the villagers who have one. Big. Kombucha tea jar
    At each family , 28 health benefits, including no joint pain , detox liver ,
    No eye problems , cure cough, colds , no cancers, no diabetes ..

  6. Christiane Pape

    Hi Lynne,
    Thank you for the valuable work you are doing over the years.
    There can be also another very easy and low cost treatment to resolve the pain in joints.

    That is to check the ph-value of the urine.
    And if it is sour to change diet.
    Quitting eating prefabricated stuff, all kind of animal proteins and eating mainly raw fruits, a lot of salads, cooked vegetables, especially green ones, making green smoothies.

    There are more and more people in Austria and Germany turning to this method after beeing told that their arthosos or Rheuma is incurable!

    And of course also living a happy life style!No more anger or complaining, starting a joyful life full of engagements for a better life and in the first place for yourself!

    There are thousands of persons who have found relief in this simple method where you have to let go of relying on others and start to take back the control mode for your life.

    All the best for you, Lynne and your readers
    Christiane Pape from Vienna, Austria

  7. Shirley Bell

    Owing to our South African exchange rate, I cannot subscribe to the magazine, but have all Lynne McTaggart’s books. I use a quantum model for living my life, since this model confirms that we are all interconnected, and that everything we say, do and think matters because we are part of the whole. I am 83 and regard myself as a healthy person. I have some disablement as have a painful spine injury owing to my car being demolished by a careless driver decades ago. I also have 24/7 quite severe chemo-induced peripheral neuropathy (for the last eight years), but lead a committed, busy and active life and have many personal projects. I like to work on my own rather than as part of a team, but often find myself cast in the role of leader and have done quite well at this, although I don’t seek it. I am not, however, a manager and have no desire to be one. My life involves activities that are complicated by a more recent irritating affliction: intermittent sharp unexpected stabs of knee pain that have caused me to fall on a couple of occasions and fortunately acquire only rather unpleasant flesh injuries. I actually have strong muscles, since I was a first-league tennis player for a good deal of my life, but now have diminished knee cartilage and knee osteoarthritis. I continue to exercise, use magnetic resonance (have an iMrs) and various other non-invasive home therapies and, despite the chronic pain and some disablement, am a healthy human being who just has some physical problems I would dearly love to be able to improve. I run my home, edit a magazine (have edited many different types of magazine over my lifetime), write for hours every day, including an online column for the Durban & Coast SPCA, have written a range of books, and still run a couple of voluntary projects, including an animal care education project based on the teaching of compassion as fundamental to the way one lives one’s life. Painkillers have never helped so I do not take them. I prepare healthy meals, have a dog I adore, and have my own quite large home and garden with pool. I have the inestimable gift of having really loving and special children, grandchildren and two baby great-grandchildren, all living overseas in England, Australia and the Netherlands. We are very close, speak regularly on Skype, and I see them every year, as they provide air tickets for me and also come to visit when they can. Although the knee problem is itself a lesser problem that the spine injury and the CIPN, it is adding a nasty little complication to my life. I will not have a knee operation or a spine operation, because my intuition gives no indication that this would be wise for me. But I would indeed like to know of anything that helps with constant pain (24/7) from my spine and the relentless CIPN. (I do knee-strengthening exercises for the knee problem and have been doing so for over a year. It seems to me that the intermittent flashes of pain are less severe and less frequent, but I do wear a knee guard when out.) I have tried just about every non-invasive treatment I know of to try to alleviate pain. I do know quite a range of ways of trying to help oneself owing to the nature of my research as a ‘wholebrain’ educator over many decades and have also had much acupuncture, physiotherapy and chiropractic at times and also some reflexology. Earlier in my career in tertiary education, I founded and ran a large voluntary project for teachers of English at secondary schools in disadvantaged areas for 17 years and was much involved in various pioneering education projects, including in wholebrain education, the teaching of literature and language, kinaesiology in education (influenced by my friend, Carla Hannaford, who is well-known as practitioner in the BrainGym field and an author of some distinction), training of journalists, publishing, magazine production, editing of research journals, and as an author. I am still active in some of these fields. I know that there is the possibility of closing the pain gate and that I could somehow learn to ‘shut off’ the spinal pain gate, and I continue to work at this despite no great evidence that I am making any difference. However, the conviction about the pain gate remains. I joined the Institute of Noetic Sciences in 1987 and remained a member for a couple of decades until the exchange rate became excessive, and I also felt that that IONS was moving away from Willis Harman’s vision. Willis had become a friend during the last years of his life. I have long used visualisation and affirmations, deep breathing, and ways of being that I see as being related to the quantum field. My life is purposeful, and my life philosophy fills my days with meaning. I have forgotten what it is like to be without pain, but cannot let go of some perhaps unrealistic sense of ‘knowing’ that it is still entirely possible for me. I have a large library and try to keep up with the latest research via the internet, but the pharmaceutical route is not one to which I can relate with any degree of trust. It has to include the mind as part of universal protoconsciousness and therefore giving us access to infinite knowledge in moments of peak experience. I have had many such experiences and have written quite a bit about them. I also ‘re-wire’ my self-belief by reading (and often re-reading) the works of the thinkers who have helped me create the always-evolving spiritual (not religious) model that nurtures my life.

  8. Mervyn Evans

    I have been a Homoeopath for 20 years and I have found pain and problems with knees have come from an emotional problem the patient has had in their life.Homoeopathic treatment sorts the proplem and their knees get better.

  9. Thera

    Thank you so much for this article!
    Very important eyeopener.

    Will you share the few simple exercises, that fixes the imbalance of muscles or posture?

    Thanks in advance.

    Truely yours,

    Thera

    • Shan Russell

      I do not know about any exercises, but Prolotherapy would probably solve the problem

      KNEE REPLACEMENT AND PROLOTHERAPY
      ROSS HAUSER, M.D.
      http://www.getprolo.com/prolotherapy_and_knee_pain.htm

      Non-Surgical Tendon, Ligament and Joint Reconstruction
      by William J. Faber, D.O.
      In acute injuries, the ligaments and tendons become torn. Ligaments function to limit the range of motion that bones can move between each other, and function to stabilize joints and hold the joint together. Tendons function to attach a muscle to bone in order to provide motion. Discs and cartilage serve to absorb shock and keep the bones from rubbing against one another. If the ligaments become torn or over-stretched the joint becomes unstable and resultant friction causes the discs or cartilage to become worn down causing a loss of height. The disc and cartilage may also become worn away by repeated motion. This loss of height causes further ligament laxity and thus more instability. The friction of the joint is a stress. Bones respond to stress by making more bone. This results in bone spurring which is the body’s attempt to splint or stabilize the unstable joint. Degenerative disease is merely the body’s attempt to stabilize joints as the tendons and ligaments have not been able to heal because of lack of blood supply. If a patient has considerable degenerative arthritis, the loss of disc or cartilage height causes a laxity of the supporting ligaments. This causes joint instability.
      Reconstruction has been shown to be effective in these conditions, causing the lax ligaments to become strengthened, thus stabilizing the joint and allowing for increased function and endurance.
      http://www.prolotherapy.com/articles/fabernstljr.htm

      biological reconstruction – alternative to hip prosthesis
      by Dr. William J. Faber
      http://www.prolotherapy.com/articles/faberbr.htm

      Injections of sodium morrhuate have been shown in scientific studies done by the University of Iowa to grow ligaments and tendons between 20%-40% stronger than the tendons and ligaments injected with a non-active substance. 1,2 The process produces a non-surgical tendon, ligament and joint reconstruction by taking advantage of the body’s own healing methods. Sodium morrhuate is a FDA approved substance which comes from cod liver fish-oil. By injecting into the area where tendon or ligament attaches to the bone controlled irritation caused fibroblasts (healing cells) to travel to the area and lay down connective tissue, thus repairing the torn or relaxed area. (See illustration 1).

      ACUPUNCTURE, TRIGGER POINTS
      & PROLOTHERAPY:
      SIMILARITIES AND DIFFERENCES
      MARC DARROW, M.D.,J.D.
      Trigger Point Therapy also uses needles to eliminate irregularities in the body’s normal functioning, in this case the taut bands of pathological muscle tissue are known as trigger points. However, tendons, ligaments and joint capsules may also refer pain to areas distant from the actual trigger point. Tender points, which are points that are sore with pressure or palpation of the doctor’s hand, may also be treated with trigger point injections or Prolotherapy. Unlike the dry needle of acupuncture, the trigger point or Prolotherapy needles deliver fluid to the target area to be treated. By puncturing the tissue, trauma to the area is caused, resulting in a rush of white blood cells to the area that provokes a reaction and stimulates the healing process. Frequently, in trigger point therapy the physician will use a local anesthetic solution such as lidocaine to relieve the pain as well
      http://www.getprolo.com/prolotherapy_acupuncture_trigger_points_marc_darrow.htm

      • Shan Russell

        And if the problem is caused by arthritis — there is protocol that heals this. My doctor has been using it successfully for over 16 years.
        In fact , even Dr Mercola uses it and used to have an article on it on his website.
        I have not checked any of these urls for at least 5 or more years, so it any of them to not work — just google the subject matter of even the name of the person who wrote the article.!

        Researchers have shown that many of the medicines recommended for Rheumatoid Diseases by The Arthritis Trust of America/The Rheumatoid Disease Foundation are anti-microbial, viral-static, anti-mycoplasmic, and antiprotozoal, so it is not at all surprising that, where there is a micro-organismic basis to the disease, such medicines will indeed have an effect on the course of the disease.

        Dr. Thomas McPherson Brown’s landmark work, The Road Back

        The Arthritis Trust
        Licensed physicians and doctors below have indicated to The Arthritis Trust/The Rheumatoid Disease Foundation that they either use or are willing to use recommended treatment modalities in the treatment of rheumatoid disease. The Arthritis Trust/The Rheumatoid Disease Foundation provides this list as a public service to those who inquire.
        http://www.arthritistrust.org/Physicians/PhysList.pdf
        http://www.arthritistrust.org/physicians.htm

        The Road Back Foundation (RBF)
        Website includes information and support regarding an important and often overlooked treatment option for rheumatic and related diseases. The particular focus here is antibiotic therapy, proven safe and effective in NIH-sponsored clinical trials. Thousands of patients have reported successfully using antibiotics for conditions including rheumatoid arthritis, scleroderma, juvenile rheumatoid arthritis, lupus, dermatomyositis, ankylosing spondylitis, Lyme disease, Reiter’s syndrome, mixed connective tissue disease, fibromyalgia and psoriatic arthritis. Results of an international survey of patients documented dramatic results including relief of pain, the lessening of swollen joints and an overall successful return of quality of life.*
        http://www.roadback.org/
        http://www.roadback.org/index.cfm/fuseaction/home.main.html

        What is Prolotherapy?
        http://www.chicagosportsmedicine.com/prolotherapy.htm

        Prolotherapy is a treatment that stimulates the body to repair the painful area. The official definition of Prolotherapy in Webster’s Third New International Dictionary is “the rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferation of new cells.”

        The term was coined by George S. Hackett, M.D., in 1956. He describes Prolotherapy as follows: “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the weld of fibrous tissue and bone to stabilize the articulation (where the bone and ligament meet) and permanently eliminate the disability. To the treatment of proliferating new cells, I have applied the name Prolotherapy from the world “Prolo” (Latin) meaning offspring- proliferate” to produce new cells in rapid succession (Webster’s Dictionary). (Hackett, G. Ligament and Tendon Relaxation Treated by Prolotherapy. Third Edition. Springfield, IL: Charles C. Thomas, Publisher, 1958.)

        Prolotherapy involves the injection of substances that cause stimulation at the fibrous tissue (ligaments and tendons) junction with the bone. The site where ligaments and tendons are typically injured is at their junction with the bone. Most things break down at a junction site because this is the weakest part of the structure. This is especially true in the weight-bearing joints. A good example of this is when the leg of a chair is wobbly or loose. This is usually due to a loose connection where the leg attaches to the seat of the chair. By tightening the attachment of the leg to the seat, the chair becomes more stable.

    • Louise

      Any physiotherapist should be able to give you the correct exercises. I’ve had exercises to stretch one set of muscles and strengthen another set. If I do them I have a lot less pain than when I don’t.

  10. LMcpherson

    I can attest to the truth of this – I was suffering knee pain, and I read that strengthening the surrounding muscles would help support the joint. I started doing squats every day having looked up correct form, and built up gradually. Now I have hardly any pain, stairs are fine and I can bend up and down at the knee with ease!

  11. Mr W Neil

    I had knee pain on many occasions – until I bought a pair of elasticated knee supports. Bingo, pain gone. It sometimes returns – a bit – but I put the supports back on and they ALWAYS cure the pain. I never went to see a GP, and am able to jog quite happily. Make sure you measure around your knee to get the right size.

  12. William Wakeling

    In my case I find that slightly lax cruciate ligaments are the problem, for example turning a corner going up stairs my knee can click and be momentarily painful. A daily dose of 1 gram slow release vit. C with bioflavonoids makes them more taut and eases the problem, no vit. C for 1-2 days and the problem recurs!

  13. Ila little

    Yes thank you for confirmation! As a runner hiker gardener active person I have experienced sometimes great pain solved by sturdy supportive ridged sole foot wear worn out soles change posture broad stance rest stretching no knee hip surgery for me CAN YOU PLEASE SPEAK ABOUT CORNEA & CATARACT SURGERGY vs holistic practices appreciate your dedication & information!!!

  14. Trish Niblock

    Hullo Tom
    The best exercise is walking in water …in the warm sun if possible.. so not in this country… the water takes your weight so relieves the pain of a joint with weak muscles. It also provides a comfortable and natural resistance so builds up muscles too.Walk within the limits of the pain in water that is deep enough to support your weight .. and as you gain confidence don’t forget you need to strengthen your “glutes” as well.
    There should be some books on Hydrotherapy with diagrams.

    WDDTY will recommend a warming alternative cream to smooth on your knees and the muscles of your thighs after your walk which will help to keep your knees warm and prolong the benefit of your walk.
    Trish Niblock ( MCSP Retired)

  15. Trish Niblock

    Hullo Tom – again

    Before I suggested hydrotherapy and walking in the water to strengthen your knee I should have asked you if you had seen a physiotherapist. There are many reasons why a knee joint can become weak and it is important to know the whole story. Also not everyone has access to a Hydrotherapy Pool!

    Good Luck

    Trish

  16. Judith

    I am a 79-year-old lady. My FIBROMYALGIA disease appeared at the age of 74, with no hope of a cure from the hospital i looked further for an alternative treatments, a friend of mine told me about Health Herbal Clinic in Johannesburg South Africa who sell herbal treatments for diseases including FIBROMYALGIA disease, I contacted the herbal clinic via their website and purchased the fibromyalgia herbal remedy. I received the herbal remedy through DHL couriers within 8 days and i immediately commenced usage as prescribed, i used the herbal remedy for about a month and 1 week, my condition has greatly improved, all my symptoms including Chronic muscle pain, Abdominal pain, nausea, I am fibromyalgia free! contact Health Herbal Clinic via their email healthherbalclinic(at)gmail(dot)com or visit www(dot)healthherbalclinic(dot)weebly(dot)com PLS fibromyalgia is not a death sentence, there is a cure!

  17. Judith

    I am a 79-year-old lady. My FIBROMYALGIA disease appeared at the age of 74, with no hope of a cure from the hospital i looked further for an alternative treatments, a friend of mine told me about Health Herbal Clinic in Johannesburg South Africa who sell herbal treatments for diseases including FIBROMYALGIA disease, I contacted the herbal clinic via their website and purchased the fibromyalgia herbal remedy. I received the herbal remedy through DHL couriers within 8 days and i immediately commenced usage as prescribed, i used the herbal remedy for about a month and 1 week, my condition has greatly improved, all my symptoms including Chronic muscle pain, Abdominal pain, nausea, I am fibromyalgia free! contact Health Herbal Clinic via their email healthherbalclinic @ gmail . com or visit www . healthherbalclinic . weebly . com PLS fibromyalgia is not a death sentence, there is a cure!

  18. Bob Herring

    Fascinating Lynne – my mom suffered with RA and 2 knee replacements – the #1 reason I’m on a Crosstrainer 6 days a week for strength and endurance Thx for your always insightful pieces

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