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How I’ve treated knee pain in its entity to help prevent knee osteoarthritis in athletes

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As a Podiatrist that has spent the most part of my pod career working closely with high performing athletes, post gen pop/aged care, knee pain was something that I suffered from personally & something I came across every single day in clinical practice within both settings. It was soon that I also realised it was also something that was extremely easy to pick up trends in its occurrence outside of the freak martial arts accident or fall that saw a “blown out” knee. 

 

Prior to moving predominately into a multifaceted sporting performance & rehabilitation & role for athletes, my career saw me working within the aged care sector. General podiatry tasks, cut & file nails, removing corns, moisturizing feet & educating my beautiful patients. During this period it was astonishing the number of patients when assessed, would be or have experienced knee pain or even knee OA within their life. A rough figure, no clinical statistics, or calculated numbers, I would say close to 85% of my patients within the aged care facility setting had experienced knee pain within their life. 

 

With more than 56,000 Australians estimated to be living with the debilitating effects of OA in Australia, a figure predicted to reach more than 69,000 by 2029 stated in a recent article published by the Australian Physiotherapy Association. With medical costs exceeding $300 million a year within Australia, it is quite apparent that the medical costs of the condition create a large burden on the population. Why is the number increasing? Why are surgery rates of knee replacements climbing? Questions I have constantly asked myself when looking at preventing people going under the knife in ANY orthopaedic circumstance.

 

I was always looking for trends in potentially preventable conditions, not just OA of the knee. Delving deeper into the history of these patients lives and what led them to be now be unable to stand from a chair without the presence of pain, discomfort or even the inability to do so on their own. Footwear, sports, occupation, injury, lack of education within the biomechanical aspect of exercise, BMI & access to allied health professionals were all common trends among the aged population experiencing knee pain, & most of them, knee OA. Im sure much could be said about other load baring or high work load joints like the hip & shoulder. All of these, modifiable…

 

Osteoarthritis (OA) of the knee is the most common form of arthritis affecting millions of people globally. OA of the knee presents as painful, stiff, swollen and sometimes accompanied with limited flexibility and range of motion in the knee joint. Making exercise, & even normal daily tasks difficult or compromised. 

 

OA is caused by the degeneration of the protective hyaline articular cartilage that overlays and cushions the ends of the bones (the femur & the tibia in knee OA) that meet within a joint capsule. Therefore leaving the ends of the bones exposed, with no protective cushions for shock absorption and movement creating painful friction of the bones over time. 

 

Knowing all of this moving into a younger, more athletic, more competitive, higher demand population of clientele, when presented with a patient experiencing knee pain, I was now presented with the opportunity to not only assess the previous history, current activities, but now tailor a health care plan with preventable measures to ensure this person; becomes pain free, returns to full capacity activity, prevent further pain & also moves them in a direction congruent to preventing the potential formation of knee OA outside of genetical risk factors. A concept that through my career has resonated with me personally due to stopping rugby with knee issues, & water polo with shoulder & elbow issues. Seeking a medical professional that is willing to investigate an athlete in their entity, assess all factors, & develop a plan to modify discrepancies will ALWAYS lead to a greater patient outcome, not just treating the pain, the old “band aid effect”.

  

A holistic multifaceted approach can therefore be individually constructed by ticking off each & every modifiable risk factor when it comes to the rehabilitation of initial knee pain. Addressing each component individually and educating the patient on WHY we are looking at footwear, previous history of injury, diet, load, programming, occupation, muscular imbalances, recovery protocols, biomechanics, movement patterns & so on. Diving deep into the reason why all of these and many more aspects are all consistent with the potential contribution to knee pain with the patient, educating them and allowing them to understand each point for complete adherence to treatment & modification to the relevant components. Prevention is always better than a cure.

 

Though inevitably working within this demographic, knee pain is very prevalent. Often, these clients are undertaking an extremely high training load across multiple disciplines. Running, cycling, weight training, sport specific training etc. No matter all the work you put into all the preventable risk factors, they occur, & they suck! Fortunately, I have been very grateful to work alongside some very experienced and knowledgeable health care professionals & because of my personal emotional attachment to sport & my clients, always striving for the best. The best in everything. That includes treatment modalities for recovery & performance. If you owned a Ferrari, would you put the cheapest fuel & parts in it? If you said yes, well.. Goodluck! This led me into drawing on the best forms of manual treatment for my athletes, deep tissue massage, dry needling, myofascial cupping, flossing, ART, IASTM & now medical device technology including high power laser, tecar therapy, shockwave therapy & electrotherapy. All tools to stimulate repair on a cellular level, not to be confused with using this as sole form of treatment. These compliment everything else we have discussed, strength, stability, mobility, flexibility, muscular imbalances, biomechanics, load, BMI, footwear & so on. 

 

Finding where the knee pain is coming from, treating the knee pain, correcting & addressing the factors contributing to the knee pain, and building a strong platform for preventing future knee pain. 

 

Can all of these combined from an early age prevent knee OA given the preventable risk factors?

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